Insight - Risk Profile

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

Inputs and Outputs
Query Parameters
Processing Notes
- Input Resources
- Resource IDs
Example

Inputs and Outputs

The input is a FHIR R4 Bundle containing data for a single patient. If a resource in the input bundle references a patient other than the single patient resource in the bundle, that resource will not be included in the calculations of the derived data.

The output is a new FHIR R4 Bundle of type collection containing:

The original Patient resource from the input bundle.
A Measure resource containing the CMS Hierarchical risk adjustment model.
A MeasureReport resource a roll-up of patient’s diagnosis data into Hierarchical Condition Categories (HCCs).
A RiskAssessment resource showing monthly risk scores to enable trending.
An OperationOutcome resource detailing the results (including warnings or errors) of the conversion process. OperationOutcomes from the input bundles are not carried forward.

Query Parameters

hcc_version integer

The version of hierarchical condition category (HCC) risk adjustment model. Must be one of: 22 (default), 23, 24.

period_end_date string

The end date for the calculation period, in YYYY-MM-DD format. Default is the last day of the current month.

ra_segment

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.

Processing Notes

See the Programming Guide for general principles that apply to all Insight API operations.

Input Resources

The Risk Profile operation only examines the following FHIR resources as part of the input bundle. All other resources will be skipped:

Patient
Condition
Encounter
Procedure
Medication
Observation

Resource IDs

The operation will generate unique logical IDs for all new resources that were generated to describe the derived data concept. The returned patient resource will retain its input resource id.

Resources within a bundle may refer to other resources within the same bundle (e.g. a MeasureReport referencing a Patient/{ID}). The Insight API is stateless, and different requests are considered independent of one another. Submitting the same input information to the API multiple times will result in different logical ID elements being generated for the equivalent input concept.

Example

Try It
Try out the operations, with examples, in the Developer Portal Sandbox.

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.

Sample Output

{
  "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)
      }
    }
  ]
}