Case Study: APDRG-141 Admissions

EAPG category of Medical visit had 7,425 visits out of 9,008; it correlates to 83% of all preventable visits and 63% of preventable spend. Significant utilization is driving the observed outside of the expected for non-chronic segments; at risk, healthy, simple chronic, and stable are comprised in the aggregation. These categories are responsible for 7,576 out of 9,008 visits. High PPV rate might represent issues with access to care, lack of primary care , or patient not adhering to medical advice
TREO calculated 295 preventable admissions for the contract year, which pushed the variance to target outside of the expected. Morever, the admit source for 259 out of 295 admissions was an
ER visit. Reducing managable admissions such as APDRG-141