schema=1.0 quality=2.0 generator=0.5.0 • generated 2026-06-09T05:34:58.510520Z
Summary: 6 / 33 metrics outside ±15% tolerance.
| Metric | Target | Actual | Δ% | Flag |
|---|---|---|---|---|
| avg_age | 74.0000 | 72.6846 | -1.78% | OK |
| pct_female | 0.5500 | 0.5131 | -6.71% | OK |
| pct_dual | 0.2000 | 0.1921 | -3.97% | OK |
| pct_lis | 0.3000 | 0.3270 | 9.00% | OK |
| pct_esrd | 0.0120 | 0.0129 | 7.16% | OK |
| pct_originally_disabled | 0.1300 | 0.1328 | 2.15% | OK |
| avg_risk_score_blended | 1.0500 | 1.0330 | -1.62% | OK |
| avg_risk_score_v24 | 1.0600 | 1.0232 | -3.47% | OK |
| avg_risk_score_v28 | 1.0400 | 1.0382 | -0.18% | OK |
| pmpm_medical_total | 900.0000 | 1,054.7131 | 17.19% | HIGH |
| pmpm_rx_gross | 280.0000 | 256.9106 | -8.25% | OK |
| pmpm_rx_net | 180.0000 | 160.2304 | -10.98% | OK |
| pmpm_total | 1,080.0000 | 1,214.9434 | 12.49% | OK |
| pmpm_revenue_part_c | 1,100.0000 | 1,210.7276 | 10.07% | OK |
| pmpm_revenue_part_d | 110.0000 | 121.1428 | 10.13% | OK |
| pmpm_revenue_total | 1,210.0000 | 1,331.8703 | 10.07% | OK |
| pmpm_ip | 270.0000 | 385.7439 | 42.87% | HIGH |
| pmpm_op | 210.0000 | 234.1843 | 11.52% | OK |
| pmpm_prof | 290.0000 | 298.7272 | 3.01% | OK |
| pmpm_snf_hh | 90.0000 | 91.6631 | 1.85% | OK |
| pmpm_dme_other | 40.0000 | 44.3946 | 10.99% | OK |
| mlr_total | 0.8600 | 0.9122 | 6.07% | OK |
| admits_per_1000 | 255.0000 | 278.5817 | 9.25% | OK |
| er_per_1000 | 600.0000 | 576.9152 | -3.85% | OK |
| pcp_visits_per_1000 | 3,500.0000 | 4,769.6317 | 36.28% | HIGH |
| specialist_visits_per_1000 | 3,100.0000 | 4,944.1053 | 59.49% | HIGH |
| rx_fills_per_1000 | 55,000.0000 | 57,908.3739 | 5.29% | OK |
| hcc_prev_HCC18 | 0.1300 | 0.2827 | 117.46% | HIGH |
| hcc_prev_HCC85 | 0.1300 | 0.1268 | -2.49% | OK |
| hcc_prev_HCC111 | 0.1100 | 0.1097 | -0.31% | OK |
| hcc_prev_HCC108 | 0.1600 | 0.1509 | -5.68% | OK |
| hcc_prev_HCC138 | 0.1000 | 0.1187 | 18.71% | HIGH |
| hcc_prev_HCC58 | 0.1000 | 0.0936 | -6.44% | OK |
| Check | Count |
|---|---|
| orphan_medical_claims | 0 |
| orphan_rx_claims | 0 |
| orphan_revenue_rows | 0 |
| medical_line_id_duplicates | 0 |
| rx_line_id_duplicates | 0 |
| medical_paid_before_service | 0 |
| rx_paid_before_service | 0 |
| negative_or_high_ages | 0 |
| Year | Member-months | PMPM Medical | PMPM Rx Net | PMPM Total | PMPM Revenue | MLR |
|---|---|---|---|---|---|---|
| 2024 | 10,049 | $1099.50 | $163.21 | $1262.71 | $1264.91 | 99.8% |
| 2025 | 9,790 | $1053.35 | $161.87 | $1215.22 | $1346.02 | 90.3% |
| 2026 | 9,323 | $1007.87 | $155.29 | $1163.16 | $1389.19 | 83.7% |
| Cohort | Members | PMPM Medical | PMPM Rx | PMPM Revenue | MLR |
|---|---|---|---|---|---|
| non_dual | 814 | $976.43 | $139.87 | $1259.95 | 88.6% |
| dual | 190 | $1456.98 | $259.55 | $1741.22 | 98.6% |
| Age Band | Members | PMPM Medical |
|---|---|---|
| 65-69 | 236 | $950.94 |
| 70-74 | 267 | $1076.00 |
| 75-79 | 177 | $1015.16 |
| 80-84 | 100 | $1274.77 |
| 85-89 | 61 | $1410.52 |
| 90+ | 32 | $1013.08 |
| <65 | 121 | $957.31 |
| Metric | Value |
|---|---|
| ip_admits_per_1000 | 278.6 |
| er_visits_per_1000 | 576.9 |
| pcp_visits_per_1000 | 6,369.9 |
| specialist_visits_per_1000 | 5,024.3 |
| rx_fills_per_1000 | 57,908.4 |
Each dataset has its own dictionary with field-level type, key role, description, expected values, and observed unique values.
