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amartinson193andreas-homewardAaron Neiderhiser
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Create the HCC Recapture Mart (#1190)
* Add HCC recapture mart * Adding configs * Update naming * Updating chronic conditions + fixing linting issues * fixing linting errors * linting fixes * fixing linting issues * fixing linting * fixing linting * Updating code to fix CI/CD errors * Moving flattened hierarchy to dbt_project as a value set * removing hierarchy * Adding cms_hcc_seed info * Adding file for seed * Fixing mispelling in seed * Updating dbt_project.yml * fixing datatype * Updating comment * updated hcc_recapture to work w/ fabric * fixed linting issue * fixed linting issue * fixed linting issue --------- Co-authored-by: andreas-homeward <andreas.martinson@homewardhealth.com> Co-authored-by: Aaron Neiderhiser <aaronneiderhiser@Aarons-MacBook-Air.local>
1 parent 34b604f commit 228ec39

17 files changed

Lines changed: 1242 additions & 8 deletions

‎dbt_project.yml‎

Lines changed: 14 additions & 8 deletions
Original file line numberDiff line numberDiff line change
@@ -71,6 +71,8 @@ vars:
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# fhir_preprocessing_enabled: true # defaults to false
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# financial_pmpm_enabled: false
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# hedis_enabled: true # defaults to false
74+
# hcc_recapture_enabled: true # defaults to false
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# hcc_suspecting_enabled: true # defaults to false
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# insights_enabled: false
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# quality_measures_enabled: false
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# readmissions_enabled: true
@@ -138,12 +140,16 @@ seeds:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','bill_type.csv',compression=true,null_marker=true) }}"
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terminology__claim_type:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','claim_type.csv',compression=true,null_marker=true) }}"
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terminology__cms_acceptable_provider_specialty_codes:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','cms_acceptable_provider_specialty_codes.csv',compression=true,null_marker=true, headers=true) }}"
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terminology__cvx:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','cvx.csv',compression=true,null_marker=true) }}"
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terminology__ccs_services_procedures:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','ccs_services_procedures.csv',compression=true,null_marker=true) }}"
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terminology__discharge_disposition:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','discharge_disposition.csv',compression=true,null_marker=true) }}"
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terminology__electing_teaching_hospital_list:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','electing_teaching_hospital_list.csv',compression=true,null_marker=true, headers=true) }}"
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terminology__encounter_type:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','encounter_type.csv',compression=true,null_marker=true) }}"
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terminology__ethnicity:
@@ -180,6 +186,8 @@ seeds:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','medicare_dual_eligibility.csv',compression=true,null_marker=true) }}"
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terminology__medicare_orec:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','medicare_orec.csv',compression=true,null_marker=true) }}"
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terminology__medicare_provider_and_supplier_taxonomy_crosswalk:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','medicare_provider_and_supplier_taxonomy_crosswalk.csv',compression=true,null_marker=true, headers=true) }}"
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terminology__medicare_status:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','medicare_status.csv',compression=true,null_marker=true) }}"
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terminology__ms_drg_weights_los:
@@ -202,6 +210,8 @@ seeds:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','present_on_admission.csv',compression=true,null_marker=true) }}"
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terminology__provider:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_provider_data/0.16.0','provider.csv',compression=true,null_marker=true) }}"
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terminology__provider_taxonomy_unpivot:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_provider_data/0.16.0','provider_taxonomy_unpivot.csv',compression=true,null_marker=true, headers=true) }}"
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terminology__race:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','race.csv',compression=true,null_marker=true) }}"
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terminology__revenue_center:
@@ -216,16 +226,10 @@ seeds:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','snomed_ct_transitive_closures.csv',compression=true,null_marker=true) }}"
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terminology__snomed_icd_10_map:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','snomed_icd_10_map.csv',compression=true,null_marker=true) }}"
219-
terminology__cms_acceptable_provider_specialty_codes:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','cms_acceptable_provider_specialty_codes.csv',compression=true,null_marker=true, headers=true) }}"
221-
terminology__electing_teaching_hospital_list:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','electing_teaching_hospital_list.csv',compression=true,null_marker=true, headers=true) }}"
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terminology__medicare_provider_and_supplier_taxonomy_crosswalk:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','medicare_provider_and_supplier_taxonomy_crosswalk.csv',compression=true,null_marker=true, headers=true) }}"
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terminology__ssa_fips_state_county_crosswalk:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','ssa_fips_state_county_crosswalk.csv',compression=true,null_marker=true, headers=true) }}"
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terminology__provider_taxonomy_unpivot:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_provider_data/0.16.0','provider_taxonomy_unpivot.csv',compression=true,null_marker=true, headers=true) }}"
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terminology__:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_terminology/0.16.0','ssa_fips_state_county_crosswalk.csv',compression=true,null_marker=true, headers=true) }}"
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value_sets:
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ccsr:
@@ -253,6 +257,8 @@ seeds:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_value_sets/0.16.0','cms_hcc_disease_factors.csv',compression=true,null_marker=true) }}"
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cms_hcc__disease_hierarchy:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_value_sets/0.16.0','cms_hcc_disease_hierarchy.csv',compression=true,null_marker=true) }}"
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cms_hcc__disease_hierarchy_flat:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_value_sets/0.16.1','cms_hcc_disease_hierarchy_flat.csv',compression=false,null_marker=true,headers=true) }}"
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cms_hcc__disease_interaction_factors:
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+post-hook: "{{ load_seed(var('custom_bucket_name','tuva-public-resources') ~ '/versioned_value_sets/0.16.0','cms_hcc_disease_interaction_factors.csv',compression=true,null_marker=true) }}"
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cms_hcc__enrollment_interaction_factors:

