103 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
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4 CLINICAL DEEP DIVES
4.1 General Clinical Quality Performance and Economic Opportunity
The Relative Risk Score (RRS) is a quantitative assessment of disease and risk burden at a population level. The Care
Gap Index (CGI) quantifies the gaps identified for a population. Verscend utilizes these two factors to understand
the association between disease burden, quality, and cost.
In figure 4.1.1, members are grouped by RRS, and then by CGI. The RRS categories are DxCG Aggregate Diagnostic
Cost Groups (ADCG). ADCG categories allow for easy stratification of members into different ranges of risk and
indicate the absolute level of predicted expenses at the individual level. By categorizing members with risk scores
higher than 7.50 as "very high" you are able to stratify the riskiest members of your population from other members
who are not as costly. For each RRS bucket, corresponding decreases in care gaps (and the CGI) are associated with
decreases in the total medical spend.
Figure 4.1.1 Member costs by Risk and CGI buckets
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Members
Count
Total Spend
$ in Millions
7,825
7.32
361
0.75
59
0.1
4,242
11.39
1,007
2.25
297
0.6
2,870
16.73
1,152
7.26
700
4.2
685
9.85
466
9.29
478
9.35
67
5.53
58
6.24
86
4.83
20,353
95.70
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Note:
Refer to Table 5.5.1 in Appendix 5.5 for further detail about RRS buckets.