Per-field frequency tables / histograms. See value_distributions.json for the full data.
eligibility: 17 fields (14 categorical, 1 numeric, 1 date, 1 high-cardinality)
revenue: 24 fields (11 categorical, 11 numeric, 0 date, 1 high-cardinality)
medical_claims: 48 fields (14 categorical, 5 numeric, 3 date, 5 high-cardinality)
rx_claims: 41 fields (26 categorical, 8 numeric, 2 date, 5 high-cardinality)
{
"benchmarks.DEFAULT_TOLERANCE": 0.15,
"benchmarks.TARGETS": {
"admits_per_1000": 255.0,
"avg_age": 74.0,
"avg_risk_score_blended": 1.05,
"avg_risk_score_v24": 1.06,
"avg_risk_score_v28": 1.04,
"er_per_1000": 600.0,
"hcc_prev_HCC108": 0.16,
"hcc_prev_HCC111": 0.11,
"hcc_prev_HCC138": 0.1,
"hcc_prev_HCC18": 0.13,
"hcc_prev_HCC58": 0.1,
"hcc_prev_HCC85": 0.13,
"mlr_total": 0.86,
"pcp_visits_per_1000": 3500.0,
"pct_dual": 0.2,
"pct_esrd": 0.012,
"pct_female": 0.55,
"pct_lis": 0.3,
"pct_originally_disabled": 0.13,
"pmpm_dme_other": 40.0,
"pmpm_ip": 270.0,
"pmpm_medical_total": 900.0,
"pmpm_op": 210.0,
"pmpm_prof": 290.0,
"pmpm_revenue_part_c": 1100.0,
"pmpm_revenue_part_d": 110.0,
"pmpm_revenue_total": 1210.0,
"pmpm_rx_gross": 280.0,
"pmpm_rx_net": 180.0,
"pmpm_snf_hh": 90.0,
"pmpm_total": 1080.0,
"rx_fills_per_1000": 55000.0,
"specialist_visits_per_1000": 3100.0
},
"demographics.AGE_PYRAMID": [
[
40,
64,
0.12
],
[
65,
69,
0.25
],
[
70,
74,
0.25
],
[
75,
79,
0.18
],
[
80,
84,
0.11
],
[
85,
89,
0.06
],
[
90,
99,
0.03
]
],
"demographics.ANNUAL_NEW_ENROLLEE_RATE": 0.1,
"demographics.MONTHLY_DISENROLL": 0.0055,
"demographics.MONTHLY_MORTALITY_BY_AGE": {
"(40, 64)": 0.0008,
"(65, 69)": 0.001,
"(70, 74)": 0.0017,
"(75, 79)": 0.0028,
"(80, 84)": 0.005,
"(85, 89)": 0.009,
"(90, 99)": 0.015
},
"demographics.PCT_ESRD_BY_AGE": {
"(40, 64)": 0.045,
"(65, 69)": 0.012,
"(70, 74)": 0.01,
"(75, 79)": 0.008,
"(80, 84)": 0.006,
"(85, 89)": 0.004,
"(90, 99)": 0.002
},
"demographics.PCT_FEMALE_BY_AGE": {
"(40, 64)": 0.5,
"(65, 69)": 0.53,
"(70, 74)": 0.54,
"(75, 79)": 0.56,
"(80, 84)": 0.59,
"(85, 89)": 0.63,
"(90, 99)": 0.68
},
"demographics.PCT_ORIG_DISABLED_BY_AGE": {
"(40, 64)": 0.6,
"(65, 69)": 0.1,
"(70, 74)": 0.06,
"(75, 79)": 0.04,
"(80, 84)": 0.03,
"(85, 89)": 0.02,
"(90, 99)": 0.01
},
"dq_profiles.DQ_PROFILE": {
"adjustment_rate": 0.05,
"denial_rate": 0.02,
"duplicate_rate": 0.003,
"missing_field_rate": 0.01,
"paid_lag_mu": 3.0,
"paid_lag_sigma": 0.7,
"reversal_rate": 0.005
},
"drugs.BACKGROUND_NDCS": [
"00093505098",
