90 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
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3.1.4 Place of service - Inpatient and high acuity
Monitoring the utilization patterns for chronic conditions offers valuable insight into benefit design and/or case and
disease management program performance. In general, high utilization rates for such measures as inpatient
admissions and emergency room services in these conditions bring into question the adequacy of outpatient care,
plan design incentives to encourage outpatient care, and medical management performance.
The chart below shows which inpatient and high acuity places of service are large and are growing fast. Moving left
to right on the horizontal axis, total costs incurred get larger. Moving bottom to top on the vertical axis, growth from
previous period through current period in costs increases. Therefore, locations in the upper right corner are both
large and growing fast.
Figure 3.1.5 Cost drivers: Areas of cost and cost growth for hospital and ASC based utilization
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Note:
Figure 3.1.5 is based on select categories of Verscend Procedure Groups which utilize CPT4 Procedure Codes.
Source: Medical Intelligence : Claims Module / Trend / Medical / drill by Plan Type / Zoom Fwd / drill by Procedure Group