Dimensional Warehouse Model Data Model

Entity

Entity HHS Risk Corridor Analysis

Description

The temporary risk corridor program is designed to protect against uncertainty in rate setting for Qualified Health Plans (QHP) by limiting the extent of issuers financial losses and gains. This program compares the total allowable medical costs for a QHP (excluding non-medical or administrative costs) to those projected or targeted by the QHP. If a QHP's target is within three percentage points of 100 percent, the plan keeps all gains (or losses) for itself. For the next five percentage points, gains (or losses) are shared 50/50 between the QHP and the government. Beyond that (either below 92 percent or above 108 percent), the QHP keeps 20 percent of gains (or losses), ceding the remaining 80 percent to the government.

Attributes
Administrative Costs Excluding Taxes
After Tax Premium Earned
Allowable Administrative Costs
Allowable Costs
Calendar Dk
Claim Amount Subject To Reinsurance Payment
Claim Costs
Claim Dk
Claims Sum Amount
Condition Dk
Coverage Agreement Dimension Dk
Diagnosis Code Dk
Expenses To Implement Healthcare Information Technology
Expenses To Implement Wellness & Health Promotion
Expenses To Improve Healthcare Quality
Expenses To Improve Health Care Quality
Expenses To Improve Health Outcomes
Expenses To Improve Patient Safety
Expenses To Prevent Hospital Readmissions
Experience Rating Refunds
Experience Rating Refunds And Reserves For Experience Rating Refunds
Federal And State Tax
Geographic Area Dk
Health Plan Group Dk
Health Plan Product Dk
HHS Risk Corridor Target Amount
IBNR Reserve Amount
Increase In Reserve Amounts
Individual Risk Score
Licenses & Regulatory Fees
MLR Incurred Claims As Of 31 March
Net Healthcare Receivables
Non-Claim Costs
Number Of Members
Outstanding Claims Reserve Amount
Person Dk
Plan Average Risk Score
Plan Member Dk
Plan Risk Corridor Loss
Practitioner Dk
Premiums Earned
Provider Dk
Qualified Health Plan Risk Corridor Payment From Government
Qualified Health Plan Risk Corridor Payment To Government
Reinsurance Payment Amount
Reserves For Experience Rating Refunds
Risk Adjustment Payment
Risk Corridor Qualified Health Plan Profits
Risk Corridor Ratio
Risk Ratio Percentage Difference
Target amount subject to 20% fee
Target amount subject to 50% fee
Target amount subject to 80% fee
Total Claim Payment Amount
Total Incentive Payments
Wellness And Change In Member Behavior And Conditions Expenses
Wellness And Health Promotion Quality Reporting Expenses
Wellness Assessments Expenses
Wellness Chronic Disease Coaching Expenses
Wellness Health Information Technology Support Expenses
Wellness Lifestyle Coaching Expenses
Wellness Public Health Education Expenses
Wellness Rewards And Incentives Expenses

Relationship
HHS Risk Corridor Analysis_Calendar Dimension_FK
HHS Risk Corridor Analysis_Geographic Area Dimension_FK
HHS Risk Corridor Analysis_Plan Member Dimension_FK
HHS Risk Corridor Analysis_Person Dimension_FK
HHS Risk Corridor Analysis_Condition Dimension_FK
HHS Risk Corridor Analysis_Diagnosis Code Dimension_FK
HHS Risk Corridor Analysis_Claim Dimension_FK
HHS Risk Corridor Analysis_Provider Dimension_FK
HHS Risk Corridor Analysis_Practitioner Dimension_FK
HHS Risk Corridor Analysis_Health Plan Group Dimension_FK
HHS Risk Corridor Analysis_Health Plan Product Dimension_FK
HHS Risk Corridor Analysis_Coverage Agreement Dimension_FK

Primary Key
HHS Risk Corridor Analysis PK

Dependencies
NONE

Reverse Dependencies

Attribute Details

Administrative Costs Excluding Taxes

Description	Administrative costs are non-claim costs excluding taxes and fees. Formula: [A-B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