"00185013505",
"00378515193",
"00378150001"
],
"drugs.CLASSES": [
"ACE",
"ANTIBIOTIC_BROAD",
"ANTICOAGULANT_NOAC",
"ANTIEPILEPTIC",
"ANTIPLATELET",
"ANTIPSYCHOTIC",
"ANTIVIRAL_HEP",
"ARB",
"ARV",
"BETA_BLOCKER",
"BIGUANIDES",
"BIOLOGIC_TNF",
"BRONCHODILATOR",
"BUPRENORPHINE",
"CHOLINESTERASE",
"DIURETIC_K_SPARING",
"DMARD",
"DPP4",
"ESA",
"GABAPENTIN",
"GLP1",
"HORMONE_BLOCKERS",
"ICS",
"IMMUNOSUPPRESSANT",
"INSULIN",
"IVIG",
"LAMA",
"LEVODOPA",
"LOOP_DIURETIC",
"MS_DMD",
"MUSCLE_RELAXANT",
"NSAID",
"ONCOLOGY_IV",
"ONCOLOGY_ORAL",
"PANCREATIC_ENZYME",
"PHOSPHATE_BINDER",
"SGLT2",
"SNRI",
"SSRI",
"STATIN",
"THYROID"
],
"drugs.MAINTENANCE_CLASSES": [
"ACE",
"ANTICOAGULANT_NOAC",
"ANTIEPILEPTIC",
"ANTIPLATELET",
"ANTIPSYCHOTIC",
"ARB",
"BETA_BLOCKER",
"BIGUANIDES",
"BRONCHODILATOR",
"CHOLINESTERASE",
"DIURETIC_K_SPARING",
"DMARD",
"DPP4",
"GABAPENTIN",
"GLP1",
"HORMONE_BLOCKERS",
"ICS",
"IMMUNOSUPPRESSANT",
"INSULIN",
"LAMA",
"LEVODOPA",
"LOOP_DIURETIC",
"PHOSPHATE_BINDER",
"SGLT2",
"SNRI",
"SSRI",
"STATIN",
"THYROID"
],
"drugs.N_NDCS": 51,
"drugs.PA_REQUIRED_CLASSES": [
"ANTIPSYCHOTIC",
"ANTIVIRAL_HEP",
"BIOLOGIC_TNF",
"GLP1",
"IMMUNOSUPPRESSANT",
"INSULIN",
"IVIG",
"MS_DMD",
"ONCOLOGY_IV",
"ONCOLOGY_ORAL",
"SGLT2"
],
"drugs.SPECIALTY_CHANNEL_CLASSES": [
"ANTIVIRAL_HEP",
"ARV",
"BIOLOGIC_TNF",
"ESA",
"IVIG",
"MS_DMD",
"ONCOLOGY_IV"
],
"drugs.TIER_BY_CLASS": {
"ACE": 1,
"ANTIBIOTIC_BROAD": 1,
"ANTICOAGULANT_NOAC": 3,
"ANTIEPILEPTIC": 1,
"ANTIPLATELET": 1,
"ANTIPSYCHOTIC": 2,
"ANTIVIRAL_HEP": 5,
"ARB": 1,
"ARV": 5,
"BETA_BLOCKER": 1,
"BIGUANIDES": 1,
"BIOLOGIC_TNF": 5,
"BRONCHODILATOR": 1,
"BUPRENORPHINE": 2,
"CHOLINESTERASE": 1,
"DIURETIC_K_SPARING": 1,
"DMARD": 1,
"DPP4": 3,
"ESA": 5,
"GABAPENTIN": 1,
"GLP1": 4,
"HORMONE_BLOCKERS": 3,
"ICS": 3,
"IMMUNOSUPPRESSANT": 3,
"INSULIN": 4,
"IVIG": 5,
"LAMA": 3,
"LEVODOPA": 1,
"LOOP_DIURETIC": 1,
"MS_DMD": 5,
"MUSCLE_RELAXANT": 1,
"NSAID": 1,
"ONCOLOGY_IV": 5,
"ONCOLOGY_ORAL": 5,
"PANCREATIC_ENZYME": 3,
"PHOSPHATE_BINDER": 3,
"SGLT2": 3,
"SNRI": 2,
"SSRI": 1,
"STATIN": 1,
"THYROID": 1
},
"episodes.keys": [
"chf_exacerbation",
"ami",
"dka",
"diabetic_foot_ulcer",
"copd_exacerbation",
"pneumonia_ip",
"sepsis_ip",
"stroke",
"hip_fracture"
],
"episodes.summary": {
"ami": {
"annual_rate_per_member": 0.25,
"label": "Acute MI",
"n_lines": 7,
"trigger_hccs": [
"HCC86",
"HCC87"
]
},
"chf_exacerbation": {
"annual_rate_per_member": 0.18,
"label": "CHF Exacerbation",
