Total Cost of Care

Acronym: TCOC

A broad indicator of spending for a given population (i.e., payments from payer to provider organizations). In the context of population-based payment models, in which provider accountability spans the full continuum of care, TCOC includes all spending associated with caring for a defined population, including provider and facility fees, inpatient and ambulatory care, pharmacy, behavioral health, laboratory, imaging, and other ancillary services. Financial benchmarks reflect the TCOC for a given patient population over a given period of time. For the purposes of setting the benchmark, TCOC calculations should only include services covered under the insurance plan, because it would be unreasonable for benchmarks to reflect payments for services that are not covered (e.g., dental services).