105 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
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4.2 Case Management Opportunities
As discussed in Figure 4.1.2, Verscend uses the RRS, CGI and total cost to stratify a population for Disease
Management. Patients who have incurred a high total spend (>$25,000 PMPY) will generally benefit from Case
Management. This corresponds to Category "A" in Figure 4.1.2. If the data is sent to Verscend, Medical Intelligence
can be used to assess what proportion of high-cost members is currently enrolled in Case Management.
Figure 4.2.1 displays the highest paid diagnoses for members of this population.
Figure 4.2.1 Frequency of primary diagnosis of high cost members (>$25,000 PMPY)