1. Activity
1.1. Quality Measures
1.1.1. Active Measures
1.1.2. Excluded Measures
1.2. Task Comments
1.3. Patient Outreach
2. Monthly Values
2.1. Pharmacy Cost Total Cost Hospitalization Days All Cause Hospitalization Count ER Visit Count Outpatient Visit Count Specialty Count Generalist Seen Management Visit Count Dialysis Service Skilled Nursing Service Major Procedure Cancer Treatment Psychotherapy Service Mechanical Ventilation
2.2. Timeline Items
3. Annual Values
3.1. Age Band Pharmacy Cost Band Total Cost Band Resource Utilization Band Unscaled ACG Concurrent Risk Unscaled Concurrent Risk Unscaled Total Cost Predicted Risk Unscaled Total Cost Range Rank Probability High Total Cost Probability Persistent High User Coordination Risk Unscaled Pharmacy Cost Predicted Risk Predicted Pharmacy Cost Range Rank Probability High Pharmacy Cost High Risk Unexpected Pharmacy Cost Probability Unexpected Pharmacy Cost 30 Day Readmission Count Unplanned 30 Day Readmission Count Probability Inpatient Hospitalization 1 Year Probability Inpatient Hospitalization 6 Months Probability ICU Hospitalization Probability Injury Hospitalization Probability Extended Hospitalization Probability Unplanned 30 Day Readmission EDC Codes MEDC Codes Age Related Macular Degeneration Bipolar Disorder Condition Congestive Heart Failure Condition Depression Condition Diabetes Condition Glaucoma Condition HIV Condition Disorders of Lipid Metabolism Condition Hypertension Condition Hypothyroidism Condition Immunosuppression Transplant Condition Ischemic Heart Disease Condition Osteoporosis Condition Parkinson's Disease Condition Persistent Asthma Condition Rheumatoid Arthritis Condition Schizophrenia Condition Seizure Disorders Condition Chronic Obstructive Pulmonary Disease Condition Chronic Renal Failure Condition Low Back Paid Condition
4. Clinical Tab
4.1. Medications
4.1.1. Major Rx Codes
4.2. Diagnosis
4.2.1. Frailty
4.2.2. Major Expanded Diagnosis
4.2.3. Major Conditions
5. Left Rail
5.1. Contact Info
5.2. Attribution
5.3. Programs
6. Summary Tab
6.1. Risk
6.1.1. Concurrent Risk
6.1.2. Predicted
6.1.3. Probability High Total Cost
6.1.4. Predicted Cost
6.1.5. HCC Risk Score
6.1.6. HCC Codes
6.1.7. Predicted Pharmacy Cost
6.1.8. Extra Risk Items
6.1.8.1. Probability Inpatient Hospitalization (6/12 months)
6.1.8.2. Probability Injury Hospitilization
6.1.8.3. Probability Unplanned 30 Day Readmission
6.1.8.4. Probability Extended Hospitalization
6.1.8.5. Probability ICU Hospitalization
6.2. Cost
6.2.1. Pharmacy Cost
6.2.2. Pharmacy Cost Band
6.2.3. Total Cost
6.2.4. Total Cost Band
6.2.5. Resource Utilization Band
6.2.6. Predicted Cost Range
6.3. Utilization
6.3.1. Hospitalization Days
6.3.2. Hospitalization Count
6.3.3. 30 Day Readmission Count
6.3.4. Unplanned 30 Day Readmission Count
6.3.5. ER Visit Count
6.3.6. Outpatient Visit Count
6.3.7. Management Visit Count
6.3.8. Dialysis Service
6.3.9. Skilled Nursing Service
6.3.10. Major Procedure
6.3.11. Cancer Treatment
6.3.12. Psychotherapy Service
6.3.13. Mechanical Ventilation Service
6.3.14. Unique Provider Count
6.3.15. Specialty Count
6.3.16. Generalist Seen