CareJourney: Risk Contract Management

Description
CareJourney’s Risk Contract Management data asset is the best source to evaluate performance of entities participating in the CMS’ top risk models. Our data currently supports the following models:
ACO Realizing Equity, Access, and Community Health (REACH)
Medicare Shared Savings Program (MSSP)
Kidney Care Choices (KCC)

There are two key components needed to properly evaluate a risk entity: beneficiary-level claims data and accurate attribution. With data access to 100% of Medicare beneficiaries, their longitudinal claims data, and beneficiary to entity rosters, we are able to accurately measure entity performance across a wide range of measures - financial, quality, care coordination, specialty-specific, and more.

Data sources:
- CMS Medicare fee-for-service claims details
- CMS APM Beneficiary and Provider Rosters

Each view (by year) is organized by:
- Entity
- Entity x County
- Entity x Specialty
- Entity x Specialty x County

Sample fields include:
Demographic Metrics
- Entity ID
- Entity Name
- Entity Geography (County)

Spend and Utilization Metrics
- Total PMPY
- Inpatient PMPY
- Outpatient PMPY
- Part B PMPY
- IP per 1k
- Avoidable ED

Specialty Metrics
- Cancer Surgery Patient and Claim Count
- Chemo or Immunotherapy Patient and Claim Count
- Radiation Admin Patient and Claim Count
- Dialysis Patient and Claim Count
- Kidney Transplant Patient and Claim Count
- BH Related Medication Usage Patient and Claim Count
- Psychotherapy Patient and Claim Count
- BH ED Visit Patient Count
- BH ED Visit 7 Day Follow Up Patient Count
- BH ED Visit 30 Day Follow Up Patient Count