Demographic Reports Details

Report Name	Definition
Age-Sex Analysis Report categories	Compares the group's age and sex cohorts with the benchmark population and develops a composite Age.Sex factor for the group to tailor benchmark data
Age-Sex Factor Trend Report	Tracks historical changes over time in the group's population size and Age-Sex factor
Enrollment by Member Relationship	Compares the group's distribution of members by type (employee, spouse, child) with the benchmark population to illustrate potential adverse selection by spouses or possible existence of enrolled ineligible children
Membership Count	Shows the group's historical monthly count of employees and dependents
Member Turnover Report	Details the members joining and leaving and the average turnover for a given timeframe

Financial Reports Details

Report Name	Definition
Incurred Claims Report	Shows the group's estimated monthly incurred claims dollars and PMPM costs
Paid Claims Report	Shows the group's monthly paid claims dollars and PMPM costs
Trend Analysis Report	Shows the group's rolling 12-month and 3-month average PMPM costs used to determine emerging PMPM cost trends
Network Savings Report	Shows the group's in- vs. out-of-network claim utilization and network savings amounts to monitor savings and provide the basis for assessing actual discounts compared to a vendor's performance standard
Claims Summary Report	Shows the group's claim dollars and number of claimants by claims dollar amount categories

Utilization Reports Details

Report Name	Definition
Top Ten Report	Shows the group's top costs and services available in a large number of medical service categories
Benefit Analysis Report	Shows the disposition of the group's covered claim amounts including discounts, co-pays and deductibles, coinsurance, and coordination of benefits adjustments
MDC Drill Down Report	Shows the group's hospital inpatient cost data grouped by Major Diagnostic Category
Utilization Report	Shows the group's in- and out-of-network unit cost and utilization data compared to custom benchmarks in as many as 40 user-defined medical service categories
Utilization Trend	Provides the user with group's utilization data for exporting to Excel for the calculation of the group's emerging medical service utilization trends
Hospital Readmits Report	Analyzes the Hospital Re-Admits (30,60 and 90 Day) by Diagnosis for the population.
Hospital Readmits By Provider Report	Analyzes the Hospital Re-Admits (30,60 and 90 Day) by Provider for the population.
Advancing Imaging Utilization Report	...........
Advancing Imaging Analysis Report	...........

Benchmark Reports Details

Report Name	Definition
Benchmark Report	Shows a graphic comparison of the group's medical service unit cost and utilization per 1,000 in any of up to 40 user defined medical service categories compared to the benchmark population

Clinical Risk Groups (CRG) Reports Details

Report Name	Definition
Health Status Report	Shows the group's actual paid claims in 39 clinical risk groupings as well as the health risk index (HRI) for each grouping compared to the benchmark index
HRI Trend Development	Shows the group's retrospective (current period) and prospective (following 12 months) health risk index in 39 clinical risk groupings, as well as a composite HRI, used to predict the overall change in the group's health status
HRIPopulation Report	Displays the group’s PMPM Cost, Retrospective and Prospective Health Risk for given timeframe broken out by Acute and Chronic Clinical Category Descriptions.
Potential High Cost Members	For members covered in the last month of the current analysis period, shows the group's top 100 predicted claimants ranked by claim amount for the 12 months following the current period
Disease Burden	Compares the group's actual distribution of non-healthy claimants by major clinical category compared to the benchmark population
Clinical Category by Dollar Amount	Shows the group's top 25 clinical risk groups ranked by claim dollar amount
Potential Emerging ClaimsReport	Displays the top 25 Potential Clinical Categories and Claims Paid. The claims are ranked by the Future 12 Months claims.
Clinical Analysis Report	Compares Clinical conditions against benchmarks for the population.
Predictive Model	Evaluates the latest population's retrospective (current period) and prospective (following 12 months) health risk index in 39 clinical risk groupings, as well as a composite HRI, used to identify high-cost diagnoses that, in turn, provide a risk score indicative of the likelihood to utilize more healthcare resources and dollars than persons of the same age and gender.
Clinical Category by Number	Shows the group's top 25 clinical risk groups ranked by number of claimants

Patient Level Reports Details

Report Name	Definition
Large Claim Drill Down	Shows a user-defined high dollar claimant listing for the group with ability to drill down into claim details
Top 20 Large Claims Details Report	Displays the Top 20 high dollar claimants for the group and allows you to drill-down and export the top 20 claims paid for the group selected.

