74 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
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2.3 Clinical Disease Fingerprint
The Relative Risk Score (RRS) quantifies the disease burden of an individual member, while the Care Gap Index (CGI)
quantifies the gaps in appropriate medical care that a member is receiving. Depending on the diseases that a member
has, the extent of care gaps present serves as one assessment of the quality of care they receive.
Figures 2.3.1 show the relationship between the RRS and the CGI. As age increases, RRS and CGI usually increase
proportionally. Figure 2.3.2 shows the RRS and CGI relative to benchmark performance and discusses how to
determine the extent to which your CGI is driven by high disease burden or poor quality care.
Figure 2.3.1 Average Care Gap and RRS
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Source: Medical Intelligence : Average of RRS and CGI fields, grouping members by age in the Individuals Module