"n_lines": 4,
"trigger_hccs": [
"HCC85"
]
},
"copd_exacerbation": {
"annual_rate_per_member": 0.22,
"label": "COPD Exacerbation",
"n_lines": 4,
"trigger_hccs": [
"HCC111"
]
},
"diabetic_foot_ulcer": {
"annual_rate_per_member": 0.08,
"label": "Diabetic Foot Ulcer",
"n_lines": 3,
"trigger_hccs": [
"HCC18"
]
},
"dka": {
"annual_rate_per_member": 0.12,
"label": "Diabetic Ketoacidosis",
"n_lines": 3,
"trigger_hccs": [
"HCC17",
"HCC18"
]
},
"hip_fracture": {
"annual_rate_per_member": 0.55,
"label": "Hip Fracture",
"n_lines": 5,
"trigger_hccs": [
"HCC170"
]
},
"pneumonia_ip": {
"annual_rate_per_member": 0.3,
"label": "Pneumonia (IP)",
"n_lines": 2,
"trigger_hccs": [
"HCC114",
"HCC115"
]
},
"sepsis_ip": {
"annual_rate_per_member": 0.35,
"label": "Sepsis (IP)",
"n_lines": 2,
"trigger_hccs": [
"HCC2"
]
},
"stroke": {
"annual_rate_per_member": 0.3,
"label": "Stroke (Acute)",
"n_lines": 5,
"trigger_hccs": [
"HCC100"
]
}
},
"geography.STATE_DISTRIBUTION": [
[
"CA",
0.14,
[
[
"Los Angeles",
"06037"
],
[
"Orange",
"06059"
]
]
],
[
"FL",
0.13,
[
[
"Miami-Dade",
"12086"
],
[
"Broward",
"12011"
]
]
],
[
"TX",
0.1,
[
[
"Harris",
"48201"
],
[
"Dallas",
"48113"
]
]
],
[
"NY",
0.07,
[
[
"Kings",
"36047"
],
[
"Queens",
"36081"
]
]
],
[
"PA",
0.06,
[
[
"Philadelphia",
"42101"
],
[
"Allegheny",
"42003"
]
]
],
[
"OH",
0.05,
[
[
"Cuyahoga",
"39035"
],
[
"Franklin",
"39049"
]
]
],
[
"MI",
0.04,
[
[
"Wayne",
"26163"
],
[
"Oakland",
"26125"
]
]
],
[
"IL",
0.04,
[
[
"Cook",
"17031"
],
[
"DuPage",
"17043"
]
]
],
[
"NC",
0.04,
[
[
"Mecklenburg",
"37119"
],
[
"Wake",
"37183"
]
]
],
[
"GA",
0.04,
[
[
"Fulton",
"13121"
],
[
"Gwinnett",
"13135"
]
]
],
[
"AZ",
0.03,
[
[
"Maricopa",
"04013"
],
[
"Pima",
"04019"
]
]
],
[
"NJ",
0.03,
[
[
"Bergen",
"34003"
],
[
"Essex",
"34013"
]
]
],
[
"MA",
0.03,
[
[
"Middlesex",
"25017"
],
[
"Suffolk",
"25025"
]
]
],
[
"VA",
0.03,
[
[
"Fairfax",
"51059"
],
[
"Henrico",
"51087"
]
]
],
[
"WA",
0.02,
[
[
"King",
"53033"
],
[
"Pierce",
"53053"
]
]
],
[
"TN",
0.03,
[
[
"Davidson",
"47037"
],
[
"Shelby",
"47157"
]
]
],
[
"MO",
0.02,
[
[
"St. Louis",
"29189"
],
[
"Jackson",
"29095"
]
]
],
[
"IN",
0.02,
[
[
"Marion",
"18097"
],
[
"Lake",
"18089"
]
]
],
[
"WI",
0.02,
[
[
"Milwaukee",
"55079"
],
[
"Dane",
"55025"
]
]
],
[
"MN",
0.02,
[
[
"Hennepin",
"27053"
],
[
"Ramsey",
"27123"
]
]
],
[
"CO",
0.02,
[
[
"Denver",
"08031"
],
[
"Jefferson",
"08059"
]
]
],
[
"AL",
0.02,
[
[
"Jefferson",
"01073"
],
[
"Mobile",
