P1Model performance
Circle of Care Model Performance
Are we engaging the right members and keeping them connected to care?
Reporting period
Last 30 days
Filters
Now
Current COC Population
Who is in the model right now, and where do they stand?
COC panel
11,017
+182 this month
Critical risk
1,204
11% of panel
High risk
3,480
32% of panel
Care pathway
7,940
72% eligible
TOC pathway
258
2% eligible
Care Pathway Waterfall — All Regions
Current period · Blue line = target100%
7,940
Care Pathway Eligible Members
78%
6,210
Attempted (Outreach)
78%
4,860
Reached Family Members
78%
3,810
FM with NP Visit Scheduled
85%
3,240
FM with NP Visit Completed
77%
2,480
FM Engaged in Pathway
Care Pathway Calculation
All Regions| Care pathway stage | % of prior | % of first | Members | Target |
|---|---|---|---|---|
| Care Pathway Eligible Members | — | 100% | 7,940 | — |
| Attempted (Outreach) | 78% | 78% | 6,210 | 90% |
| Reached Family Members | 78% | 61% | 4,860 | 82% |
| FM with NP Visit Scheduled | 78% | 48% | 3,810 | 80% |
| FM with NP Visit Completed | 85% | 41% | 3,240 | 85% |
| FM Engaged in Pathway | 77% | 31% | 2,480 | 78% |
Region by Region Comparison
Conversion rates by stage · % first, members in parentheses| Region | Eligible | Attempted | Reached | NP Visit Scheduled | NP Visit Completed | Engaged in Pathway |
|---|---|---|---|---|---|---|
| Northeast | 2,620 | 81%(2,111) | 81%(1,701) | 81%(1,372) | 85%(1,166) | 79%(918) |
| Southeast | 2,144 | 75%(1,615) | 75%(1,215) | 75%(914) | 85%(778) | 73%(570) |
| Midwest | 1,747 | 78%(1,366) | 78%(1,069) | 78%(838) | 85%(713) | 77%(546) |
| West | 1,429 | 78%(1,118) | 78%(875) | 78%(686) | 85%(583) | 77%(446) |
Care Pathway Waterfall Metric Definitions
Source systems per definition sheet| Metric | Definition | Supporting system |
|---|---|---|
| Care Pathway Eligible Members | Unique count of family members identified for care pathway | CinqDB |
| Attempted (Outreach) | Unique count of family members that have had one or more outreach attempt | Medent & CINQIQ |
| Reached Family Members | Unique count of family members successfully reached by any method at least one time | Medent & CINQIQ |
| FM with NP Visit Scheduled | Unique count of FMs with NP visit scheduled since Jan 1, 2026 to current date and looking ahead 30 days | Medent |
| FM with NP Visit Completed | Unique count of FMs with NP visit completed since Jan 1, 2026 (any visit type) | Medent |
| FM Engaged in Pathway | Unique count of FMs enrolled in care journey with minimum 2 visits with a clinical team member (RN or NP), one within the last 30 days | Medent |
Cohort Health & Tenure
Current panel composition182
New
41
Re-entered
Exited
96
74%
71 members
Attrition
26%
25 members
Deceased
1,440
13%
< 30 days
3,210
29%
1–3 months
2,880
26%
4–6 months
3,487
32%
7+ months