Experience Summary Reports Details

Report Name	Definition
Healthcare Benchmarking	Produces standard report without custom analysis ready for printing containing preset report categories
Variance Analysis	Displays the variance between the benchmarks and actuals and provides recommendations based upon the variance

Prescription Drug Reports Details

Report Name	Definition
Rx Benchmark Cost Per Script	Compares the group’s average Incurred Cost per Rx versus the Benchmark.
Rx Benchmark PMPM	Shows the group's average Per Member per Month Incurred Cost compared to the benchmark for the given population.
RX Benchmark Scripts PMPM	Compares the population’s average scripts per member versus the benchmark.
Rx Summary	Compares the group's Rx cost and utilization by Brand/Generic, and Retail/Mail-Order cohorts
Top 20 Rx Drugs Report	Compares the top 20 Rx Drugs prescribed with all other drugs prescribed for the population
Rx Drugs By Therapeutic Class Report	Summarizes the top 25 Rx Drugs by Therapeutic Class, Brand/Generic, Total Paid, Percentage of Total Rx Paid, Number of Scripts and Total Prescriptions.
Rx Utilization Brand vs. Generic Report	Compares Total Prescriptions, Paid and Copay Amount by Drug Type (Brand/Generic) for the selected population
Top 25 Therapeutic Classes Report	Summarizes up to the top 25 Therapeutic Classes and displays the Total Paid and Total Prescriptions.
Rx Therapeutic Class Avg. Cost Report	Summarizes the Paid Amount, Rx Scripts and Average Costs for the Top 25 Therapeutic Classes.
Rx Benefit Analysis	Shows the composition of the group's monthly Rx total and PMPM claim costs including ingredient cost, dispensing fee, sales tax, co-pay, and discount.Added a stacked bar graph displaying the breakdown of Sales Tax, Ingredient Cost, Dispensing Fee and Copay amount.
Rx Trend Analysis Report	Compares the PMPM, Rolling 3 and 12 month PMPM Claims and Trends
Specialty Rx Drug Report	Shows top 20 Details of 'Chemotherapy Drugs','Drugs Administered Other than Oral Method' and 'Miscellaneous Drugs and Solution'(Specialty Drugs Category).
Monthly Cost Per Script Report	Compares the monthly average Incurred Cost per Rx versus the Benchmark
Rx Cost PMPM Report	Displays the monthly average Rx PMPM cost compared to the benchmark.
Script PMPM Report	Displays the average monthly Prescriptions per Member versus the benchmark.

Dental Reports Details

Report Name	Definition
Dental Benchmark Cost per Procedure	Shows the group's average cost per dental procedure compared to the benchmark population
Dental Benchmark PMPM	Shows the group's average dental PMPM cost compared to the benchmark population
Dental Benchmark Procedure PMPM	Shows the group's average number of dental services per 1,000 members compared to the benchmark population
Dental Benefit Analysis	Shows the disposition of the group's covered dental claim amounts including discounts, co-pays and deductibles, coinsurance, and coordination of benefits adjustments
Dental Trend Analysis	Shows the group's rolling 12-month and 3-month average dental PMPM costs used to determine emerging PMPM cost trends
Dental Membership Count	Shows the group's historical monthly count of employees and dependents with dental coverage

Vision Reports Details

Report Name	Definition
Vision PMPM Report	Compares the population’s average vision costs per member versus the benchmark.
Vision Cost Per Services	Compares the group’s average Incurred Cost per Service.
Vision Services PMPM	Compares the population’s average services costs per member versus the benchmark.
Vision Benefit Analysis	Shows the disposition of the group's covered Vision claim amounts including discounts, co-pays and deductibles, coinsurance, and coordination of benefits adjustments
Vision Utilization	Displays the average number of services per 1000 and the average costs per service.

DM Monitoring Reports Details

The Disease Monitoring section contains a series of reports designed to identify the demographics, health status, medical resource utilization, and cost associated with members who have been diagnosed with major health conditions that are chronic in nature and many times related to lifestyles. The conditions include Asthma, Hypertension, Cancer, COPD, Diabetes, and Heart disease. The purpose of the reports is first to establish baseline metrics for each disease category, then, over time, to measure the changes in these metrics that may be the result of a plan sponsor's disease management or wellness program.

Report Name	Definition
Age-Sex Analysis Report	Compares the group's age and sex cohorts with the benchmark population and develops a composite Age.Sex factor for the group to tailor benchmark data
DM Monitoring Report	Reports designed to provide healthcare cost and utilization metrics focused on members with specific disease categories typically included in a Disease Management program
Utilization Report	Shows the group's in- and out-of-network unit cost and utilization data compared to custom benchmarks in as many as 40 user-defined medical service categories
Trend Analysis Report	Shows the group's rolling 12-month and 3-month average PMPM costs used to determine emerging PMPM cost trends
Rx Benchmark Scripts PMPM	Compares the population’s average scripts per member versus the benchmark
Top 20 Rx Drugs	Compares the top 20 Rx Drugs prescribed with all other drugs prescribed for the population
Rx Utilization Brand vs. Generic	Compares Total Prescriptions, Paid and Copay Amount by Drug Type (Brand/Generic) for the selected population
Rx Therapeutic Class Avg. Cost	Summarizes the Paid Amount, Rx Scripts and Average Costs for the Top 25 Therapeutic Classes