‎models/hcc_recapture/final/hcc_recapture__gap_status.sql‎

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@@ -0,0 +1,18 @@
1+
{{ config(
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enabled = var('hcc_recapture_enabled',var('claims_enabled',var('tuva_marts_enabled',False)))) | as_bool
3+
}}
4+
5+
-- Using distinct to remove the hierarchy group and data source
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select distinct
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person_id
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, payer
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, hcc_code
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, risk_model_code
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, model_version
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, payment_year
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, recapture_flag
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, gap_status
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, suspect_hcc_flag
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from {{ ref('hcc_recapture__int_gap_status') }}
17+
-- Apply hierarchies
18+
where filtered_out_by_hierarchy = 0

‎models/hcc_recapture/final/hcc_recapture__hcc_status.sql‎

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@@ -0,0 +1,36 @@
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{{ config(
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enabled = var('hcc_recapture_enabled',var('claims_enabled',var('tuva_marts_enabled',False)))) | as_bool
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}}
4+
5+
select distinct
6+
stg.person_id
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, stg.payer
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, stg.data_source
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, coalesce(gap.payment_year, {{ date_part('year', 'recorded_date') }} + 1) as payment_year
10+
, stg.recorded_date
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, stg.claim_id
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, stg.rendering_npi
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, stg.model_version
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, stg.hcc_code
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, stg.hcc_description
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, stg.hcc_hierarchy_group
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, stg.hcc_hierarchy_group_rank
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, stg.suspect_hcc_flag
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, stg.risk_model_code
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, stg.eligible_claim_indicator
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, stg.eligible_bene
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, stg.reason
23+
, gap.gap_status
24+
, gap.recapture_flag
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from {{ ref('hcc_recapture__int_hccs') }} as stg
26+
left outer join {{ ref('hcc_recapture__gap_status') }} as gap
27+
on stg.person_id = gap.person_id
28+
and stg.payer = gap.payer
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and stg.model_version = gap.model_version
30+
and stg.hcc_code = gap.hcc_code
31+
and stg.suspect_hcc_flag = gap.suspect_hcc_flag
32+
and (case
33+
when gap.gap_status = 'open' then stg.collection_year + 2
34+
else stg.collection_year + 1
35+
end) = gap.payment_year
36+
where eligible_bene = 1

