Utilization Reports
Inpatient, outpatient, and service utilization per 1,000 members
Admits /1,000
142
Benchmark: 155
Bed Days /1,000
712
Benchmark: 800
ER Visits /1,000
189
Benchmark: 200
OP Surgery /1,000
234
Benchmark: 220
Referrals /1,000
1,820
Benchmark: 1,900
Utilization Trend (8 Quarters)
Utilization by Age Band
Benchmark Comparison
| Metric | Our Rate | Industry Benchmark | Variance | Status |
|---|---|---|---|---|
| IP Admits /1,000 | 142 | 155 | -13 (-8.4%) | Below Benchmark |
| Average Length of Stay | 3.8 days | 4.2 days | -0.4 days | Below Benchmark |
| ER Visits /1,000 | 189 | 200 | -11 (-5.5%) | Below Benchmark |
| OP Surgery /1,000 | 234 | 220 | +14 (+6.4%) | Above Benchmark |
| Specialist Referrals /1,000 | 1,820 | 1,900 | -80 (-4.2%) | Below Benchmark |
| 30-Day Readmission Rate | 12.4% | 11.0% | +1.4 pts | Above Benchmark |
| SNF Days /1,000 | 184 | 210 | -26 (-12.4%) | Below Benchmark |
Top 10 High Utilizers (by Total Cost)
| Rank | Patient | Total Cost YTD | Admit Count | ER Visits | Primary Dx | Risk Score |
|---|---|---|---|---|---|---|
| #1 | Anonymous 4821 | $84,200 | 4 | 7 | CHF + COPD | 4.8 |
| #2 | Anonymous 3174 | $71,500 | 3 | 5 | ESRD + DM | 4.6 |
| #3 | Anonymous 9205 | $58,900 | 2 | 8 | Behavioral Health | 3.9 |
| #4 | Anonymous 6348 | $52,100 | 3 | 4 | Cancer + DM | 3.7 |
| #5 | Anonymous 7891 | $47,800 | 2 | 6 | COPD + HTN | 3.4 |
| #6 | Anonymous 2456 | $44,200 | 1 | 9 | Behavioral Health | 3.2 |
| #7 | Anonymous 5132 | $41,700 | 2 | 3 | CHF | 3.0 |
| #8 | Anonymous 8847 | $38,900 | 3 | 2 | ESRD | 2.9 |
| #9 | Anonymous 1293 | $36,400 | 1 | 5 | DM + CKD | 2.7 |
| #10 | Anonymous 4417 | $34,100 | 2 | 4 | HTN + CAD | 2.5 |