"01097"
]
]
],
[
"LA",
0.02,
[
[
"Orleans",
"22071"
],
[
"Jefferson",
"22051"
]
]
],
[
"KY",
0.02,
[
[
"Jefferson",
"21111"
],
[
"Fayette",
"21067"
]
]
],
[
"OR",
0.01,
[
[
"Multnomah",
"41051"
],
[
"Washington",
"41067"
]
]
],
[
"CT",
0.01,
[
[
"Hartford",
"09003"
],
[
"Fairfield",
"09001"
]
]
],
[
"OK",
0.01,
[
[
"Oklahoma",
"40109"
],
[
"Tulsa",
"40143"
]
]
],
[
"SC",
0.01,
[
[
"Greenville",
"45045"
],
[
"Richland",
"45079"
]
]
],
[
"UT",
0.01,
[
[
"Salt Lake",
"49035"
],
[
"Utah",
"49049"
]
]
],
[
"XX",
0.07,
[
[
"National Avg",
"99999"
]
]
]
],
"geography.STATE_DUAL_MULT": {
"AL": 1.2,
"AZ": 0.9,
"CA": 1.1,
"CO": 0.85,
"CT": 1.0,
"FL": 1.05,
"GA": 0.95,
"IL": 1.0,
"IN": 1.0,
"KY": 1.2,
"LA": 1.3,
"MA": 1.1,
"MI": 1.1,
"MN": 0.9,
"MO": 1.05,
"MS": 1.45,
"NC": 1.0,
"NJ": 1.05,
"NY": 1.25,
"OH": 1.05,
"OK": 1.1,
"OR": 0.9,
"PA": 1.1,
"SC": 1.1,
"TN": 1.05,
"TX": 0.95,
"UT": 0.8,
"VA": 0.9,
"WA": 0.9,
"WI": 0.95,
"WV": 1.4,
"XX": 1.0
},
"hcc_library.HCC_HIERARCHY": {
"HCC1": [
"HCC6"
],
"HCC10": [
"HCC11",
"HCC12"
],
"HCC100": [
"HCC99"
],
"HCC103": [
"HCC104"
],
"HCC104": [],
"HCC106": [
"HCC107",
"HCC108"
],
"HCC107": [
"HCC108"
],
"HCC108": [],
"HCC11": [
"HCC12"
],
"HCC111": [
"HCC112"
],
"HCC112": [],
"HCC114": [
"HCC115"
],
"HCC115": [],
"HCC12": [],
"HCC134": [
"HCC135",
"HCC136",
"HCC137",
"HCC138"
],
"HCC135": [
"HCC136",
"HCC137",
"HCC138"
],
"HCC136": [
"HCC137",
"HCC138"
],
"HCC137": [
"HCC138"
],
"HCC138": [],
"HCC157": [
"HCC158",
"HCC159"
],
"HCC158": [
"HCC159"
],
"HCC159": [],
"HCC169": [],
"HCC17": [
"HCC18",
"HCC19"
],
"HCC170": [
"HCC169"
],
"HCC18": [
"HCC19"
],
"HCC19": [],
"HCC27": [
"HCC28",
"HCC29"
],
"HCC28": [
"HCC29"
],
"HCC29": [],
"HCC46": [
"HCC47",
"HCC48"
],
"HCC47": [
"HCC48"
],
"HCC48": [],
"HCC51": [
"HCC52"
],
"HCC52": [],
"HCC54": [
"HCC55",
"HCC56"
],
"HCC55": [
"HCC56"
],
"HCC56": [],
"HCC57": [
"HCC58",
"HCC59",
"HCC60"
],
"HCC58": [
"HCC59",
"HCC60"
],
"HCC59": [
"HCC60"
],
"HCC6": [],
"HCC60": [],
"HCC70": [
"HCC71",
"HCC72",
"HCC103",
"HCC104"
],
"HCC71": [
"HCC72",
"HCC103",
"HCC104"
],
"HCC72": [
"HCC103",
"HCC104"
],
"HCC8": [
"HCC9",
"HCC10",
"HCC11",
"HCC12"
],
"HCC85": [],
"HCC86": [
"HCC87",
"HCC88"
],
"HCC87": [
"HCC88"
],
"HCC88": [],
"HCC9": [
"HCC10",
"HCC11",
"HCC12"
],
"HCC99": []
},
"hcc_library.N_HCCS": 81,
"hcc_library.codes": [
"HCC1",
"HCC2",
"HCC6",
"HCC8",
"HCC9",
"HCC10",
"HCC11",
"HCC12",
"HCC17",
"HCC18",
"HCC19",
"HCC21",
