The Home screen is of value to all users as it provides summary data in key areas of interest using a snapshot format.

 

 

Target Audience for this Report

Board of Directors, Chief Medical Officer, Finance Department and CFO, Leadership team, Medical Management/Care Management, Pharmacy & Therapeutics Committee, Physician Relations, Quality Management, Utilization Management.

 

Business Impacts of this Report

Evaluation of membership using a high-level snapshot approach for a Board Meeting, a community presentation, and/or other groups where detail is not required.  Strategic planning where tracking and trending is informative to assess which areas to explore further and gain additional detail inside the platform.   Provider network presentations and planning sessions where the audience is interested in trends in utilization and cost at a high level. 

 

Detail and Definitions

The Home Screen is divided into six panels (or quadrants):

 

Client Summary

Shows high level information regarding the platform in the data for the last 12 months:

  • Incurred and Paid From – The period detailed data defined in the platform.
  • Total Member Months - a member month is defined as the number of members covered by an insurance plan each month.  
  • Average Members – The average member months for the last 12 months.
  • Medical PMPM (Average) – The total medical amount paid / average members for the last 12 months.
  • Pharmacy PMPM (Average) – The total pharmacy amount paid / average members for the last 12 months.
  • Date of Refresh – The last date that data was loaded for the plan.

 

Medical PMPM CY (calendar year) Trend

  • Period – The time period of the data.  The time period can be selected as: Year, Quarter, Month, Quarter over Quarter, and Month over Month, using the Trend Level drop down.
  • Member Months – Total number of unique members associated with the time period.
  • Total Paid – Total paid amount for the time period.
  • Medical PMPM – Total Paid / Member Months
  • PMPM % Change – Shows the percentage of PMPM change from the previous time period.

Medical KPI’s

  • Show’s six medical key performance indicators trended over time.

Pharmacy PMPM CY (calendar year) Trend

  • Period – The time period of the data.  The time period can be selected as: Year, Quarter, Month, Quarter over Quarter, and Month over Month, using the Trend Level drop down.
  • Member Months – Total number of unique members associated with the time period.
  • Total Paid – Total paid amount for the time period.
  • Pharmacy PMPM – Total Paid / Member Months
  • PMPM % Change – Shows the percentage of PMPM change from the previous time period.