KPI Suite
(Key Performance Indicators)
The KPI Suite can be found under the Analytics tab in Health Endeavors.
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Year of Service - Select the year of claims data you want to view, e.g., selecting 2021 will show claims from 2021 calendar year. Year of Service is intended to display the data for the year selected.
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Population - Select the patient payer population you want to view, e.g., Medicare, Medicare Advantage, Self-Insured Employer, Commercial or Medicaid. You have the ability to choose more than one population at a time.
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Effective Period - Select the period for the patients you want to view e.g., the active/attributed patients during that period. Effective periods apply to Accountable Care Organizations (ACOs), Primary Care First (PCF), and Direct Contracting Entity (DCE) but not commercial populations as it shows only the most recently imported membership list. Effective Period is intended to display patients for the time period selected and the current year of data unless the Year of Service is changed to a different year.
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Division - Select a Division (groups of facilities setup in a group, created in Network Manager), if you are using divisions. You may select more than one.
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TIN Name - Select TIN/Practice Name from the drop down. You may select more than one.
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SubGroup Name - Select subgroup(s) (group of NPIs setup in Network Manager) if you are using subgroups. You may select more than one.
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NPI - Select your NPI/Provider Name(s) from the drop down. You may select more than one.
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Click on the 'Clear All' button to reset your filters.
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Once you have selected all your filters, click the 'Go' button to generate the Population Stats grid and Provider NPI Stats grid.
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Filters
Population Stats
The Population Stats section is an overall view of the entire population. If you choose more than one population in your filters. You will see a separate line for each population chosen.
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Population - Patient Payer population
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Number of Patients with Claims - Shows the number of patients that are active/attributed and have claims data. Patients with no encounters or that have opted out of data sharing will not display in the number.
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Count of Costly Patients - Costly patients today or trending to be costly in the future.
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Top 30% HCC risk score this year or previous year​
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1 or more hospitalizations in last 12 months, 3 or more ED visits in the last 24 months
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2 or more chronic conditions
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Opt Outs - Number of patients that have opted out of data sharing
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HCC Benchmark YTD - The financial benchmark calculated using the HCC Risk Score for the organization, TIN, Subgroup or NPI based on the Average HCC score of assigned patients.
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Benchmark Leakage - Benchmark Leakage is the loss in benchmark caused by not capturing a diagnosis in the performance year that existed in your previous benchmark years. Providers must recode chronic diagnosis codes within their claims annually or they are removed from the beneficiary's risk score.
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% HCC Benchmark YTD Used - Percentage of HCC Benchmark Used YTD.
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Average HCC Score - The average HCC risk score for assigned patients calculated for TIN, Sugbroup or NPI. An average above 1.5 is a moderately sick population. An average above 2.0 is a very sick population.
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Recapture Rate - A comparison of the current year to past year recaptured HCC diagnoses codes. This column displays the total percentage of HCC diagnoses (recurring chronic condition codes) that have been captured again in the current year
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Average Patient Age - Average age of patient population
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Top Chronic Conditions - Top chronic condition for the population shown.
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Average Chronic Conditions - The average number of chronic conditions for the population shown.
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Count of Frequent ED Patients - All patients with more than 2 visits are considered having 'Frequent' visits.
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ED Visits per 1000 - Count of ED visits per 1000 beneficiaries.
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ED Visits that lead to hospitalizations per 1000 - ED Visits that led to Hospitalizations per 1000 beneficiaries.
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Discharge per 1000 - Discharges per 1000 beneficiaries.
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Readmission % - Hospital readmission percentage.
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CT Scans per 1000 - CT scans per 1000 beneficiaries
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MRI Events per 1000 - MRI events per 1000 beneficiaries.
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30-day Post Discharge Provider Visits per 1000 - 30-days post discharge provider visits per 1000 beneficiaries
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Hospital Admissions with Stays Between 1 and 3 per 1000 - Hospital admissions with stays between 1 and 3 days per 1000 beneficiaries.Hospital admissions with stays between 1 and 3 days per 1000 beneficiaries.