"HCC22",
"HCC23",
"HCC27",
"HCC28",
"HCC29",
"HCC34",
"HCC35",
"HCC40",
"HCC43",
"HCC46",
"HCC47",
"HCC48",
"HCC51",
"HCC52",
"HCC54",
"HCC55",
"HCC56",
"HCC57",
"HCC58",
"HCC59",
"HCC60",
"HCC70",
"HCC71",
"HCC72",
"HCC73",
"HCC74",
"HCC75",
"HCC77",
"HCC78",
"HCC79",
"HCC80",
"HCC82",
"HCC83",
"HCC84",
"HCC85",
"HCC86",
"HCC87",
"HCC88",
"HCC96",
"HCC99",
"HCC100",
"HCC103",
"HCC104",
"HCC106",
"HCC107",
"HCC108",
"HCC110",
"HCC111",
"HCC112",
"HCC114",
"HCC115",
"HCC110A",
"HCC134",
"HCC135",
"HCC136",
"HCC137",
"HCC138",
"HCC157",
"HCC158",
"HCC159",
"HCC161",
"HCC162",
"HCC166",
"HCC169",
"HCC170",
"HCC176",
"HCC186",
"HCC188",
"HCC189"
],
"hcc_library.summary": {
"HCC1": {
"drug_classes": [
"ARV"
],
"dual_multiplier": 1.8,
"hierarchy_group": "INFECTION",
"hierarchy_rank": 1,
"label": "HIV/AIDS",
"n_typical_dx": 2,
"prevalence_base": 0.005,
"v24_coef": 0.35,
"v28_coef": 0.3
},
"HCC10": {
"drug_classes": [
"ONCOLOGY_IV"
],
"dual_multiplier": 1.05,
"hierarchy_group": "CANCER",
"hierarchy_rank": 3,
"label": "Lymphoma & Other Cancers",
"n_typical_dx": 3,
"prevalence_base": 0.018,
"v24_coef": 0.68,
"v28_coef": 0.75
},
"HCC100": {
"drug_classes": [
"ANTIPLATELET",
"STATIN"
],
"dual_multiplier": 1.2,
"hierarchy_group": "STROKE",
"hierarchy_rank": 1,
"label": "Ischemic / Hemorrhagic Stroke (Acute)",
"n_typical_dx": 2,
"prevalence_base": 0.012,
"v24_coef": 0.24,
"v28_coef": 0.3
},
"HCC103": {
"drug_classes": [],
"dual_multiplier": 1.3,
"hierarchy_group": "PARALYSIS",
"hierarchy_rank": 4,
"label": "Hemiplegia/Hemiparesis",
"n_typical_dx": 1,
"prevalence_base": 0.008,
"v24_coef": 0.43,
"v28_coef": 0.4
},
"HCC104": {
"drug_classes": [],
"dual_multiplier": 1.3,
"hierarchy_group": "PARALYSIS",
"hierarchy_rank": 5,
"label": "Monoplegia, Other Paralytic Syndromes",
"n_typical_dx": 1,
"prevalence_base": 0.004,
"v24_coef": 0.32,
"v28_coef": 0.3
},
"HCC106": {
"drug_classes": [
"ANTIPLATELET"
],
"dual_multiplier": 1.4,
"hierarchy_group": "VASCULAR",
"hierarchy_rank": 1,
"label": "Atherosclerosis of Extremities w/ Ulceration/Gangrene",
"n_typical_dx": 2,
"prevalence_base": 0.008,
"v24_coef": 1.32,
"v28_coef": 1.2
},
"HCC107": {
"drug_classes": [
"ANTIPLATELET",
"STATIN"
],
"dual_multiplier": 1.2,
"hierarchy_group": "VASCULAR",
"hierarchy_rank": 2,
"label": "Vascular Disease w/ Complications",
"n_typical_dx": 2,
"prevalence_base": 0.025,
"v24_coef": 0.38,
"v28_coef": 0.35
},
"HCC108": {
"drug_classes": [
"STATIN",
