Adjusted Plan Risk ScoreCalendar DkDiagnosis Code DkGeographic Area DkHealth Plan Group DkHealth Plan Product DkMember Risk ScoreNumber Of MembersPerson DkPlan Average Risk ScorePlan Member DkRisk Adjustment PaymentRisk Adjustment Ratio
| Dimensional Warehouse Model Data Model |
| Description | The risk adjustment program is intended to provide increased payments to healthcare plan organizations that attract higher-risk populations and reduce the incentives for issuers to avoid higher-risk enrollees. Funds are transferred from organizations with lower-risk enrollees to organizations with higher-risk enrollees. The risk adjustment methodology includes a risk adjustment model, a determination of plan average actuarial risk, and a calculation of payments and charges. A model is used to predict health care costs based on the relative actuarial risk of enrollees in risk adjustment Qualified Healthcare Plans (QHP). The model will calculate an average risk score for each QHP based upon the relative risk scores of the plan’s enrollees, and apply a payment transfer formula in order to determine risk adjustment payments and charges between plans within a risk pool within a market within a State. |
| Primary Key | |
 HHS Risk Adjustment Analysis PK |
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| Dependencies | |
 NONE |
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| Reverse Dependencies | |
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| Attribute Details |
Adjusted Plan Risk Score
| Description | Adjustments to plan average risk score. This figure is calculated using the risk adjustment model embedded in a Risk Adjustment System (RAS). Normalization, AV Adjustment and Rating Adjustments are applied to the plan average risk score. Actuarial Value (AV)Differences: Risk scores must be adjusted to remove the impact of AV on predicted plan liability. Normalization: RA model is based on a national sample. Risk scores must be adjusted to account for State differences in predicted liability. A State-specific adjustment must be applied to risk scores to account for the difference between the State average predicted cost and the average predicted cost in the model sample. |
| 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 |
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 |
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 |
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 |
Member 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 |
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 |
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 |
Risk Adjustment Payment
| Description | This is the payment figure calculated using the risk adjustment model embedded in a Risk Adjustment System (RAS). |
| 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 Ratio
| Description | The program compares individual risk scores against the plan average risk score to determine if a member is above or below the average which may indicate an expected profit or loss. 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 |
| Relationship Details |
HHS Risk Adjustment Analysis_Calendar Dimension_FK
| Is Identifying Relationship | true |
| Child Table | HHS Risk Adjustment 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 Adjustment Analysis_Geographic Area Dimension_FK
| Is Identifying Relationship | true |
| Child Table | HHS Risk Adjustment 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 Adjustment Analysis_Person Dimension_FK
| Is Identifying Relationship | true |
| Child Table | HHS Risk Adjustment 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 Adjustment Analysis_Plan Member Dimension_FK
| Is Identifying Relationship | true |
| Child Table | HHS Risk Adjustment 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 Adjustment Analysis_Diagnosis Code Dimension_FK
| Is Identifying Relationship | true |
| Child Table | HHS Risk Adjustment 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 Adjustment Analysis_Health Plan Group Dimension_FK
| Is Identifying Relationship | true |
| Child Table | HHS Risk Adjustment 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 Adjustment Analysis_Health Plan Product Dimension_FK
| Is Identifying Relationship | true |
| Child Table | HHS Risk Adjustment 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 |
| Primary Key Details |
HHS Risk Adjustment Analysis PK
| Key Attribute | Person Dk |
| Key Attribute | Plan Member Dk |
| Key Attribute | Diagnosis Code Dk |
| Key Attribute | Health Plan Group Dk |
| Key Attribute | Health Plan Product Dk |
| Key Attribute | Calendar Dk |
| Key Attribute | Geographic Area Dk |
| Dimensional Warehouse Model Data Model |