110 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
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4.4 Wellness 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 are well are most efficiently addressed through Wellness Programs. This corresponds
to Category "C" in Figure 4.1.2.
Table 4.4.1 details screening and preventative tests - and the associated compliance with these tests - for the entire
population. These data are benchmarked against the Verscend Commercial Norm. Wellness programs (e.g. an
initiative to increase mammogram compliance rates) based on this information can significantly improve health plan
performance on these measures.
Table 4.4.1 Preventative Measures
45,
46
Performance Relative to
Verscend Norms
Good
<=-5%
Average
>-5% and <5%
Poor
>=5%
Group
Condition
Screening/Preventive
Variation
from Norm
Both
>= 51 years old (E)
Patients without long office visit in the last 2 years.
27.7%
>=50 years old (E)
Patients without any colorectal cancer screening in the last
24 months.
1.6%
Male
Men >50 years old
(E)
Men without PSA level in the last 2 years (controversial
test).
4.5%
Female
Women between 40
and 49 y/o (E)
Women without mammogram in the last 24 months.
0.5%
Women between 49
and 69 y/o (E)
Women without mammogram in the last 18 months.
2.4%
Women between 21
and 65 y/o (E)
Women without pap smear in the last 24 months.
0.3%
Women >20 y/o (E)
Women without pap smear in the last two years.
0.7%
Women between 40
and 49 y/o (E)
Women without mammogram in the last 2 years.
0.5%
Women >=49 y/o (E)
Women without mammogram in last 12 months.
2.2%
Please Note:
If the underlying CPT codes for each laboratory test or panel are not submitted to Verscend in the medical claims then the
compliance in the Quality and Risk Measures will appear lower than they actually are.
*(E) = Enrollment criterion is applied to the Quality and Risk Measure and its Condition
45
Note:
Refer to Table 5.5.2 in Appendix 5.5 for further detail.
1.
The percentage of members for a specific Group, Condition and Screening combination are calculated for the members who are eligible
on the last day of the custom time period and whether or not they are in a particular Screening is calculated on the members’ full cycle
data
2.
The results displayed in this table are based on members who were eligible on the last day of the custom time period selected for the
group specified by the user (selection on business levels)
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Norm or Verscend Norm in this report refers to the values from Verscend's Commercial Normative database.