adult_rxc_hcc_inter

A dataset containing the adult model RXC/HCC interaction factors for the
risk adjustment model. Some HCCs have built-in risk for the associated
drugs, so if a member has both the diagnosis and the drug, their risk is
overstated. Other drugs combined with conditions indicate a greater severity
than either the drug or the condition alone, so risk is understated. The
RXC/HCC interaction factors make these adjustments.

datasets

Datasets from most recent CCIIO DIY entry
in a tidy format. These support the Centers for Medicare and Medicaid
Services' (CMS) risk adjustment Do-It-Yourself (DIY) process, which allows
health insurance issuers to calculate member risk profiles under the Health
and Human Services-Hierarchical Condition Categories (HHS-HCC) regression
model. This regression model is used to calculate risk adjustment transfers.
Risk adjustment is a selection mitigation program implemented under the
Patient Protection and Affordable Care Act (ACA or Obamacare) in the USA.
Under the ACA, health insurance issuers submit claims data to CMS	in order
for CMS to calculate a risk score under the HHS-HCC regression model.
However, CMS does not inform issuers of their average risk score until after
the data submission deadline. These data sets can be used by issuers to
calculate their average risk score mid-year. More information about risk
adjustment and the HHS-HCC model can be found here:
<https://www.cms.gov/mmrr/Articles/A2014/MMRR2014_004_03_a03.html>.

Ethan Brockmann

edgedata

Datasets that Support the EDGE Server DIY Logic

adult_rxc_hcc_inter function

An object of class <code>tbl_df</code> (inherits from <code>tbl</code>, <code>data.frame</code>) with
32 rows and 8 columns<dl class="dl-horizontal">
<dt>used</dt><dd>Whether or not the category is used in the RA model</dd>
<dt>plat, gold, silver, bronze, cat</dt><dd>HCC grouping risk score for each
metal level</dd>
<dt>rxc</dt><dd>RXC label for risk scores (Includes leading zeroes)</dd>
<dt>hcc</dt><dd>HCC label for risk scores (Includes leading zeroes)</dd>
</dl>

Format

Adult RXC/HCC Interaction Factors - Table 9 — adult_rxc_hcc_inter

An object of class <code>tbl_df</code> (inherits from <code>tbl</code>, <code>data.frame</code>) with
32 rows and 8 columns<dl class='dl-horizontal'>
<dt>used</dt><dd>Whether or not the category is used in the RA model</dd>
<dt>plat, gold, silver, bronze, cat</dt><dd>HCC grouping risk score for each
metal level</dd>
<dt>rxc</dt><dd>RXC label for risk scores (Includes leading zeroes)</dd>
<dt>hcc</dt><dd>HCC label for risk scores (Includes leading zeroes)</dd>
</dl>

adult_rxc_hcc_inter: Adult RXC/HCC Interaction Factors - Table 9

Description

Usage

Arguments

Format

See Also