After Tax Premium Earned

Description	Premiums earned minus taxes. Formula: [A-B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Allowable Administrative Costs

Description	The sum of the administrative costs other than taxes plus profits earned by the qualified health plan which sum is limited to 20 percent of after tax premiums earned by the qualified health plan plus taxes. For example: The administrative cost is €35, the calculated profit is €10, the tax is €15, 20% of after tax premium is €37. Based on the formula the calculation would be: (€35 + €10), limited to 20% of after tax premium which is €37 plus taxes €15. €45 limited to €37 plus taxes €15. €37 plus €15. €52 is the allowable administrative cost. Formula: [(A+B) limited to 20% of C (+D)] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Allowable Costs

Description	The sum of claims costs, health quality related expenses and health information technology expenses. Formula: [A+B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Calendar Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Claim Amount Subject To Reinsurance Payment

Description	Sum amount of claims where the member's claim amount is over the attachment point and under the reinsurance cap. This is the amount that is subject to the reinsurance payment calculations. A member may have multiple claims which must be summed up to determine if the total amount is to be included in this figure. (Claim sum amount under the attachment point + Claim sum amount over the reinsurance payment)=Claim Amount Subject To Reinsurance Payment
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Claim Costs

Description	The sum of Incurred Claims As Of 31 March + IBNR Reserve Amount + Reinsurance payment amount + Risk Adjustment Amount. Formula: [A+B+C+D] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Claim Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Claims Sum Amount

Description	The sum amount for claims for all members. This figure can include multiple claim amounts from the same member.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Condition Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Coverage Agreement Dimension Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Diagnosis Code Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Expenses To Implement Healthcare Information Technology

Description	Expenses incurred by the insurer to implement Health Information Technology (HIT) that is attributable to improving healthcare and wellness. These may include expenses related to: - improving health care - preventing hospital readmissions - improving patient safety and reducing errors - promoting health activities and wellness to an individual or an identified segment of the population - HIT implemented to control or contain costs for example to improve claim processing should not be considered as a quality improving activities
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Expenses To Implement Wellness & Health Promotion

Description	Expenses incurred by the insurer to implement wellness and health promotion activities. These are: (1) designed to improve health quality (2) designed to increase the likelihood of desired health outcomes in ways that are capable of being objectively measured and of producing verifiable results and achievements (3) directed toward individual enrollees or incurred for the benefit of specified segments of enrollees or provide health improvements to the population beyond those enrolled in coverage as long as no additional costs are incurred due to the non-enrollees (4) grounded in evidence based medicine, widely accepted best clinical practice, or criteria issued by recognized professional medical associations, accreditation bodies, government agencies or other nationally recognized health care quality organizations Formula: [A+B+C+D+E+F+G+H] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Expenses To Improve Healthcare Quality

Description	Expenses incurred by the insurer in order to improve Health Care Quality for the enrollee.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Expenses To Improve Health Care Quality

Description	Expenses incurred by the insurer in order to improve Health Care Quality for the enrollee. Formula: [A+B+C+D+E] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Expenses To Improve Health Outcomes

Description	Expenses incurred by insurer to improve health outcomes. These include the implementation of activities such as: - quality reporting - effective case management - care coordination - chronic disease management - medication and care compliance initiatives (including through the use of the medical homes model)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Expenses To Improve Patient Safety

Description	Expenses incurred by the insurer to implement activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence-based medicine and health information technology under the plan or coverage.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Expenses To Prevent Hospital Readmissions

Description	Expenses incurred by the insurer to implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge. These activities include: - patient-centered education and counseling - comprehensive discharge planning - post discharge reinforcement by an appropriate health care professional
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Experience Rating Refunds

Description	Experience rating refunds are retrospective premium adjustments arising from retrospectively rated contracts
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Experience Rating Refunds And Reserves For Experience Rating Refunds

Description	Experience rating refunds are retrospective premium adjustments arising from retrospectively rated contracts. Formula: [A+B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Federal And State Tax

