FAQ Directory: Patient-Centered Medical Home (PCMH)

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4.07.2020 CM 01 Could a chronic condition be considered under the high cost/high utilization category if it is expensive to treat?

The intent behind the high cost/high utilization category is that the practice is actively measuring the total cost of services or how much utilization occurs. A diagnosis of a condition may not be used as a proxy for high cost/high utilization. For instance, measuring the number of patients with uncontrolled asthma would not count under high cost/high utilization, but if those patients have multiple ER visits per year, this would be considered high utilization.