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SNF Admissions per 1000 - SNF admissions per 1000 beneficiaries. Admission may have occurred in previous year, however discharge was in current year.
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Average SNF Length of Stay - Average SNF length of stay. Stays may have started in previous year, however the discharge was in current year.
Provider NPI Stats
In the Provider NPI Stats section you will see a separate line for each NPI available in each population selected. Default sort is by Population. Click in the NPI Name header to view an NPI that is in multiple populations together.
The Provider NPI Stats grid by default shows the TIN Name and NPI Name columns. If you would also like to see the TIN number and NPI number click on the 'Columns' button to view these columns.
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The 'Columns' button also gives users the ability to hide columns they do not wish to view.
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Clicking on the 'Export to Excel' button will export the Provider NPI Stats grid to an Excel worksheet.
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To view details about each column within the grid, click on the button to expand column descriptions above the column headers.
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Each line in the Provider NPI stats has a PDF icon. Click on the to download a PDF version of the data in the line selected.
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Population - Patient Payer population
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Division - Group of facilities created in the Network Manager.
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TIN Name- Individual Facilities designated by a Tax Identification Number (TIN). A facility is a single TIN with access to all provider data under the TIN.
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Subgroup Name - NPIs setup in a group, created in Network Manager
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NPI Name - Individual providers within the organization. The provider/NPI is the specific provider billing under the given National Provider Identifier​​
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Number of Patients with Claims - Shows the number of patients that are active/attributed and have claims data. Patients with no encounters or that have opted out of data sharing will not display in the number.
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Opt Outs - Number of patients that have opted out of data sharing.
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Count of Costly Patients - Costly patients today or trending to be costly in the future.
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Top 30% HCC risk score this year or previous year​
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1 or more hospitalizations in last 12 months, 3 or more ED visits in the last 24 months
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2 or more chronic conditions​
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HCC Benchmark YTD - The financial benchmark calculated using the HCC Risk Score for the organization, TIN, Subgroup or NPI based on the Average HCC score of assigned patients.
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Benchmark Leakage - Benchmark Leakage is the loss in benchmark caused by not capturing a diagnosis in the performance year that existed in your previous benchmark years. Providers must recode chronic diagnosis codes within their claims annually or they are removed from the beneficiary's risk score.
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% HCC Benchmark YTD Used - Percentage of HCC Benchmark Used YTD.
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Average HCC Score - The average HCC risk score for assigned patients calculated for TIN, Sugbroup or NPI. An average above 1.5 is a moderately sick population. An average above 2.0 is a very sick population.​​
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Recapture Rate - A comparison of the current year to past year recaptured HCC diagnoses codes. This column displays the total percentage of HCC diagnoses (recurring chronic condition codes) that have been captured again in the current year
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Average Patient Age - Average age of patient population
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Top Chronic Conditions - Top chronic condition for the population shown.
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Average Chronic Conditions - The average number of chronic conditions for the population shown.
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Count of Frequent ED Patients - All patients with more than 2 visits are considered having 'Frequent' visits.
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ED Visits per 1000 - Count of ED visits per 1000 beneficiaries.
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ED Visits that lead to hospitalizations per 1000 - ED Visits that led to Hospitalizations per 1000 beneficiaries.​​
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​Discharge per 1000 - Discharges per 1000 beneficiaries.
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Readmission % - Hospital readmission percentage.
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CT Scans per 1000 - CT scans per 1000 beneficiaries
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MRI Events per 1000 - MRI events per 1000 beneficiaries.
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30-day Post Discharge Provider Visits per 1000 - 30-days post discharge provider visits per 1000 beneficiaries
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Hospital Admissions with Stays Between 1 and 3 per 1000 - Hospital admissions with stays between 1 and 3 days per 1000 beneficiaries.Hospital admissions with stays between 1 and 3 days per 1000 beneficiaries.
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SNF Admissions per 1000 - SNF admissions per 1000 beneficiaries. Admission may have occurred in previous year, however discharge was in current year.
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Average SNF Length of Stay - Average SNF length of stay. Stays may have started in previous year, however the discharge was in current year.