Description	Federal taxes as all Federal taxes and assessments allocated to health insurance coverage excluding Federal income taxes on investment income and capital gains. State taxes and assessments that must be separately identified and reported to the Secretary include: Any industry-wide (or subset) assessments (other than surcharges on specific claims) paid to the State directly, or premium subsidies that are designed to cover the costs of providing indigent care or other access to health care throughout the State; advertising required by law, regulation or ruling, except advertising associated with investments; State income, excise, and business taxes other than premium taxes; State premium taxes plus State taxes based on policy reserves, if in lieu of premium taxes; State sales taxes, if the issuer does not exercise the option of including such taxes with the cost of goods and services purchased; and any portion of commissions or allowances on reinsurance assumed that represents specific reimbursement of premium taxes.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Geographic Area Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Health Plan Group Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Health Plan Product Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

HHS Risk Corridor Target Amount

Description	The target amount is defined as premiums earned reduced by allowable administrative costs. Formula: [A-B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

IBNR Reserve Amount

Description	The incurred but not reported (IBNR) reserve amount is an amount that is set aside to meet the cost of claims that have been incurred but have not yet been reported to the health plan organization.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Increase In Reserve Amounts

Description	The total increase in reserves for outstanding claims and IBNR claims during the reference period. Formula: [Min((A end of the period - A start of the period), 0) + Min((B end of the period - B start of the period), 0)] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Individual Risk Score

Description	This is the figure calculated using the risk adjustment model embedded in a Risk Adjustment System (RAS). Information such as age, sex and diagnosis or diagnosis group such as Hierarchical Condition Category (HCC) is used for this calculation.
Data Type	Standards - Data Domains.ddm/Data Domains/Number Decimal [DECIMAL(10,4)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Licenses & Regulatory Fees

Description	Licenses & regulatory fees paid by the insurer as part of doing business in the state
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

MLR Incurred Claims As Of 31 March

Description	Medical loss included in paid and unpaid claims at 31 March of the year following the reporting year. Calculation is based on: - incurred claims is the sum of direct paid claims incurred in the MLR reporting year - unpaid claim reserves associated with claims incurred during the MLR reporting year - the change in contract reserves - reserves for contingent benefits - the claim portion of lawsuits - any experience rating refunds paid or received Formula: [A+B+C+D+E+F-G] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Net Healthcare Receivables

Description	The change in amount of receivables.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Non-Claim Costs

Description	Non-claim costs are expenses for administrative services that do not constitute adjustments to premium revenue, reimbursement for clinical services to enrollees or expenditures on quality improvement activities. For example: Direct sales salaries, workforce salaries and benefits. Agents and brokers fees and commissions.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Members

Description	The total count of members or total number of people who are enrolled in a healthcare plan during the period of analysis.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Outstanding Claims Reserve Amount

Description	A provision made by the Health Plan Organization for future claim payments for claims received and reported but not yet adjudicated. That is, the current best estimate of the ultimate value of losses that will be paid in the future, for known claims.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Person Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Plan Average Risk Score

Description	This is the average average risk score for a qualified health plan. This figure is used to analyze member's individual risk score against the plan average. Formula: [A/B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Number Decimal [DECIMAL(10,4)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Plan Member Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Plan Risk Corridor Loss

Description	This is the calculated loss for the Qualified Health Plan(QHP). It is the payment to the government from the QHP and is based on a percentage of the target amount. Depending on the Risk Corridor Ratio, there are up to 3 rules to be used when calculating this figure: Rule 1: Where the Risk Corridor Ratio is between 100% to 103%, calculate 0% x 3% = X% Rule 2: Where the Risk Corridor Ratio is between 103% to 108%, calculate 50% of Risk Ratio Percentage Difference = Y% Rule 3: Where the Risk Corridor Ratio is greater that 108%, calculate 20% of Risk Ratio Percentage Difference = Z% Total percentage (X%+Y%+Z%) x Target Amount Formula: [((A20)/100) + ((B50)/100) +((C*80)/100)] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Practitioner Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Premiums Earned

