Contract Overview

Cost and performance details for a selected contract.

Figure 4-2 Contract Overview

The Contract Overview tab contains a snapshot of contract performance. Included in this view is the estimated achieved value of the contract and any contract gates that may be impacting the contract's total value. By displaying the contract gates in the contract overview, you can focus on measures and targets that most affect the contract's overall performance.

The following key performance indicators (KPIs) are included:

• The average cost per member per month (PMPM), displayed as a graph.
• HCC redocumentation percentage, displayed as a graph.
• Inpatient and emergency department admissions per 1,000, displayed as a graph.
• All Members: A count of all members
• The risk adjustment score.
• The readmission rate (30-day)
• Members (yearly visit): The percentage of members who have any outpatient visit during the performance year.
• Members (CPE/AWV): The percentage of members who have received a comprehensive physical exam (CPE) or adult wellness visit (AWV) during the performance year.
• Opportunities: A list of actionable opportunities that support access to a patient worklist. In a filtered state, opportunities are specific to the contract selected.
  • AI Patient Prioritization Insight: Artificial intelligence (AI)-based member monitoring aims to help identify which patients are at highest risk for acute utilization and suggest the next best action to reduce the likelihood of acute care utilization. The recommended action is to schedule a primary care provider (PCP) visit.
  • Condition Documentation: A list of persons with four or more undocumented conditions during the performance period and persons who have the top two highest suspected conditions that are undocumented.
  • Quality: The top three underperforming contract measures that are closest to the target.