Key Performance Indicators

Key performance indicators (KPIs) drive strategies for several key areas of a healthcare organization's business to drive utilization management, actuarial analysis, and network management. Strategic organizations use KPIs to align health plans and providers to drive high quality, effective care.

Give your finance, care, quality, network, utilization, and population health management teams tools to evaluate cost, utilization, quality, pharmacy and prevention KPIs over time.

Key Performance Indicators Dashboard

Key Performance Indicators Dashboard

QualMetrix provides Key Performance Indicator dashboards around:

  • Cost KPI trends to measure and compare the medical and Rx PMPM, and billing Level 4 and 5 evaluation and management
  • Utilization KPI trends to measure and compare ER visits, admits, average length of stay, and lab/radiology services
  • Quality KPI trends to measure and compare readmission rates, avoidable ER rates, complication rates, and hospital acquired condition rates
  • Pharmacy KPI trends to measure and compare cost around Rx PMPM, script by member, brand/generic, and compliance for non-formulary and formulary metrics
  • Prevention KPI trends to create impactful, targeted member and provider education, identify gaps in care, and support quality management
  • Employer Cost KPI trends to compare employer costs around medical and Rx PMPM, utilization rate, prevention and other quality measures
  • Employer Comparison KPIs to rank and sort their peers