Description	It is the sum of all monies paid by a policyholder as a condition of receiving coverage from a health insurance issuer.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Provider Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Qualified Health Plan Risk Corridor Payment From Government

Description	This is the calculated gain for the Qualified Health Plan(QHP). It is the payment from the government to the QHP and is based on a percentage of the target amount. Depending on the Risk Corridor Ratio, there are up to 3 rules to be used when calculating this figure: Rule 1: Where the Risk Corridor Ratio is between 100% to 103%, calculate 0% x 3% = X% Rule 2: Where the Risk Corridor Ratio is between 103% to 108%, calculate 50% of Risk Ratio Percentage Difference = Y% Rule 3: Where the Risk Corridor Ratio is greater that 108%, calculate 80% of Risk Ratio Percentage Difference = Z% Total percentage (X%+Y%+Z%) x Target Amount For example: The Risk Corridor Ratio for a Qualified Health Plan (QHP) is 110%. The QHP Risk Corridor Payment from the Government can be calculated as follows: - Corridor 1: 100% to 103% 0% x 3% = 0% - Corridor 2: 103% to 108% 50% x 5% = 2.5% - Corridor 3: 108%+ 80% x 2% = 1.6% Total = 4.1% of Target Amount Formula: Total percentage (X%+Y%+Z%) x Target Amount (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Qualified Health Plan Risk Corridor Payment To Government

Description	This is the calculated loss for the Qualified Health Plan(QHP). It is the payment to the government from the QHP and is based on a percentage of the target amount. Depending on the Risk Corridor Ratio, there are up to 3 rules to be used when calculating this figure: Rule 1: Where the Risk Corridor Ratio is between 97% to 100%, calculate 0% x 3% = X% Rule 2: Where the Risk Corridor Ratio is between 92% to 97%, calculate 50% of Risk Ratio Percentage Difference = Y% Rule 3: Where the Risk Corridor Ratio is less that 92%%, calculate 80% of Risk Ratio Percentage Difference = Z% Total = Total Percentage (X%+Y%+Z%) x Target Amount For example: The Risk Corridor Ratio for a Qualified Health Plan (QHP) IS 90.0%. The QHP Risk Corridor Payment to Government can be calculated as follows: - Corridor 1: 97% to 100% 0% x 3 % = 0%, - Corridor 2: 92% to 97% 50% x 5% = 2.5% - Corridor 3: below 92% 80% x 2% = 1.6% - Total = 4.1% of Target Amount
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Reinsurance Payment Amount

Description	The amount payable to the healthcare plan organization. This is based on the amount subject to reinsurance extended by a reinsurance rate. As of 2013 the applicable reinsurance rate is set at 80% Formula: f[A] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Reserves For Experience Rating Refunds

Description	Reserves allocated for Experience Rating Refunds, for retrospective premium adjustments and claim law suites.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Risk Adjustment Payment

Description	This is the payment figure calculated using the risk adjustment model embedded in a Risk Adjustment System (RAS). This could be a net benefit or liability to the health plan organization.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Risk Corridor Qualified Health Plan Profits

Description	Profits are defined as the greater of either: 3% of after tax premiums earned or Premiums earned by the health plan minus the sum of allowable costs and administrative costs of the same health plan. Formula: [A-(B+C)] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Risk Corridor Ratio

Description	The comparison of allowable costs against a target amount. Allowable costs are essentially claim costs plus various adjustments, including adjustments for the other two Rs and quality and health information technology costs. The target amount is essentially premium less allowable administrative (non-claim) costs, where the administrative costs include a certain allowance for profit. If the ratio of these amounts is greater than one, then the premium was less than what was required, and if the ratio is less than one, then the premium was more than what was required. Formula: [A/B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Risk Ratio Percentage Difference

