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

搜集汇总

背景与挑战

背景概述

CareJourney的风险合同管理数据集用于评估参与CMS主要风险模型（如ACO REACH、MSSP、KCC）的实体表现，基于100% Medicare受益人的纵向索赔数据和准确的归属关系，提供财务、质量、护理协调及专科等多维度指标。数据来源包括CMS Medicare FFS索赔详情和APM名册，并按实体、地区、专业等维度组织，涵盖人口统计、花费利用和专科指标等字段。