Common use of Financial Performance Measures Clause in Contracts

Financial Performance Measures. Contractor shall provide reports quarterly on trends in utilization for each category of eligibility in a format as directed by the Department. These categories of eligibility trends should include but not necessarily be limited to:  inpatient hospital admissions and days per thousand Member months;  outpatient hospital visits per thousand Member month;  emergency room visits per thousand Member months;  percent of emergency room visits resulting in admission;  ambulatory surgery / procedures per thousand Member months; hospital readmissions within 30 days per thousand Member months;  average visits per provider by major provider type;  PRTF admits and days per thousand;  mental hospital admits and days per thousand;  prescriptions dispensed by major drug class per thousand Member months;  Pharmacy cost per Member per month. In addition a report shall be provided that displays expenditures by category of service by both month of service and month of payment; this report should distinguish between the eight major categories of eligibility: 1) Families and Children – Child, 2) Families and Children – Adult, 3) SSI without Medicare Adult, 4) SSI Child and 5) Xxxxxx Care Child, 6) Dual Eligibles, 7) ACA MAGI Adults, and 8) ACA Former Xxxxxx Care Child.

Financial Performance Measures. Contractor shall provide reports quarterly on trends in utilization for each category of eligibility in a format as directed by the Department. These categories of eligibility trends should include but not necessarily be limited to:  inpatient hospital admissions and days per thousand Member months;  outpatient hospital visits per thousand Member month;  emergency room visits per thousand Member months;  percent of emergency room visits resulting in admission;  ambulatory surgery / procedures per thousand Member months; hospital readmissions within 30 days per thousand Member months;  average visits per provider by major provider type;  PRTF admits and days per thousand;  mental hospital admits and days per thousand;  prescriptions dispensed by major drug class per thousand Member months;  Pharmacy cost per Member per month. In addition addition, a report shall be provided that displays expenditures by category of service by both month of service and month of payment; this report should distinguish between the eight major categories of eligibility: 1) Families and Children – Child, 2) Families and Children – Adult, 3) SSI without Medicare Adult, 4) SSI Child and 5) Xxxxxx Care Child, 6) Dual Eligibles, 7) ACA MAGI Adults, and 8) ACA Former Xxxxxx Care Child.

Financial Performance Measures. Contractor shall provide reports quarterly on trends in utilization for each category of eligibility in a format as directed by the Department. These categories of eligibility trends should include but not necessarily be limited to:  • inpatient hospital admissions and days per thousand Member months;  • outpatient hospital visits per thousand Member month;  • emergency room visits per thousand Member months;  • percent of emergency room visits resulting in admission;  • ambulatory surgery / procedures per thousand Member months; hospital readmissions within 30 days per thousand Member months;  • average visits per provider by major provider type;  • PRTF admits and days per thousand;  • mental hospital admits and days per thousand;  • prescriptions dispensed by major drug class per thousand Member months;  • Pharmacy cost per Member per month. In addition a report shall be provided that displays expenditures by category of service by both month of service and month of payment; this report should distinguish between the eight five major categories of eligibility: 1) eligibility (i.e. Families and Children – ChildChildren, 2) Families SSI Adults, SSI Children, Xxxxxx Care, and Children – Adult, 3) SSI without Medicare Adult, 4) SSI Child and 5) Xxxxxx Care Child, 6) Dual Eligibles, 7) ACA MAGI Adults, and 8) ACA Former Xxxxxx Care Child).