Total Cost of Care Population-Based PMPM Index
Identifying Attributes
Care Settings
Primary Care
Country
United States of America
Publishing Organisation
HealthPartners
Type of Quality Indicator
Outcome
IOM Quality Dimension
Efficiency
Domain
Wait and System Planning / Access
Defining Attributes
Definition
Total Cost of Care reflects a mix of complicated factors such as patient illness burden, service utilisation and negotiated prices. Total Cost Index (TCI) is a measure of a primary care provider's risk adjusted cost effectiveness at managing the population they care for. TCI includes all costs associated with treating members including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioural health services. A Total Cost Index when viewed together with the Total Resource Use measure (NQF-endorsed #1598) provides a more complete picture of population based drivers of health care costs.
Numerator
Denominator
Exclusions
Use of Risk Adjustment
Yes
Risk Adjustments
Stratifications
Collection and Reporting Attributes
Type of Data Collection
Administrative data
Data Collection Methods
Claims data
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Reporting Frequency
Reporting Frequency in Days
Indicator Has Recommended Targets
No
Source and Reference Attributes
Evidence Source
Technical Specifications
Link to Measurement Tools
Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
No
Australian Consortium for Aged Care Endorsed
No
Identified by PHARMA-Care Project
No
Upload Date
02 December 2025
Contents
Actions
Date Modified 02 December 2025