Understanding Network Leakage

What is Leakage?

Leakage represents claims for a selected MSSP ACO's where assigned beneficiaries were admitted to a SNF, home health agency or hospital that is not participating in that ACO. For a network you design, leakage will be calculated for the providers you include in your network.

Outpatient or physician professional claims are not included in leakage metrics.

In Mosaic, we calculate leakage percentages based on claim events occurring at an applicable provider not participating in the MSSP ACO or not in your created network. 

We also make a percentile calculation of the selected MSSP ACO’s Network Leakage to the Network Leakage of all other MSSP ACOs to provide a helpful ranking.

Exceptions

If you don't see leakage percentages:

• SNF/HHA/Hospitals with null or insufficient beneficiaries to calculate Network Leakage are excluded in the comparison.
• Unpublished Network Leakage numbers could be due to an MSSP ACO having Physician Groups only (no facilities) or with a facility legal business name given in the ACO Participant list that does not match the organization name given in the NPI registry.

Calculation

Leakage is the percentage of discharges from the selected hospital who are admitted to an out of network organization; HHA, SNF, or hospital. The following formula shows the calculation for the overall metric for the selected provider.

Leakage metrics include admissions to non-network facilities during the one year reporting period represented by the sunburst chart at any subsequent level. (See Understanding Leakage Metrics, below.)

For facilities later in the patient path, the patient count for the denominator can be found in the Path Detail table in the column Discharge Count. The numerator is a bit more tricky because the some of the admissions counts are <11 and can't really be counted. We create an estimate for the numerator from the destination admission we can count and state averages.

So, for our selected slice from the sunburst chart, with home health as the chosen provider type in level 3, we would have a calculation like this:

Where to find Leakage

Network Leakage can be found on the Strategize page.

Getting Started

Since leakage metrics are calculated based on claim events connecting a specific hospital and a network, the following must be true:

• You need to have a network set up in order to define what is inside and what is outside the network. Setting up a network is done on the My Networks page. If you are viewing an ACO, inside and outside are already part of the ACO.
• The hospital selected must be in the same network, or must be part of the ACO.
• You will need to select the network in the dropdown above.

Remember that the patient paths you are able to trace, from level to level represent connections between claim events, discharges and admissions, that take place during the time period you select. When you change the time period, you would expect the leakage percentages to change.

Quick reminder of patient paths

In our example above, we have selected "Home Health" from the third level of the sunburst chart. The patient discharge counts and the calculated leakage are for the provider at the selected level.

Although the column is called "Discharge Count," it is more accurate to think of it as an "Admitted to" count for the chosen provider type at that level. See the comparison.

Compare:

When we choose home health at level 2, we see 503 patients. This means that 503 patients went from the hospital (level 1) into home health (level 2). The leakage is the percentage of those 503 patients who were admitted to home health outside of the selected ACO/network.

In this example, we select home health from level 3. The 134 patients are those who went from the selected hospital (level 1) to any SNF (level 2) and then to home health, level 3. The leakage is the percentage of those 134 patients who were admitted to home health outside of the selected ACO/network.

The table also shows us leakage for the SNF at level 2. The 846 patients were those who went from the hospital (Level 1) to any SNF (level 2). The leakage is the percentage of the 846 patients who were admitted to a SNF outside of the selected ACO/network.

Understanding Leakage Metrics

Back to our Strategize page, let's look at the visible leakage metrics.

This percentage is the leakage for the selected hospital. It is the percentage of discharges admitted to any non-network SNF, home health agency, or hospital at any subsequent level.

This metric is the leakage for the selected network overall. In other words, it includes leakage from every applicable organization in the selected network, not just the hospital selected for viewing on the Strategize page.

This is the leakage percentage for SNFs at level 2 where patients went from the selected hospital to SNF. Leakage is the percent of patients admitted to SNF who were admitted to an out of network SNF.

This is the leakage percentage for home health agencies at level 3 where patients went from the selected hospital to SNF and then to home health. Leakage is the percent of patients admitted to a home health who were admitted to an out of network home health agency.