CMS-HCCs

CMS-HCC is the risk adjustment model used by CMS. Analyzing risk scores based on the output of this model is an important use case for value-based care analytics.

Average CMS-HCC Risk Scores

select
    count(distinct patient_id) as patient_count
    , avg(blended_risk_score) as average_blended_risk_score
    , avg(normalized_risk_score) as average_normalized_risk_score
    , avg(payment_risk_score) as average_payment_risk_score
from cms_hcc.patient_risk_scores

Average CMS-HCC Risk Scores by Patient Location

select
      patient.state
    , patient.city
    , patient.zip_code
    , avg(risk.payment_risk_score) as average_payment_risk_score
from cms_hcc.patient_risk_scores as risk
    inner join core.patient as patient
        on risk.patient_id = patient.patient_id
group by
      patient.state
    , patient.city
    , patient.zip_code;

Distribution of CMS-HCC Risk Factors

select
      risk_factor_description
    , count(*) as total
    , cast(100 * count(*)/sum(count(*)) over() as numeric(38,1)) as percent
from cms_hcc.patient_risk_factors
group by risk_factor_description
order by 2 desc

Risk Weighted by Member Months

select sum(payment_risk_score_weighted_by_months) / sum(member_months) as weighted_risk_total
from cms_hcc.patient_risk_scores;

Stratified CMS-HCC Risk Scores

select
      (select count(*) from cms_hcc.patient_risk_scores where payment_risk_score <= 1.00) as low_risk
    , (select count(*) from cms_hcc.patient_risk_scores where payment_risk_score = 1.00) as average_risk
    , (select count(*) from cms_hcc.patient_risk_scores where payment_risk_score > 1.00) as high_risk
    , (select avg(payment_risk_score) from cms_hcc.patient_risk_scores) as total_population_average;

Top 10 CMS-HCC Conditions

select
      risk_factor_description
    , count(*) patient_count
from cms_hcc.patient_risk_factors
where factor_type = 'Disease'
group by risk_factor_description
order by count(*) desc
limit 10;