Medical Loss RatioOn target
84.2%
Target ≤ 86.0%78% to goal
▼-1.8 pts vs. prior quarter
PMPM cost $912 against $1,083 revenue
Admits / 1,000 (APK)Watch
196
Target ≤ 18556% to goal
▲+7 vs. prior quarter
SNF-origin admits driving the variance
ED Visits / 1,000 (EDK)On target
412
Target ≤ 45084% to goal
▼-24 vs. prior quarter
After-hours line diverted 61 visits YTD
Stars CompositeWatch
4.0★
Target 4.5 ★71% to goal
▲+0.5 vs. 2025 final
3 measures within 2 pts of the next cut point
Cost & utilization trend
Rolling seven quarters, each measure on its own scale
Medical Loss Ratio
84.2%-0.9 QoQ
89.1
88
87.2
86.4
86
85.1
84.2
Q4 24Q1 25Q2 25Q3 25Q4 25Q1 26Q2 26
Admits / 1,000 (APK)
196+7 QoQ
214
208
201
197
189
189
196
Q4 24Q1 25Q2 25Q3 25Q4 25Q1 26Q2 26
ED Visits / 1,000 (EDK)
412-12 QoQ
478
461
449
438
436
424
412
Q4 24Q1 25Q2 25Q3 25Q4 25Q1 26Q2 26
Program participation
What this practice is enrolled in with us
- Active
Care Management Services
Embedded RN care manager, 2 days/week on site
214 patientsSince Mar 2024 - Active
Transitions of Care
48-hour post-discharge outreach + 7-day visit scheduling
96 patientsSince Jan 2025 - Active
Pre-Visit Planning Forms
Forms delivered 5 business days ahead of each AWV
1,842 patientsSince Feb 2024 - Not enrolled
Behavioral Health Integration
Not enrolled — eligible, contracting review pending
- Not enrolled
Remote Patient Monitoring
Not enrolled — declined 2025 cycle
- Active
In-Home Assessments
Vendor visits for unseen members, 128 completed YTD
128 patientsSince Jun 2025
Stars measure detail
Measure-level rates against 4.5-star cut points
| Measure | Rate | Progress | Stars | Open gaps |
|---|---|---|---|---|
| COACare for Older Adults | 88% | ★★★★★ | 42 | |
| CBPControlling Blood Pressure | 74% | ★★★★★ | 118 | |
| HBDDiabetes — HbA1c Control | 81% | ★★★★★ | 63 | |
| COLColorectal Cancer Screening | 71% | ★★★★★ | 137 | |
| BCSBreast Cancer Screening | 79% | ★★★★★ | 54 | |
| SPCStatin Therapy — CVD | 86% | ★★★★★ | 39 | |
| TRCTransitions of Care | 68% | ★★★★★ | 27 | |
| FMCFollow-up After ED Visit | 64% | ★★★★★ | 31 |
Risk coding & pre-visit planning
HCC recapture and care gap closure driven by the forms
HCC Recapture Rate
82%
1,109 of 1,352 chronic conditions recaptured
Risk Score (RAF)
1.184
+0.061 vs. prior year
Unrecaptured HCCs
243
Weighted RAF opportunity 0.078
AWV Completion
76%
1,400 of 1,842 attributed members
Pre-Visit Forms Returned
68%
884 of 1,300 forms sent YTD
Quality Gaps Closed via Form
1,462
41% of all gap closures YTD
Provider detail
Recapture, form return and open gaps by provider
| Provider | Panel | Recapture | Forms returned | Open gaps |
|---|---|---|---|---|
| A. Whitfield, MD | 412 | 91% | 268/290(92%) | 74 |
| R. Osei, DO | 388 | 86% | 212/274(77%) | 96 |
| M. Delacroix, MD | 341 | 79% | 168/240(70%) | 121 |
| S. Patel, NP | 296 | 77% | 131/208(63%) | 138 |
| T. Brennan, MD | 254 | 74% | 78/176(44%) | 152 |
| K. Nowak, PA-C | 151 | 69% | 27/112(24%) | 88 |
Sample data shown for layout review — figures are illustrative.