2016 Relative Resource Use Benchmark File - Medicare

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Relative Resource Use (RRU) Benchmark File—Your Roadmap to Resource Utilization Improvement

New data file allows greater insights into RRU data at risk factor and demographic levels.

With the health care system’s move to value-based pay, being able to identify, track and adjust resource utilization is increasingly important. Relative Resource Use measures indicate how intensively plans use resources such as physician visits and hospital stays to care for members with a chronic disease (i.e., cardiovascular disease, COPD, diabetes, hypertension, asthma).

Compare your organization’s RRU data against this benchmark file to identify detailed areas of improvement, as well as areas where your organization may excel. This file contains information from Medicare health plans.

Source for Essential Cost Metric Data

The benchmark file was developed through analysis of RRU data from hundreds of health plans. Data provide an accurate representation of resource utilization across the health care system.  

The file provides national per member per month (PMPM) averages for each of the eight RRU cost metrics. Using plan-level observed information, it calculates the cohort-level expected benchmarks that organizations can use to determine opportunities for quality improvement. NCQA also provides risk group stratification by using the CMS Hierarchical Condition Category approach, which considers age and gender, disease severity and presence of comorbidity—and excludes other dominant conditions and related interactions—to determine a risk score.

The RRU Benchmark file allows data segmentation along multiple parameters:

  • Product Line (Commercial, Medicare, Medicaid).
  • Plan Type (HMO, PPO).
  • RRU Disease States (Cardiovascular, COPD, Diabetes, Hypertension, Asthma).
  • Cost Metrics (Diagnostic Imaging, Diagnostic Laboratory, Inpatient Evaluation & Management, Inpatient Facility, Inpatient Surgery & Procedures, Outpatient Evaluation & Management, Outpatient Surgery & Procedures, Pharmacy).
  • Risk Groups (1–13).
  • Gender (Male, Female).
  • Age (5–17, 18–44, 42–44, 45–54, 45–64, 55–64, 65–74, 65–75, 65–85, 75+).
  • Member Months.
  • PMPM.