Average risk score is a numeric score where a higher score indicates a riskier population on average. Example scores: 0.70, 1.00, 1.30.

The market average risk score.

Total capitation amount.

Capitation per member per month (PMPM). Capitation is a fixed amount of money per patient per month paid in advance to the physician [or health care provider] for the delivery of health care services.

Total dental capitation.

Total dental capitation per member per month (PMPM).

Total reinsurance capitation.

Reinsurance captitation per member per month (PMPM).

Care coordination fee (CCF) is per member per payments based on the number of patients that are assigned to primary care physicians.

Goal or target hierarchical condition category (HCC) Risk Adjustment Factor (RAF).

Acutal hierarchical condition category (HCC) Risk Adjustment Factor (RAF).

Earnings from care coordination fees.

Performance for care coordination fees.

Potential upside earnings for care coordination fees.

Potential downside earnings for care coordination fees.

Earned incentive payment.

Earnings from quality incentive payments.

Performance for quality incentive payments.

Potential upside earnings for quality incentive payments.

Potential downside earnings for quality incentive payments.

Earnings from shared savings surplus/loss.

Performance for shared savings surplus/loss.

Potential upside earnings for shared savings surplus/loss.

Potential downside earnings for shared savings surplus/loss.

Earnings from capitated payments.

Performance for capitated payments.

Potential upside earnings from capitated payments.

Potential downside earnings for capitated payments.

% of payment tied to quality.

% of shared savings can earn based on quality metric performance.

Interim payment rate.

Incurred but not yet reported (IBNR) per member per month (PMPM).

Estimated medical expenses incurred but not yet reported (IBNR).

Estimated pharmacy expenses incurred but not yet reported (IBNR).

Estimated medical and pharmacy expenses incurred but not yet reported (IBNR).

Total revenues earned, which includes premiums and other resources that a payer receives.

Revenue earned per member per month (PMPM).

Average revenue per member per month (PMPM) for a market.

Cost target.

A general term that refers to Medicare and Medicaid administrative costs, as well as CMS administrative costs. Medicare administrative costs are comprised of the Medicare related outlays and non-CMS administrative outlays. Medicaid administrative costs refer to the Federal share of the States' expenditures for administration of the Medicaid program. CMS administrative costs are the costs of operating CMS (e.g., salaries and expenses, facilities, equipment, rent and utilities, etc.). These costs are reflected in the Program Management account.

Total amount of the pharmacy cost.

The goal or target pharmacy spend level as specified by a value-based contract below which savings are generated, often represented as a percent of total revenue.

Pharmacy cost per member per month (PMPM).

The goal or target pharmacy spend level per member per month (PMPM) as specified by a value-based contract below which savings are generated, often represented as a percent of total revenue.

Total amount of the medical cost.

The goal or target medical spend level as specified by a value-based contract below which savings are generated, often represented as a percent of total revenue.

Medical cost per member per month (PMPM).

The goal or target medical cost per member per month (PMPM).

Total dollars available for medical spend calculated using the medical cost target relative to estimated revenue.

The market average medical cost per member per month (PMPM) over revenue PMPM.

Total spend on medical and pharmacy cost for a specified population.

Target spend on medical and pharmacy cost for a specified population.

Total spend on pharmacy cost for a specified population represented on a per member per month (PMPM) basis.

The market average medical pharmacy cost per member per month (PMPM).

How much actual costs vary from projected (target) costs.

The Medical Loss Ratio (MLR) is the proportion of premium revenues spent on clinical services and quality improvement.

The goal or target medical spend level relative to revenue as specified in a value-based care contract, often represented as a percent of revenue.

Medical expense ratio.

Medical expense ratio per member per month (PMPM).

Total member months in a given period.

Total medical member months in a given period.

Total pharmacy member months in a given period.

Adjusted paid claim, excludes catastrophic claims.

Bonus to qualified annual care visit (ACV). A type of quality incentive payment.

Bonus earned when achieve a certain Average Star Rating. A type of quality incentive payment.

Bonus earned when achieve improvement performance year over year based on average star rating. A type of quality incentive payment

Quality metric performance incentive payment is a type of quality incentive payment.

Quality payment chronic disease management.

Quality payment annual office visit.

The amount of shared saving deficit.

The average quality score across a specified set of measures, weighted by importance of the individual measures for a specific population. Often used in relation to CMS Medicare Star rating reports, e.g., where medication adherence measures are 3x weighted relative to other quality measures in the set.

The number of conditions.

Number of members with 1 closed gap.

Number of members with 2 closed gaps.

Total paid claim amount.

Paid claim per member per month (PMPM).

Total diagnosis related group (DRG) expense.

Diagnosis related group (DRG) expense per member per month (PMPM).

Provider quality expense per member per month (PMPM).

Subrogation per member per month (PMPM).

Average number of members with office visit.

Total number of Emergency Department (ED) visits.

Total number of eligible members.

Total number of inpatient acute stays.

Total number of inpatient admissions.

Total number calls of the nurse hotline.

Total nurse hotline per member per month (PMPM).

The number of skilled nursing facility average length of stay.

Total number of readmissions

Total number of skilled nursing facility admissions.

Total provider quality expense.

Total subrogation amount.

Average membership.