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Old 12-17-2019, 07:30 PM
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Question MA CMS Maximum Risk Score?

Anyone in the MA space have any idea what the maximum possible CMS risk score is? Ballpark numbers welcome.

Thanks in advance!
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Old 12-18-2019, 09:28 AM
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Anyone in the MA space have any idea what the maximum possible CMS risk score is? Ballpark numbers welcome.

Thanks in advance!
Theoretically, could be as high as 50-60 (choose a type (dual status, community type, etc.), add all HCC coeff. and co-mobidity factors, and pick a highest demo coeff.)

Realistically, 10 to 15 being the max.
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Old 12-18-2019, 01:25 PM
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Theoretically, could be as high as 50-60 (choose a type (dual status, community type, etc.), add all HCC coeff. and co-mobidity factors, and pick a highest demo coeff.)

Realistically, 10 to 15 being the max.
I was curious and looked at a few million member months of MMR data, and the highest Part C risk score in the set was a 15.332 (from PY2019 so could change with final sweeps). Next highest was 13.002.
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Old 12-20-2019, 03:27 PM
Actuarialsuck Actuarialsuck is offline
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Theoretically, could be as high as 50-60 (choose a type (dual status, community type, etc.), add all HCC coeff. and co-mobidity factors, and pick a highest demo coeff.)

Realistically, 10 to 15 being the max.
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I was curious and looked at a few million member months of MMR data, and the highest Part C risk score in the set was a 15.332 (from PY2019 so could change with final sweeps). Next highest was 13.002.
Don't you have to take into account the type of member? For example ESRD are on a different payment model so those risk scores tend to be a lot higher than say for Full Duals vs Partial Duals vs non-Duals (which each have their own payment models as well IIRC).
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Old 12-20-2019, 03:42 PM
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Don't you have to take into account the type of member? For example ESRD are on a different payment model so those risk scores tend to be a lot higher than say for Full Duals vs Partial Duals vs non-Duals (which each have their own payment models as well IIRC).
Because ESRD members are using a different payment model, their HCC coefficients are not that different than non-ESRD members. (coefficients not 10 times higher, even though the payment can be 10x higher).

Theoretical max and practical max are still similar to non-ESRD members.
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Old 12-22-2019, 06:48 PM
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Because ESRD members are using a different payment model, their HCC coefficients are not that different than non-ESRD members. (coefficients not 10 times higher, even though the payment can be 10x higher).

Theoretical max and practical max are still similar to non-ESRD members.
I always wondered why the HCC factors for ESRD were seemingly low. I forgot that there might be payment model limitations. Fascinating!
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Old 01-02-2020, 11:13 AM
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Thanks everyone! Very helpful
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