Table 3.

Outcome Measurements and Coding Algorithm

Cost ReductionsDecreased ED/Hospital UtilizationImproved 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 CareIncreased Preventive ServicesImproved 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.