Description	The difference between the risk ratio percentage and the nearest relevant percentage on the scale. The percentage parameters scale defined as part of the risk corridor program is as follows: (--------92%--97%--100%--103%--108%--------) For example: Risk Corridor Ratio is 106%. Therefore, the risk ratio percentage difference is 108% - 106% = 2% Risk Corridor Ratio is 90.4%. Therefore, the risk ratio percentage difference is 92% - 90.4% = 1.6%
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Target amount subject to 20% fee

Description	It is the QHP's gain or payment to the Government and is based on a percentage of the target amount. Calculation Rules: If the Risk Corridor Ratio is greater than 108% or less than 92%, calculate 20% of the Risk Ratio Percentage Difference = X%. Multiple Target Amount by X%.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Target amount subject to 50% fee

Description	This is the calculated gain or loss for the Qualified Health Plan(QHP). It is a fee or payment that the QHP from the government and is based on a percentage of the target amount. Calculation Rules: If the Risk Corridor Ratio is between 103% to 108% or 92% to 97% calculate 50% of the Risk Ratio Percentage Difference = X%. Multiple Target Amount by X%.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Target amount subject to 80% fee

Description	It is the payment to the QHP or Government and is based on a percentage of the target amount. Calculation Rules: If the Risk Corridor Ratio is greater than 108% or less than 92%, calculate 80% of the Risk Ratio Percentage Difference = X%. Multiple Target Amount by X%.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Total Claim Payment Amount

Description	The total amount of claim payments made to healthcare providers.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Total Incentive Payments

Description	The sum of all incentive payments.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Wellness And Change In Member Behavior And Conditions Expenses

Description	Expenses associated with coaching, education programs and health promotion activities designed to change member behavior and conditions. For example: Smoking cessation program Weight loss program to address obesity
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Wellness And Health Promotion Quality Reporting Expenses

Description	Expenses associated with quality reporting and related documentation that are in non-electronic form for wellness and health promotion activities.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Wellness Assessments Expenses

Description	Expenses associated with Wellness assessments of wellness and health promotion initiatives.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Wellness Chronic Disease Coaching Expenses

Description	Expenses associated with Coaching programs designed to educate individuals on clinically effective methods for dealing with a specific chronic disease or condition.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Wellness Health Information Technology Support Expenses

Description	Expenses associated with health information technology to support all the Wellness and Health Promotion activities.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Wellness Lifestyle Coaching Expenses

Description	Expenses associated with Wellness/lifestyle coaching programs designed to achieve specific and measurable improvements.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Wellness Public Health Education Expenses

Description	Expenses associated with public health education campaigns that are performed in association with state or local health departments and agents.
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Wellness Rewards And Incentives Expenses

Description	Expenses associated with and incurred as part of giving rewards, incentives, bonuses, reductions in copayments (excluding administration expenses), that are not already reflected in premiums or claims
Data Type	Standards - Data Domains.ddm/Data Domains/Currency Amount [DECIMAL(14,2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Relationship Details

HHS Risk Corridor Analysis_Calendar Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Calendar Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Geographic Area Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Geographic Area Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Plan Member Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Plan Member Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Person Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Person Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Condition Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Condition Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Diagnosis Code Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Diagnosis Code Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Claim Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Claim Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Provider Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Provider Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Practitioner Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Practitioner Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Health Plan Group Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Health Plan Group Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Health Plan Product Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Health Plan Product Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HHS Risk Corridor Analysis_Coverage Agreement Dimension_FK

Is Identifying Relationship	true
Child Table	HHS Risk Corridor Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Coverage Agreement Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Primary Key Details

HHS Risk Corridor Analysis PK

Key Attribute	Plan Member Dk
Key Attribute	Person Dk
Key Attribute	Condition Dk
Key Attribute	Diagnosis Code Dk
Key Attribute	Claim Dk
Key Attribute	Provider Dk
Key Attribute	Practitioner Dk
Key Attribute	Health Plan Group Dk
Key Attribute	Health Plan Product Dk
Key Attribute	Calendar Dk
Key Attribute	Geographic Area Dk
Key Attribute	Coverage Agreement Dimension Dk

Overview

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Package

Entity

Dimensional Warehouse Model Data Model