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. The following key performance indicators (KPIs) are included:

• Average cost per member per month (PMPM)
• HCC redocumentation percentage
• Inpatient and emergency department admissions per 1,000.
• All Members: count of all members
• Risk adjustment score
• Readmission rate (30-day)
• Members (yearly visit): Percent of members who have any outpatient visit during the performance year.
• Members (CPE/AWV): Percent of members who have received a comprehensive physical exam (CPE) or adult wellness visit (AWV) during the performance year.
• Opportunities: Provides 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: Displays 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: Displays the top three underperforming contract measures that are closest to the target.