2025 PCMH Core Efficiency Metrics
Efficiency Metrics for Adult Organizations
| Core Metric | Source | Description | Threshold |
|---|---|---|---|
| Ambulatory care - ED visits per 1,000 member months | HEDIS (AMB) | Number of ED visits per 1,000 member months | 58.30 |
| Inpatient discharges per 1,000 member months – Total inpatient | HEDIS (IPU) | Number of acute inpatient discharges per 1,000 member months | 7.10 |
Efficiency Metrics for Family Organizations
| Core Metric | Source | Description | Threshold |
|---|---|---|---|
| Ambulatory care - ED visits per 1,000 member months | HEDIS (AMB) | Number of ED visits per 1,000 member months | 48.00 |
| Inpatient discharges per 1,000 member months – Total inpatient | HEDIS (IPU) | Number of acute inpatient discharges per 1,000 member months | 4.95 |
Efficiency Metrics for Pediatric Organizations
| Core Metric | Source | Description | Threshold |
|---|---|---|---|
| Ambulatory care - ED visits per 1,000 member months | HEDIS (AMB) | Number of ED visits per 1,000 member months | 37.00 |
| Inpatient discharges per 1,000 member months – Total inpatient | HEDIS (IPU) | Number of acute inpatient discharges per 1,000 member months | 1.50 |