This month's pipeline run successfully processed 47,663 attributed members across 299 practices. The average PMPM cost is $1,634.63.
Of the attributed population, 11,260 members (23.6%) are enrolled in value-based care arrangements, and 30,827 members (64.7%) qualify for care management programs.
This is the first run - no prior period comparison available.
Data quality checks completed with 4 passing and 2 warning(s). All critical checks passed. The warnings are informational and do not block the pipeline.
Attention: 40 high-severity anomalies detected requiring review. These include significant denominator shifts and utilization spikes. An additional 20 medium-severity items are flagged for monitoring.
Attribution Methodology
Members are attributed to primary care providers using a claims-based attribution model that prioritizes continuity of care:
- Plurality Rule: Members are attributed to the provider with the most E&M visits in the measurement period
- Tie-Breaker: In case of equal visits, the most recent visit determines attribution
- Minimum Threshold: Members must have at least 1 qualifying visit to be attributed
- Provider Eligibility: Only providers in participating practices with active contracts are eligible for attribution
This methodology ensures members are aligned with the providers who are most engaged in their primary care, supporting accurate performance measurement and quality improvement initiatives.
Roster Generation Logic
Three rosters are generated from the attributed population:
Members enrolled in value-based care arrangements. Criteria include:
- Active attribution to a VBC-participating provider
- Minimum 3 months continuous enrollment
- Contract effective date within measurement period
Members qualifying for care management outreach based on:
- Risk score in top 20% of attributed population
- Presence of chronic conditions (diabetes, CHF, COPD)
- ED utilization above practice benchmark
Members included in performance benchmarking:
- Full 12-month claims runout available
- No gaps in enrollment exceeding 45 days
- Attributed to practices with minimum panel size