POST /insight/v1/riskprofile
This operation computes an HCC Risk Adjustment Profile for the provided patient. It also provides monthly risk scores to enable trending. Data is processed in accordance with the Da Vinci Risk Adjustment Implementation Guide.
See the Programming Guide for general principles that apply to all Insight API operations.
Contents
The input for this operation is FHIR R4 Bundle containing data for a single patient.
The output is a new FHIR R4 Bundle containing:
The version of hierarchical condition category (HCC) risk adjustment model. Must be one of: 22 (default), 23, 24.
The end date for the calculation period, in YYYY-MM-DD format. Default is the last day of the current month.
Risk adjustment segment to be used in the calculations. One of: community nondual aged
(default), community full benefit dual aged
, community full benefit dual disabled
, community nondual disabled
, long term institutional
.
FHIR Bundles are verbose, so the output below just shows a small sample to illustrate how the data is structured. For a more complete example, try out the API in the Developer Portal Sandbox, or refer to the FHIR Specification.
{
"resourceType": "Bundle",
"type": "searchset",
"entry": [
{
"resource": {
"resourceType": "Patient",
... (patient fields)
}
},
{
"resource": {
"resourceType": "Measure",
"title": "Risk Adjustment Model Version 22 - CMS Hierarchical Category Condition (CMS-HCC)",
... (CMS risk model fields)
}
},
{
"resource": {
"id": "2db67503-e347-4933-8919-5d8469957a4f",
"resourceType": "MeasureReport"
... (HCC categories for diagnoses)
}
},
{
"resource": {
"id": "16b2f479-a15a-4414-87f5-fb2631e80917",
"resourceType": "RiskAssessment"
... (monthly risk scores)
}
}
{
"resource": {
"resourceType": "OperationOutcome",
"issue": [
... (any processing issues)
}
}
]
}