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Population Overview
ACO-wide RAF scores · 14,946 beneficiaries · Jan–Dec 2024
V28 Model
Total Beneficiaries
Medicare patients attributed to ACO
Avg GHCC Score
December 2024 final
Min
Max
StdDev
High Risk Patients
GHCC ≥ 2.0
Total HCCs Coded
Avg /pt · with 0
Monthly GHCC Trend — Jan → Dec 2024
Average, min, max · cumulative diagnosis logic
Score Distribution
Patient count by GHCC band
Average GHCC by Cohort
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Risk Tier Breakdown
Population split by GHCC threshold
Very High
GHCC ≥ 3.0
High
GHCC 2.0–3.0
Medium
GHCC 1.0–2.0
Low
GHCC < 1.0
Top 10 HCCs by Patient Count
Updates with cohort filter · click row to drill into stratification
#HCCConditionPatientsPrevalenceCoeff (Aged ND)
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Patient Risk List
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⚠ Coding Gap Patients
High demo RAF · low HCC count · likely undercoded
↑ Top Score Risers
Highest GHCC growth Jan → Dec 2024
Pipeline Steps
Raw claims → GHCC scores · 7 BigQuery SQL transformations
Data Completeness
Cohort Distribution
Methodology
Model: CMS-HCC V28 · 2026 Payment Year ICD-10 mappings
Coefficients: CMS Final Rule published values · 7 cohorts
ICD-10 Crosswalk: 8,019 codes · 115 payment HCCs
Hierarchy: 109 trumping pairs · 35% HCC reduction applied
Interactions: 11 terms (Diabetes×HF, HF×CKD, HF×Arrhythmia…)
Population: 14,946 scored beneficiaries · Jan–Dec 2024
Infrastructure: BigQuery · risk-adjustment-492923.aco_ra
Pipeline: 7 SQL steps · CREATE OR REPLACE · fully idempotent