Core 5.1 Model | Population Health | hccprofile

hccprofile

The hccprofile table represents a roll-up of all diagnosis data for a person from all data sources into Hierarchical Condition Categories (HCCs) as specified by the CMS RAPS risk adjustment algorithm.

Each row in the table summarizes one HCC that has been coded for a person at any time in their health history. Columns describe the first detected diagnosis for the condition, the date of the most recent diagnosis, as well as administrative status (defined by the RAPS algorithm) and the numeric weight used to compute the current risk score. These properties are also useful for detecting conditions related to chronic diagnoses that have not been coded recently; such conditions may represent a coding or care management opportunity.

A person that does not have ICD10 or ICD9 coded diagnoses that are contained within any HCC value sets will have zero rows in this table.

The rows in the hccprofile table are computed using coded diagnoses from all sources consolidated in the condition table.

Usage

This table is useful to understand the overall disease load of a person or population. It can be used to construct disease registries, break down utilization by specified sets of conditions, or identify patients with multiple chronic conditions.

Use the ceriskscore table (which is computed using these HCC profiles) for a simplified representation of the computed risk score.

Use the personhcc table for a pivoted representation of HCC profiles. In this table, each row represents a person with a column for each HCC.

Use the ccsprofile table for a similarly structured representation of a person’s conditions using the CCSR algorithm.

Source Concepts

HIEBus problem (encounter) consolidated in condition
HIEBus claimproblem (claim) consolidated in condition

Table Schema

Name	Type	Description
personid	VARCHAR(38) (GUID)	Unique identifier representing a unique person that may include data from several sources that have been linked. This identifier is the person_id of a HIEBus recordgroup.
hcc	INTEGER	The number of the HCC. For example “19” for a row representing “Diabetes without Complication”.
condition	VARCHAR	The description of the represented condition, for example: “Diabetes without Complication”.
mostrecentevent	TIMESTAMP	The date (in any care setting; from EHR or claims data) of the most recent ICD9 or ICD10 code related to the HCC for the personid.
firstevent	TIMESTAMP	The date (in any care setting; from EHR or claims data) of the earliest ICD9 or ICD10 code related to the HCC for the personid.
dayssincelastevent	INTEGER	The number of days between today and the mostrecentevent.
status	VARCHAR	Values in this field: ‘Active’: dayssincelastevent <= 365 days ‘Inactive’: dayssincelastevent > 365 days and ischronic=FALSE (none of the diagnosis codes that roll up to this HCC do represent chronic disease per HCUP CCI) ‘Unmanaged’: dayssincelastevent > 365 days and ischronic=TRUE (one or more of the diagnosis codes that roll up to this HCC represent a chronic disease per HCUP CCI) ‘Superseded’: if the person has an status=Active conditionprofile that overrides this conditionprofile per the condition hierachy specified by the alogrithm’
ischronic	BOOLEAN	TRUE if one or more of the the historical diagnoses (from any source and any date) is tagged Chronic by the HCUP Chronic Condition Indicator algorithm, described here
riskadjustmentmodel	VARCHAR	The algorithm used to specify HCCs, their value sets, and their weights. For example: CMS-HCC Part C v23
riskadjustmentsegment	VARCHAR	The beneficiary group for the person, used to determine the coefficient assigned to the HCC. For example: New Enrollee, Continuing Enrollee, Disabled, etc.
coefficient	DECIMAL	The numeric weight assigned to this HCC by the RAPS algorithm. Coefficients for status=Active HCCs are summed to determine the condition component of the HCC Score. Coefficients for status=Unmanaged HCCs are summed to determine the condition component of the Unmanaged Score.

Back to Tables