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Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
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Figure 2.3.2 shows the RRS and CGI relative to the Verscend Norm. Four scenarios are possible:
1. The population has a
higher RRS but a lower CGI
relative to the norm. This is a positive finding. The population
has a higher disease burden, yet compliance with evidence-based medicine generates a CGI lower than the norm.
2. The population has a
higher RRS and a higher CGI
relative to the norm. This is a mixed finding. The population
is sicker than the Verscend norm. Because it is sicker, we expect gaps in care to be more prevalent as well. This
population presents an opportunity to reduce care gaps and claims cost through disease management.
3. The population has a
lower RRS and a lower CGI
relative to the norm. This is a positive finding. The population
is healthier than the Verscend norm and also enjoys correspondingly fewer gaps in care.
4. The population has a
lower RRS but a higher CGI
relative to the norm. This is a negative finding. Although the
illness burden is low for this population, there exist disproportionate gaps in compliance with evidence-based care
guidelines - either through member non-compliance or poor provider quality.
Figure 2.3.2 Spread of disease burden and gaps in care by age groups.
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Age
Group
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Norm or Verscend Norm in this report refers to the values from Verscend's Commercial Normative database.