Total Cost of Care Population-Based PMPM Index (Cost/Resource use Measure)

INACTIVE REVIEW: This measure review is older than five years.

Total Cost of Care reflects a mix of complicated factors such as patient illness burden, service utilization and negotiated prices.

Total Cost Index (TCI) is a measure of a primary care provider's risk adjusted cost effectiveness at managing the population they care for. TCI includes all costs associated with treating members including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services.

A Total Cost of Care Index when viewed together with a Resource Use measure provides a more complete picture of population based drivers of health care costs.

Date Reviewed: November 7, 2015

Measure Info

NQF 1604 NQF Endorsed
Measure Type
Resource Use
Measure Steward
Clinical Topic Area
Utilization and Cost

Care Setting
Emergency Department and Services
Home Care
Outpatient Services
Post-Acute Care
Data Source

ACP does not support this measure. This measure does not qualify as a quality measure because it is solely measuring cost, rather than balancing cost against quality. Furthermore, the measure intends to be risk-adjusted, but appropriate risk-adjustment is not feasible based on what data is available.