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Utilization and Cost

The PMC reviewed relevant performance measures and makes the following recommendations.

Printable version of the recommendations.

ACP does not support this measure.

ID# NQF 1604

More Information

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

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

ACP supports this measure.

ID# NQF 0052

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Use of Imaging Studies for Low Back Pain

The percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain x-ray, MRI, CT scan) within 28 days of the diagnosis.

The measure is reported as an inverted rate [1-(numerator/eligible population)]. A higher score indicates appropriate treatment of low back pain (i.e.; the proportion for whom imaging studies did not occur).
Date Reviewed: November 7, 2015