‎models/hcc_recapture/final/hcc_recapture__recapture_rates.sql‎

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@@ -0,0 +1,25 @@
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{{ config(
2+
enabled = var('hcc_recapture_enabled',var('claims_enabled',var('tuva_marts_enabled',False)))) | as_bool
3+
}}
4+
5+
with monthly_hcc_counts as (
6+
select
7+
payer
8+
, payment_year
9+
, sum(closed_hccs) as closed_hccs
10+
, sum(open_hccs) as open_hccs
11+
, sum(total_hccs) as total_hccs
12+
from {{ ref('hcc_recapture__recapture_rates_monthly') }}
13+
group by
14+
payer
15+
, payment_year
16+
)
17+
18+
select
19+
payer
20+
, payment_year
21+
, closed_hccs
22+
, open_hccs
23+
, total_hccs
24+
, closed_hccs / total_hccs as recapture_rate
25+
from monthly_hcc_counts

‎models/hcc_recapture/final/hcc_recapture__recapture_rates_monthly.sql‎

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@@ -0,0 +1,54 @@
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{{ config(
2+
enabled = var('hcc_recapture_enabled',var('claims_enabled',var('tuva_marts_enabled',False)))) | as_bool
3+
}}
4+
5+
with flatten_hccs as (
6+
-- Remove claim ID and rendering NPI
7+
select distinct
8+
person_id
9+
, payer
10+
, payment_year
11+
, cast({{ concat_custom([
12+
"payment_year"
13+
, "'-'"
14+
, date_part('month', 'recorded_date')
15+
, "'-'"
16+
, "'1'"
17+
]) }} as date) as payment_year_month
18+
, recorded_date
19+
, model_version
20+
, hcc_code
21+
, gap_status
22+
, recapture_flag
23+
, row_number() over (partition by person_id, payer, payment_year, model_version, hcc_code order by recorded_date asc) as earliest_hcc_code
24+
from {{ ref('hcc_recapture__hcc_status') }}
25+
where gap_status not in ('inappropriate for recapture', 'new')
26+
and gap_status is not null
27+
and suspect_hcc_flag = 0
28+
)
29+
30+
, monthly_hcc_counts as (
31+
select
32+
payer
33+
, payment_year
34+
, payment_year_month
35+
, sum(case when lower(gap_status) like '%closed%' then 1 else 0 end) as closed_hccs
36+
, sum(case when gap_status = 'open' then 1 else 0 end) as open_hccs
37+
, count(*) as total_hccs
38+
from flatten_hccs
39+
where earliest_hcc_code = 1
40+
group by
41+
payer
42+
, payment_year
43+
, payment_year_month
44+
)
45+
46+
select
47+
payer
48+
, payment_year
49+
, payment_year_month
50+
, closed_hccs
51+
, open_hccs
52+
, total_hccs
53+
, closed_hccs / total_hccs as recapture_rate
54+
from monthly_hcc_counts

‎models/hcc_recapture/final/hcc_recapture__recapture_rates_monthly_ytd.sql‎

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{{ config(
2+
enabled = var('hcc_recapture_enabled',var('claims_enabled',var('tuva_marts_enabled',False)))) | as_bool
3+
}}
4+
5+
with ytd_hccs as (
6+
select
7+
payer
8+
, payment_year
9+
, payment_year_month
10+
, closed_hccs as monthly_closed_hccs
11+
, open_hccs as monthly_open_hccs
12+
, total_hccs as monthly_total_hccs
13+
, recapture_rate as monthly_recapture_rate
14+
, sum(closed_hccs) over (partition by payer, payment_year order by payment_year_month rows between unbounded preceding and current row) as ytd_closed_hccs
15+
, sum(open_hccs) over (partition by payer, payment_year order by payment_year_month rows between unbounded preceding and current row) as ytd_open_hccs
16+
, sum(total_hccs) over (partition by payer, payment_year) as yearly_total_hccs
17+
from {{ ref('hcc_recapture__recapture_rates_monthly') }}
18+
)
19+
20+
select
21+
payer
22+
, payment_year
23+
, payment_year_month
24+
, monthly_closed_hccs
25+
, monthly_open_hccs
26+
, monthly_total_hccs
27+
, monthly_recapture_rate
28+
, ytd_closed_hccs
29+
, ytd_open_hccs
30+
, yearly_total_hccs
31+
, ytd_closed_hccs / yearly_total_hccs as ytd_recapture_rate
32+
from ytd_hccs

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