> For the complete documentation index, see [llms.txt](https://docs.lucernahealth.com/guide/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.lucernahealth.com/guide/consumer-360/consumer-profile/utilization.md).

# Utilization

Top opportunities, encounters and claims. Select any value in the **Source System** column to see where that data originates.

| Section             | Field                                             | What it means                                                                           | Source System                                                 | Badge                                                  |
| ------------------- | ------------------------------------------------- | --------------------------------------------------------------------------------------- | ------------------------------------------------------------- | ------------------------------------------------------ |
| Top Opportunities   | Top Opportunities                                 | Ranked utilization-related actions, such as likely preventable ER use.                  | [Derived in Leap](#top-opportunities-1)                       | The first three are shown; View More reveals the rest. |
| Provider Encounters | Provider Encounters                               | Encounters recorded by the provider organization, with provider, facility and category. | [EMR](#provider-encounters-1)                                 | -                                                      |
| Payer Claims        | Visit count tiles (ER, Inpatient, Outpatient, BH) | Visit counts over the selected window.                                                  | [Payer claims](#visit-count-tiles-er-inpatient-outpatient-bh) | -                                                      |
|                     | Visit Details (timeline and table)                | Individual visits with location, treating provider, diagnosis and network status.       | [Payer claims](#visit-details-timeline-and-table)             | -                                                      |

{% hint style="info" %}
**Why encounter counts and claim counts disagree.** Provider Encounters comes from the EMR and only covers care delivered inside the provider network. Payer claims are complete across in and out of network, but lag 30 to 90 days behind the actual visit.
{% endhint %}

***

### Data Lineage

#### Top Opportunities

<details>

<summary>Top Opportunities</summary>

| Source system                                | Leap table          | UDM source                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |
| -------------------------------------------- | ------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Derived in Leap from claims and model output | `top_opportunities` | consumer\_factors, [`fct_factor`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/phm/fct_factor), care\_gaps, [`fct_quality`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/phm/fct_quality), care\_programs, [`fct_care_program`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/care_program/fct_care_program), [`agg_claim`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/claim/agg_claim), [`fct_med_encounter_procedure`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/claim/fct_med_encounter_procedure), [`fct_appointment`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/appointment/fct_appointment), [`fct_roster`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/roster/fct_roster), [`dim_consumer`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_application/cps/dim_consumer), [`rpt_consumer_latest_insurance`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/cross_domain/rpt_consumer_latest_insurance), assessment\_phq9, assessment\_sdoh, top\_opportunities\_tenant\_config |

</details>

#### Provider Encounters

<details>

<summary>Provider Encounters</summary>

| Source system      | Leap table   | UDM source                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
| ------------------ | ------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
| EMR encounter feed | `encounters` | [`fct_appointment`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/appointment/fct_appointment), [`dim_provider_directory_provider`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_application/provider_directory/dim_provider_directory_provider), [`dim_provider_directory_facility`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_application/provider_directory/dim_provider_directory_facility) |

</details>

#### Payer Claims

<details>

<summary>Visit count tiles (ER, Inpatient, Outpatient, BH)</summary>

| Source system | Leap table | UDM source                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
| ------------- | ---------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Payer claims  | `claims`   | [`fct_med_claim_header`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/claim/fct_med_claim_header), [`fct_med_claim_header_diagnosis`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/claim/fct_med_claim_header_diagnosis), [`dim_provider_directory_provider`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_application/provider_directory/dim_provider_directory_provider), [`dim_provider_directory_facility`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_application/provider_directory/dim_provider_directory_facility) |

</details>

<details>

<summary>Visit Details (timeline and table)</summary>

| Source system | Leap table | UDM source                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
| ------------- | ---------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Payer claims  | `claims`   | [`fct_med_claim_header`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/claim/fct_med_claim_header), [`fct_med_claim_header_diagnosis`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_norm_model/claim/fct_med_claim_header_diagnosis), [`dim_provider_directory_provider`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_application/provider_directory/dim_provider_directory_provider), [`dim_provider_directory_facility`](https://sanitas.leap.lucernahealth.com/data-hub/data-model/catalog-overview/leap_application/provider_directory/dim_provider_directory_facility) |

</details>