Release Notes

Added counts of HCCs for both Within-Year-Updated and Historical-Diagnoses scenarios.

Removed errant testing object.

outputs 11-20 added to so_ursa_hcc_cond_003; fixed bug related to new Is Acceptable CMS MAO-004 Diagnosis field name in so_ursa_hcc_pat_002

Final Action Qualifying Diagnoses for CMS-HCC Calculations object overhaul the way "acceptable" document types are flagged. This ensures we are count claims by source and not attributing them to Bill dx when a patient has both

addition of chronic vs. not chronic type category and bug fix in concatenation of historical model output summary

Added capability to capture and use HCC model outputs in slots 11 – 20 (prior version was limited to first 10 outputs only). Updated the timeline logic in the Historical-Diagnoses scenario to include diagnoses in the 3 prior calendar years and up to the current record’s period end date (e.g., for a timeline record covering January 1, 2024 – March 20, 2024, diagnoses with service dates between January 1, 2021 and March 20, 2024 will be considered; this change makes the Historical-Diagnoses scenario more directly comparable to the Within-Year-Updated scenario, which, in this example, would look at diagnoses with service dates between January 1, 2024 and March 20, 2024). Relatedly, updated the v24 / v28 blending of the Historical-Diagnoses scenario to treat results as if they were a projection of the next year’s RAF score (the same approach already used by the Within-Year-Updated scenario).

Fixed bug in Patient Timelines of Final Action CMS-HCC Model Demographic Inputs object that was producing inaccurate CMS-HCC model demographics for patients with one or more non-default statuses (i.e., LTI status, ESRD status, dual status, and new enrollee status) in cases where an MMR record with a populated CMS RAF Type Code value was not present.

Fixed a bug in how the Is Patient With CMS-HCC Calculations Using Claim Diagnoses and Is Patient With CMS-HCC Calculations Using Bill Diagnoses flags were being calculated, resulting in false positive values under some circumstances.

Updated URSA-HCC-R02 to use new fields (and remove orphan fields) related to recent "acceptable" diagnosis document type changes.

Cosmetic tweaks related to last submission (dealing with "acceptable" diagnosis documentation types).

Added logic to define "acceptable" document types for HCC diagnoses, through which, now, by default, only the best available evidence for diagnoses is used for each source (hierarchy is: MAO-004 > claims > billing); extended Initial Run and Midyear Run logic to use claims and billing diagnoses when acceptable (per this new definition) rather than only MAO-004; added patient-level flags to identify which of the three document types were used to generate HCC/RAF results for each patient.

Updated with latest 2024 CPT/HCPCS codes from CMS for identifying qualifying claims.

Added Patient Timelines of Initial, Midyear, and Final Run RAF Results from MMR object.

Added terms.

Several new boards added to the URSA-HCC | Foundations report.

Added a number of detailed boards in the URSA-HCC | Foundations report to introduce user to key concepts and illustrate analyses on missing historical HCCs in the current year.

Overhauled URSA-HCC-R03 (Missing Historical-Diagnoses CMS-HCC Model Outputs) and related upstream objects to provide lists of missing model outputs throughout the year, not just on a single snapshot date.

Wove together (1) new logic to produce initial and midyear run logic with (2) new logic to generate long-form lists of HCCs that are "missing" (i.e., not yet documented in the current year), including a new registry measure for these; made some related cosmetic tweaks, including renaming some fields for better clarity and consistency, and unpublishing many of the individual model output code and description fields from the master timeline and data mart, which were largely redundant with the "summary" text strings.

New logic (and data mart and registry measure) for generating long-form lists of missing HCC model outputs (between Historical-Diagnoses vs. Within-Year-Updated scenarios).

Major extension to add assets used to generate Standard Initial Run and Standard Midyear Run HCC/RAF results.

Corrected URSA-HCC-R02 for upstream field name change.

Overhaul of Periods of Most Recent MAO-004 Diagnosis Transactions to use new MAO-004 Diagnosis Transactions (Natural Object); tweaks to Patient Timelines of CMS-HCC Model Demographic Inputs (publishing RAAG and using it as a backup for determining new enrollee status).

Handling updating field name ("CMS MAO-004 Encounter Submitted Date" to "Last CMS MAO-004 Encounter Submitted Date") in MAO-004 Natural Object.

Removed errant test object from package.

Bug fix for a rare scenario in which a professional claim diagnosis would be considered qualifying for HCC/RAF model use when it shouldn't have (occurring when a different service line item on the same claim had a qualifying HCPCS).

Fixed bug that was resulting in failure to use MAO-004 diagnoses; fixed bug that was resulting in some non-duals being flagged as duals.

Major overhaul of approach and object infrastructure: added dedicated objects for patient timelines of demographic information (which now incorporates information from the new MMR Member-Months Natural Object) and all qualifying diagnoses (which now incorporates information from the new MAO-004 Diagnoses Natural Object); now allowing model demographics to change from month to month; rebranded “Calendar Year” scenario to “Standard Final Action” scenario, and changed the diagnosis catchment period of this scenario to mirror the standard CMS approach (i.e., using diagnoses in the prior calendar year).

Updates to the pre-built "Overview" board (cosmetic only) in Analytics Portal. No structural changes to the objects or measures.

Refinements to Qualifying Diagnoses for CMS-HCC Calculation; added new Synthetic Objects: CMS MAO-004 Diagnosis Transaction Influence Periods and Patient Timelines of CMS-HCC Model Eligibility.

Added new object, Qualifying Diagnoses for CMS-HCC Calculations, to include MAO-004 records and provide patient-date-diagnosis code grain data.

Minor changes related to upstream changes in how LTI and OREC fields are structured.

Relaxed restriction to patient-years with MA or Medicare FFS membership; now any membership in a calendar year will result in HCC/RAF calculations being performed. (This change is to make the logic less brittle to missing information about plan financial class, not necessarily because it typically would make sense to calculate HCC/RAF results for, e.g., commercial members, though there are some use cases there in theory.)

Published fields in the Data Mart for URSA-HCC Patient Timelines related to patient demographic features (e.g., eligibility code, OREC, etc.) used by the model to generate RAF results in that calendar year.

Remapped fields on objects / measures affected by the de-truncation of long column names.

Initial commit of URSA-HCC 1.0. Added boards to foundations report; updated some terms; revised logic for including patients (to include patients with a calculated RAF score regardless of any other status).