As the DCE program ramps up for its second performance year, we want to ensure that our clients understand how we derive our alignment estimates and the limitations of our methodology.
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Metric |
Oct 14, 2021 Release | November Release | January Release | Upcoming |
| DCE Claims Aligned Lives (Estimate) – PY1 | Ineligible beneficiaries removed from attribution model • Beneficiary must be enrolled in Part A and B for the entire 2 year alignment period • Beneficiary not enrolled in MA or any other Medicare managed care plan in either alignment year • Does not have Medicare as a secondary payer • Resident of the US Note: still includes beneficiaries aligned to an MSSP ACO |
Removed beneficiaries that were assigned to a Prospective MSSP ACO for the base or performance year of each of our DCE metrics |
* Identify and remove as many beneficiaries living in an institutional setting as possible
* SNF Services Exclusion – updating the attribution methodology to include limited services provided in a SNF setting |
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| DCE Patient Risk Score (HCC) | • Risk scores are normalized based on the National FFS risk scores • All AD&D + ESRD beneficiaries are based on the same HCC risk model • Beneficiary costs are aggregated first and then adjusted at the Physician level using the normalization factor * Normalized Risk Score = (Risk Score / National Average FFS Risk Score) * Adjusted cost = (Unadjusted cost / Normalized Risk Score) See Normalization factors below |
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| DCE PMPM | Accounts for ineligible beneficiaries (see Claims Aligned Lives) • Patients that died during PY • Patients that become ineligible during PY Accounts for CMS’ eligible months criteria |
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| All DCE Metrics | Removed beneficiaries that were assigned to a Prospective MSSP ACO for the base or performance year of each of our DCE metrics |
