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.
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 |
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