Rush and CareJourney Develop ACO-level HCC Benchmarking Analytics

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Benchmarking at the national level is a helpful starting point. More actionable data are unlocked when specified for ACOs to evaluate performance across HCCs and identify opportunity within a targeted patient population. By working with CareJourney, ACOs can obtain a detailed workbook that highlights the ACO’s prevalence of medical conditions and compares recapture rates against other ACOs.

After identifying a few focus areas through our analytics, organizations can further investigate potential variability in clinical diagnosis and documentation practices within their ACO, resulting in a more accurate representation of medical complexity. If you would like a fresh look at your HCCs, please contact CareJourney today for a customized HCC benchmarking calculator.

Now that you are subscribed to CareJourney JumpStart, discover more reports just like this one to see insightful metrics on other relevant topics. Or take the data further with our Population Insights tool built on the CMS-supplied CCLF files for a portfolio of clinically-relevant insights at the patient-level.

Data Source & Methodology

The benchmarking tool utilizes the national Medicare Fee-for-Service claims database to establish the foundation for national benchmarking. There are two main metrics: prevalence and recapture rate. The base population prevalence of medical conditions aligned to HCCs is measured as count per 1,000 members. This forms the initial benchmark of medical complexity for an ACO’s population. 

The recapture rate is modeled by identifying patient diagnoses aligned to HCCs submitted on claims in the prior year (year 1) that were not submitted on claims in the most recent year (year 2). A maximum population medical complexity by HCCs was estimated by adding the medical conditions that were not recaptured to the most recent year prevalence.