HCC Recapture

What is HCC Recapture?

The HCC recapture data mart enables organizations to track HCCs which have been coded in a collection year and determine if they have been 'recaptured' (the diagnosis has been coded) in the year after the collection year (i.e. the payment year). This is important because:

• It accurately codes the chronic conditions for a patient
• It affects that patient's risk score
• The risk score affects reimbursement for value-based care contracts

This mart not only tracks HCCs which were previously coded, but also automatically includes any suspect HCCs from the suspect HCC mart and flags them using the suspect_hcc_flag.

Additionally, the mart provides recapture rates and a lot of detail into the type of gap closure.

Methods

Code on Github

The HCC recapture data mart identifies gaps for patients who either an HCC coded or are suspected of an HCC in a collection year.

Gap Closure

The type of gap closure if provided using the gap_status field. Here are the gap status definitions based on the hcc_recapture__gap_status model:

Gap Status	Definition
closed using higher coefficient hcc in hierarchy group	An HCC in the same group was closed, but its coefficient is greater than the prior year HCC
closed	The specific HCC in question has been observed in a risk adjustable claim during the collection year
closed using lower coefficient hcc in hierarchy group	An HCC in the same group was closed, but its coefficient is less than the prior year HCC
new	Defined as an HCC that has not been coded in the past 2 years
open	For gaps and claims, it's a chronic condition appropriate for recapture that has not been documented in current collection year
inappropriate for recapture	The specific HCC in question is "Open" and no related/equivalent HCC has been closed, but it is not appropriate for risk adjustment because it's not a chronic diagnosis

Instead of just listing an HCC as closed, more detail is provided which presents an opportunity to improve future HCC recapture initiatives.

Recapture Curves

When calculating HCC gap closure, YTD recapture curves are often used. Recapture curves are supported within this mart and can be built using the hcc_recapture__recapture_rates_monthly_ytd model.

Data Dictionary

All of the models below are the final models output from the HCC recapture data mart.

gap_status

Column Name	Data Type	Primary Key	Description

hcc_status

Column Name	Data Type	Primary Key	Description

recapture_rates

Column Name	Data Type	Primary Key	Description

recapture_rates_monthly

Column Name	Data Type	Primary Key	Description

recapture_rates_monthly_ytd

Column Name	Data Type	Primary Key	Description

Example SQL

Get Data for Recapture Rate Curve

select
      payer
    , payment_year
    , payment_year_month
    , monthly_closed_hccs
    , monthly_open_hccs
    , monthly_total_hccs
    , monthly_recapture_rate
    , ytd_closed_hccs
    , ytd_open_hccs
    , yearly_total_hccs
    , ytd_recapture_rate
from hcc_recapture.recapture_rates_monthly_ytd
order by payment_year_month
;

Get Count of All Open HCCs

select
      payer
    , payment_year
    , model_version
    , max(suspect_hcc_flag) as suspect_hcc_flag   
    , count(hcc_code) as hcc_count
from hcc_recapture.gap_status
where gap_status = 'open'
group by
      payer
    , payment_year
    , model_version
;

Get All Open Suspect HCCs

select
      payer
    , payment_year
    , model_version
    , count(hcc_code) as hcc_count
from hcc_recapture.gap_status
where gap_status = 'open' and suspect_hcc_flag = 1
group by
      payer
    , payment_year
    , model_version
;