Event Rate Analysis ROI Measurement Sample Clauses

Event Rate Analysis ROI Measurement. To determine gross savings, Caremark will use an event rate analysis methodology which uses outcomes across all eligible Members via a standard analytic design that compares the Participating Group’s population before implementing the Program to the population after implementing the Program (referred to as a “pre/post analytical design”). Caremark will use Participating Group Data to establish an annual baseline and measure Program performance; provided, however that if Participating Group has between Members, only book of business data will be used. Notwithstanding the foregoing, Caremark may incorporate book of business and industry data to adjust the baseline and measure Program performance. The cost savings calculations in the event rate analysis methodology are based on identified behavior changes resulting from the Program. Specifically, Caremark will measure differences in the identified behaviors between the baseline group (“Pre-Program Group”), and the in-period group (“Post-Program Group”) during the Measurement Period. Examples of changes in behaviors that will be measured may include, but are not limited to, screenings, vaccinations, adherence to diabetes-related medications, and use of blood glucose monitoring devices. Each identified behavior change will have a dollar savings associated with it which will be evaluated and established at the Program level prior to the start of the Measurement Period. The dollar savings for all identified behaviors will be aggregated for purposes of the ROI Guarantee. The methodology will take into account exceptional or unexpected changes (e.g., addition or removal of complementary programs, COVID-19 impact on utilization) by leveraging multi-year, Participating Group-specific, and book of business experience. The savings calculation methodology will remove cost outliers and normalize for: a. differences in costs such as, but not limited to, demographic and Plan design differences between the Pre-Program Group and the Post-Program Group, and b. the potential impact of Program overlap with other care management programs. Caremark reserves the right to restrict the cost savings calculation to Members continuously enrolled in the Plan during the Pre-Program period and the Measurement Period and to Members managed in the Program within the first four months of the Measurement Period.
Sample 1
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Related to Event Rate Analysis ROI Measurement

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