VMC is committed to providing our Network with the most comprehensive statistical information available.  Our Data Team gathers medical and pharmacy claims data from each of our contracted payer, combines that with member and provider information, and uses Structured Query Language (SQL) to produce high quality and meaningful reports on various utilization patters in a myriad of perspectives.

• PCP Detail Reporting
• Requesting Data Reports
• Questions or Comments

PCP DETAIL REPORTING
VMC is proud to present to our Network Primary Care Physicians (PCP) the newly created "VMC Primary Care Detail Reports."  In the Fall of 2006 VMC decided to develop this report through our internal Data Management Department so we could bring our PCPs a high quality product and also have the ability to produce drill-down supporting information our PCPs may be interested in.  With the purchase of the Symmetry ETG/ERG Grouper program, VMC has obtained the ability to calculate a patient severity index without the need for an external consultant.

We are very pleased to provide our PCPs with a unique report, that pools data from the three VMC contracts; MVP, TVHP and the Fletcher Allen Preferred Medical Plans, enlarging the denominator and making the information more statistically significant.

This report captures data for a rolling 12 months with a three month run-out, and is delivered to Network PCPs who have an average of 100 members over the reporting period and have been part of the VMC Network for a minimum of four consecutive months.  VMC will be providing reports to our PCPs every six  months, and will be working to develop similar reports for our Specialty providers.

Samples of the Informational Thresholds page, PCP Details Report, and Report Definitions can be found via the links below.

    Informational Thresholds

    PCP Details Report

    Report Definitions

REQUESTING DATA REPORTS
VMC continues to strive toward sharing the most up to date and relevant information possible with all network participants.  As a step towards fulfilling that vision, the VMC Board of Directors, with recommendations from VMC Senior Leadership, has recently approved the VMC Data Release Policy.

What this means to you is you can request ad-hoc data reports from VMC as they relate to the contracts you hold through VMC.  VMC will review your request and if it is within the parameters of the Data Release Policy, your report will be approved.  You will be notified of receipt of your request, whether your request was approved, and the time needed to generate your report(s).

As additional report requests are approved, we will add them to the list of "Available Reports" below.  If you are interested in requesting one of these reports or would like to request a new report, go to the "ASK VMC" link found in the "red swirl" in the top left corner of this and every page of the VMC Web Site.

We are very excited to be able to provide you with this resource to help you with the management decisions you face in your practices and hospitals on a regular basis.

Approved Reports:

• Withhold Claims Detail:  withhold report at claim level.
  Added 10/26/07
  
  
• PT/OT TVHP Reconciliation Detail: PT/OT Reconciliation Report at claim level.
  Added 10/26/07
  
  
• Home Health & Hospice Services: services, cost & utilization FAP and VMC-TVHP members received, by VNA location, for a 12 month period.
  
  
• Facility Cost and Utilization Breakdown:  cost and utilization breakdown report by type of service as compared to other VMC facilities in total.
  
  
• PCP Practice Pattern Comparison Data: comparison data based on cost measures by provider age (over 40 vs. under 40), provider county (outside Chittenden County vs. inside Chittenden County), and solo vs. group practices.
  
  
• Facility Physical Therapy Utilization Reporting:  A) monthly reports detailing number of PT visits and total costs, sorted by referring provider, as compared in total to visits to other in-network facilities or providers, sorted by referring provider, zip code of referring provider, and patient's diagnosis grouping.  B) report calculating the percent of PT services performed by facility as compared to other in-network facilities or providers in total by member county of residence.
  
  
• Referral Pattern Summary: report summarizing referral patterns into and out of network practice.
  
  
• PHO Hospital, PCP and Specialty Claims Summary: Network PHO's Gross Revenue broken down by Hospital, Primary Care, and Specialty claims for MVP, TVHP and FAP lines of business.

QUESTIONS OR COMMENTS
Your questions and comments are important to us because we want to provide you with information that is useful and applicable in your day-to-day practice management.  Feel free to contact your Provider Relations Team at 802-847-8161 or 800-639-3881, or via the "Ask VMC" link above.