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 Insight API Overview for general principles that apply to all Insight API operations.
Contents
Inputs and Outputs
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 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
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.
Example
Try out the operations, with examples, in the Rosetta 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 one of the Quickstart Tools, 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)
}
}
]
}