2. IBH, Cost (Risk Adjusted)

3. IBH, Quality (Risk Adjusted)

5. Total Cost PMPM, Adjusted and Unadjusted by Practice

6. Total Cost, Adjusted and Unadjusted by Practice

11. Demographic Summary
Cohort IBH 1

12. Demographic Summary
Cohort IBH 2

13. Measure Definitions UTILIZATION Inpatient Discharges
This measure reports per 1,000 MM utilization of acute inpatient care, excluding mental health, chemical dependency, and maternity claims.
Outpatient ED Visits
This measure reports per 1,000 MM utilization of emergency department (ED) visits, excluding mental health, chemical dependency, and maternity claims.
Specialist Visits
This measure reports per 1,000 MM outpatient specialist utilization. It includes both medical and surgical specialists.
COST
Prescription Cost
This measure reports PMPM pharmacy costs.
Total Cost
This measure reports PMPM costs associated with care for members attributed to a practice, including all covered professional, pharmacy, and hospital and ancillary care. It does not include costs associated with mental health, chemical dependency, maternity, acupuncture, vision services, or dental services. It is calculated as the sum of the reported paid amount + copay amount + coinsurance amount + deductible amount + fee for service equivalent amount.
QUALITY
Prevention Quality Indicator (PQI) 90 - Ambulatory Care Sensitive Conditions: PQI Overall Composite
This measure reports an overall composite per 1,000 members, ages 18 years and older, and includes admissions for one or more of the following conditions: diabetes with short-term complications, diabetes with long-term complications, uncontrolled diabetes without complications, diabetes with lower-extremity amputation, chronic obstructive pulmonary disease (COPD), asthma, hypertension, heart failure, angina without a cardiac procedure, dehydration, bacterial pneumonia, and urinary tract infection.
Low Back Pain
This measure reports the percentage of members with a primary diagnosis of low back pain who did not have an imaging study (i.e., X-Ray, MRI, CT Scan) within 28 days of diagnosis.
Plan All-Cause Readmissions (PCR)
This measure reports the number of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days of discharge in the form of a ratio of observed versus expected admissions. Values higher than 1 indicate higher than expected readmissions.
FUH7 (Follow-Up After Hospitalization for Mental Illness) This measure reports the percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who received follow-up within 7 days of discharge.
FUH30 (Follow-Up After Hospitalization for Mental Illness) This measure reports the percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who received follow-up within 30 days of discharge.