CMS HCC Payment Risk Score Weighting by Member Months

macros/substring.sql

@@ -0,0 +1,31 @@
+{% macro substring(string, start, length) %}
+  {{ return(adapter.dispatch('substring', 'macros')(string, start, length)) }}
+{% endmacro %}
+
+{% macro default__substring(string, start, length) %}
+  substring({{ string }}, {{ start }}, {{ length }})
+{% endmacro %}
+
+{% macro postgres__substring(string, start, length) %}
+  substring({{ string }} from {{ start }} for {{ length }})
+{% endmacro %}
+
+{% macro snowflake__substring(string, start, length) %}
+  substr({{ string }}, {{ start }}, {{ length }})
+{% endmacro %}
+
+{% macro bigquery__substring(string, start, length) %}
+  substr({{ string }}, {{ start }}, {{ length }})
+{% endmacro %}
+
+{% macro redshift__substring(string, start, length) %}
+  substring({{ string }}, {{ start }}, {{ length }})
+{% endmacro %}
+
+{% macro databricks__substring(string, start, length) %}
+  substring({{ string }}, {{ start }}, {{ length }})
+{% endmacro %}
+
+{% macro duckdb__substring(string, start, length) %}
+  substring({{ string }}, {{ start }}, {{ length }})
+{% endmacro %}

models/cms_hcc/cms_hcc_models.yml

@@ -536,4 +536,30 @@ models:
       - name: birth_date
         description: Date the patient was born.
       - name: death_date
-        description: The death date of the patient if there is one.
+        description: The death date of the patient if there is one.
+  - name: cms_hcc__stg_financial_pmpm__member_months
+    config:
+      schema: |
+        {%- if var('tuva_schema_prefix',None) != None -%}{{var('tuva_schema_prefix')}}_cms_hcc{% else %}cms_hcc{%- endif -%}
+      alias: _stg_member_months
+      tags: cms_hcc
+      materialized: ephemeral
+    description: Staging member months from financial_pmpm
+    columns:
+      - name: patient_id
+        description: Unique identifier for each patient in the dataset.
+      - name: year_month
+        description: Unique year-month of in the dataset computed from eligibility.
+      - name: payer
+        description: Name of the payer (i.e. health insurer) providing coverage.
+      - name: plan
+        description: Name of the plan (i.e. sub contract) providing coverage.
+      - name: data_source
+        description: >
+          User-configured field that indicates the data source (e.g. typically 
+          named after the payer and state "BCBS Tennessee").
+      - name: tuva_last_run
+        description: >
+          The last time the data was refreshed.  Generated by 
+          `dbt_utils.pretty_time` as the local time of the `dbt run` 
+          environment.  Timezone is configurable via the `tuva_last_run` var.

models/cms_hcc/final/cms_hcc__patient_risk_scores.sql

@@ -24,6 +24,18 @@ with seed_adjustment_rates as (
 
 )
 
+, member_months as (
+
+    select
+        patient_id
+        , cast({{ substring('year_month', 1, 4) }} as integer) as eligible_year
+        , COUNT(1) as member_months
+    from  {{ ref('cms_hcc__stg_financial_pmpm__member_months') }}
+    group by
+        patient_id
+        , cast({{ substring('year_month', 1, 4) }} as integer)
+)
+
 , raw_score as (
 
     select
@@ -135,6 +147,24 @@ with seed_adjustment_rates as (
 
 )
 
+, weighted_score as (
+
+    select
+        payment.patient_id
+        , payment.v24_risk_score
+        , payment.v28_risk_score
+        , payment.blended_risk_score
+        , payment.normalized_risk_score
+        , payment.payment_risk_score
+        , member_months.member_months
+        , payment.payment_risk_score * member_months.member_months as payment_risk_score_weighted_by_months
+        , payment.payment_year
+    from payment
+    left join member_months
+            on payment.patient_id = member_months.patient_id
+            and payment.payment_year = member_months.eligible_year
+)
+
 , add_data_types as (
 
     select
@@ -144,8 +174,10 @@ with seed_adjustment_rates as (
         , round(cast(blended_risk_score as {{ dbt.type_numeric() }}),3) as blended_risk_score
         , round(cast(normalized_risk_score as {{ dbt.type_numeric() }}),3) as normalized_risk_score
         , round(cast(payment_risk_score as {{ dbt.type_numeric() }}),3) as payment_risk_score
+        , round(cast(payment_risk_score_weighted_by_months as {{ dbt.type_numeric() }}),3) as payment_risk_score_weighted_by_months
+        , cast(member_months as integer) as member_months
         , cast(payment_year as integer) as payment_year
-    from payment
+    from weighted_score
 
 )
 
@@ -156,6 +188,8 @@ select
     , blended_risk_score
     , normalized_risk_score
     , payment_risk_score
+    , payment_risk_score_weighted_by_months
+    , member_months
     , payment_year
     , '{{ var('tuva_last_run')}}' as tuva_last_run
 from add_data_types

models/cms_hcc/staging/cms_hcc__stg_financial_pmpm__member_months.sql

@@ -0,0 +1,12 @@
+{{ config(
+     enabled = var('cms_hcc_enabled',var('financial_pmpm_enabled', var('claims_enabled',var('tuva_marts_enabled',False)))) | as_bool
+   )
+}}
+select
+     patient_id
+    , year_month
+    , payer
+    , plan
+    , data_source
+    , '{{ var('tuva_last_run')}}' as tuva_last_run
+from {{ ref('financial_pmpm__member_months') }}