Population Health
South Carolina — spend composition and condition signals derived from provider billing
Provider-level proxy, not patient-level data.
These views are derived from provider billing aggregates (T-MSIS claims summaries), not member-level records. Beneficiary counts are claim-line service events per provider — one person seen by three providers counts three times. Spend buckets are assigned from procedure codes and provider types, not diagnoses. Treat these as directional signals; true cohorts, utilization rates, and outcomes require the patient-level data your agency already holds.
Monthly Spend by Service Bucket
Predictable Condition Cohorts
What your internal data would add
- Patient-level cohorts: unduplicated member counts and true condition prevalence, instead of provider service events.
- Real clinical values: actual A1C results and lab trends — control rates instead of test-utilization proxies.
- Case-management lists: named members overdue for monitoring, exportable directly to care teams.
- Longitudinal & survival analysis: disease progression, readmission, and cost trajectories across eligibility spans.