The data presented identifies the top 20 disease (based on Admits/1000) representing the hospital stays, the rank of hospitals by critical metrics, an interactive performance graph with variables, and medical specialties list linked with hospitalization metrics.  This robust report describes hospitalization metrics in detail and provides an important performance graph which offers a quick reference point to identify outliers.   

 

 

Target Audience for this Report

Chief Medical Officer, Compliance & Regulatory Department, Finance Department and CFO, Leadership Team, Medical management/Care Management Department, Pharmacy & Therapeutics Committee, Physician Relations, Quality Management, and Utilization Management.

 

Business Processes Impacted by this Report

Concurrent review and discharge planning models are informed by hospitalization information and strategies can be refined to implement best practices in the Medical Management Department.   Quality and Utilization Departments require most of these metrics to determine resources needed to support members during and after hospitalizations.  

 

The costs described for hospitalizations is a significant portion of the health plan budget.  The report provides analytic and predictive value which leads to premium and rate decisions.  Leadership team will use these metrics for benchmarking, determine network structure, and creating focused strategies to reduce hospitalizations where appropriate.

 

Network evaluation is an ongoing process that is assisted by hospitalization metrics and costs.   Determining high performing hospitals by objective methods such as ALOS, Readmissions, Hospital Acquired Conditions, and others is invaluable in making network decisions.

Detail and Definitions

KPI’s:

Hospitals – Total number of Hospitals included in report.

Admissions – Total number of Admissions.

Admits/1000 – Admissions per 1000 member months.

ALOS – Average Length of Stay.

Cost/Admit – Cost per Admit (average)

Readmission – Number of Readmissions.

HAC – Hospital Acquired Conditions. (Present on Admission flag must be sent in data for this field to populate.

 

Report Panels:

Top 20 Frequent Diseases

  • Disease Group
  • Admits/1000
  • Total Paid
  • Paid/Admit
  • ALOS
  • Readmit Rate

Hospitals

  • Hospital
  • Avg Risk
  • Total Paid
  • Paid/Admit
  • ALOS

Hospital Performance Quadrant

  • Performance Variables
  • X Axis Metric
  • Y Axis Metric
  • Graph

Medical Specialty

  • Medical Specialty by
    • Paid/Admit by cost
    • ALOS by days
    • Admits/1000 by rates per 1000