108 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
38
|
Page
Gaps in Care
% of Individual
with Gap/Risk
Clinical Condition
Members
with
Condition
Description
Actual
Norm
bleed hospitalization.
Misc
GI bleed-related
admission
8
Patients without CBC or hematocrit
within 6 weeks of discharge from GI
bleed hospitalization.
62.50%
40.91%
Behavioral
Dilantin in the
last 12 months
(E)
23
Patients without dilantin level in the last
12 months.
69.57%
48.76%
Behavioral
Patients >=18
y/o with at least
one active
substance abuse
related visit in
the last 24
months (E)
7
Patients with only one visit to a
behavioral health professional in the
last 12 months.
42.86%
22.58%
Behavioral
Depression-
related ER visit
(E)
35
Patients without outpatient behavioral
health office visit(s) during 12 months
prior to the ER visit
57.14%
37.62%
Misc
Patients with >=
6 events of otitis
media in the last
12 months (E)
22
Patients not receiving a tympanostomy
tube in the last 12 months.
68.18%
48.83%
Misc
Patients with >=
6 events of otitis
media in the last
12 months
25
Patients not receiving a tympanostomy
tube in the last 12 months.
68.00%
48.83%
RF
Renal
Failure/ESRD (E)
100
Patients without serum creatinine test
in the last 12 months.
31.00%
12.83%
Gen
Diuretic (E)
1,190
Patients without serum potassium level
in the last 12 months.
43.45%
25.99%
Gen
Diuretic
1,250
Patients without serum potassium level
in the last 12 months.
44.08%
27.06%
Cardiac
CHF (E)
49
Patients without LDL-C or lipid profile
test in the last 12 months.
53.06%
36.75%
DM
Diabetes (E)
963
Patients without serum creatinine in the
last 12 months.
32.61%
16.45%
Misc
Patients taking
Methotrexate in
the last 12
months (E)
71
Patients without liver function in the
last 12 months
26.76%
11.08%
Behavioral
Depression-
related
admission (E)
10
Patients without behavioral health
office visit within 14 days of discharge.
30.00%
14.40%
RF
Renal
Failure/ESRD (E)
100
Patients without lipid profile test in the
last 12 months.
51.00%
35.83%
DM
Diabetes (E)
963
Patients without HbA1c test in the last 30.94%
16.23%