Outcome Measurements and Coding Algorithm
| Cost Reductions | Decreased ED/Hospital Utilization | Improved Quality |
|---|---|---|
| • 0: Little, no, or negative reductions in cost | • 0: No or worse utilization reduction | • 0: No improvement noted |
| • 1: Some improvement noted in cost reductions | • 1: 1–10% utilization (ED or admits) reduction noted | • 1: Some improved quality measures noted |
| • 2: Major improvement in cost reductions noted (>$1 million or an ROI >2 or a PMPM or PMPY reduction >10% or a >10% reduction in total costs) | • 2: >10% utilization reduction noted | • 2: Health improved dramatically or all HEDIS measures improved by at least 10% |
| Improved Access to Care | Increased Preventive Services | Improved Patient Satisfaction |
| • 0: No change noted | • 0: No change noted | • 0: No change noted |
| • 1: The site described a significant change | • 1: The site described any increase in preventive services | • 1: The site described a significant improvement in patient satisfaction |
| • 2: The site described a significant change and provided meaningful numbers or data showing improvement | • 2: The site documented a >10% increase in preventive services | • 2: The site described a documented >8% increase in patient satisfaction |
ED, emergency department; PMPM, per-member, per-month; PMPY, per-member, per-year; ROI, return on investment.