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Description of Health Care Utilization Metrics

We provide comprehensive health care utilization and cost metrics in Volume II.C. Health care services and products are segmented into 53 separate categories of care.  Major categories include inpatient and outpatient facilities, physician services, prescription drugs and other products and services. In addition, beneficiary contributions are also reported for each of the major categories. Subcategories reflect modalities of care but also diagnosis in certain instances, such as maternity and mental health.

Sample Table of Contents

The following illustrates how data is presented. It reflects the costs and utilization rates of health care in an intuitive and coherent way. The following is an illustration, using fictitious values for inpatient maternity.


Cost per Admission

Admissions per 1,000 Members

x

ALOS

=

Days per 1,000 Members

x

Cost per Day 

=

Cost PMPM

Costs Pct. Of Total Health Benefits

$4,000

10

x

3.0

=

26

=

$2,000

x

$4.00

3.0%

The data is provided in aggregate but also by each product in the universe that you choose. In addition, because in some cases, health plans are unable to supply reliable information, we take advantage of our 50 participant panel and compile a Volume II.C that contains utilization information from all universes. Since each of the universes define their utilization and products similarly, the combined utilization metrics benefit from the statistical advantages of scale. There is no additional charge for this combined Volume II.C analysis.

Products Offered by Universe

Volume II.C presents utilization metrics, not only to reflect the typical experience of plans, but it also weights the utilization by members in each of the plans submitting data. This latter presentation captures population norms, rather than the plan norms that we customarily provide.

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