Simplifying healthcare

The time has come for the PCC/APC models to start being implemented, changing the way populations and their scores shape up. With the PCC model now including the additive risk scores for the condition count, CMS has decreased many of the individual HCC risk scores used in the current model—for instance diabetes will see a 14% decrease, with reductions counterbalanced by an increase in other risk scores. The change led us to do a statistical analysis that assessed the impact of these substantial changes.

In January 2019, when the new CMS-HCC Risk-Adjustment Model (V23) takes effect, it will include 4 additional HCC categories, 83 new HCC codes, and more than 9,500 ICD-10 codes. Learn how to overcome the challenges health plans will face with these changes.