Evaluation of CMS HCC Risk Model
For anyone wanting to do a deeper dive into the history of the methodology of the CMS HCC risk model, here is Greg Pope’s recent evaluation of the model.
Mr. Pope is the Director of Health Care Financing and Payment Program at RTI International. He was one of the principal architects of the original DCG/HCC model which used 189 condition categories (and you thought 70 HCCs was alot), from which CMS created a simplified model with 70 HCCs.
A key point in the paper that many forget is that the CMS HCC model is not intended to predict individual costs, rather has been calibrated to predict costs at a group level.
Here is the pdf: Evaluation_Risk_Adj_Model_2011
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