"ANTIPLATELET"
],
"dual_multiplier": 1.1,
"hierarchy_group": "VASCULAR",
"hierarchy_rank": 3,
"label": "Vascular Disease",
"n_typical_dx": 2,
"prevalence_base": 0.165,
"v24_coef": 0.3,
"v28_coef": 0.28
},
"HCC11": {
"drug_classes": [
"ONCOLOGY_ORAL"
],
"dual_multiplier": 1.0,
"hierarchy_group": "CANCER",
"hierarchy_rank": 4,
"label": "Colorectal, Bladder, Other Cancers",
"n_typical_dx": 3,
"prevalence_base": 0.035,
"v24_coef": 0.31,
"v28_coef": 0.35
},
"HCC110": {
"drug_classes": [
"BRONCHODILATOR"
],
"dual_multiplier": 1.3,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Cystic Fibrosis",
"n_typical_dx": 1,
"prevalence_base": 0.0008,
"v24_coef": 0.5,
"v28_coef": 0.45
},
"HCC110A": {
"drug_classes": [
"ICS",
"BRONCHODILATOR"
],
"dual_multiplier": 1.15,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Asthma",
"n_typical_dx": 2,
"prevalence_base": 0.08,
"v24_coef": 0.0,
"v28_coef": 0.0
},
"HCC111": {
"drug_classes": [
"BRONCHODILATOR",
"ICS",
"LAMA"
],
"dual_multiplier": 1.25,
"hierarchy_group": "COPD",
"hierarchy_rank": 1,
"label": "COPD",
"n_typical_dx": 3,
"prevalence_base": 0.11,
"v24_coef": 0.34,
"v28_coef": 0.32
},
"HCC112": {
"drug_classes": [
"BRONCHODILATOR"
],
"dual_multiplier": 1.15,
"hierarchy_group": "COPD",
"hierarchy_rank": 2,
"label": "Fibrosis of Lung & Other Chronic Lung Disorders",
"n_typical_dx": 2,
"prevalence_base": 0.025,
"v24_coef": 0.22,
"v28_coef": 0.2
},
"HCC114": {
"drug_classes": [
"ANTIBIOTIC_BROAD"
],
"dual_multiplier": 1.3,
"hierarchy_group": "PNEUMONIA",
"hierarchy_rank": 1,
"label": "Aspiration & Specified Bacterial Pneumonias",
"n_typical_dx": 2,
"prevalence_base": 0.02,
"v24_coef": 0.51,
"v28_coef": 0.45
},
"HCC115": {
"drug_classes": [
"ANTIBIOTIC_BROAD"
],
"dual_multiplier": 1.2,
"hierarchy_group": "PNEUMONIA",
"hierarchy_rank": 2,
"label": "Pneumococcal Pneumonia, Empyema, Lung Abscess",
"n_typical_dx": 1,
"prevalence_base": 0.01,
"v24_coef": 0.13,
"v28_coef": 0.12
},
"HCC12": {
"drug_classes": [
"ONCOLOGY_ORAL",
"HORMONE_BLOCKERS"
],
"dual_multiplier": 1.0,
"hierarchy_group": "CANCER",
"hierarchy_rank": 5,
"label": "Breast, Prostate & Other Cancers/Tumors",
"n_typical_dx": 3,
"prevalence_base": 0.075,
"v24_coef": 0.15,
"v28_coef": 0.18
},
"HCC134": {
"drug_classes": [
"ESA",
"PHOSPHATE_BINDER"
],
"dual_multiplier": 1.4,
"hierarchy_group": "RENAL",
"hierarchy_rank": 1,
"label": "Dialysis Status (ESRD)",
"n_typical_dx": 2,
"prevalence_base": 0.012,
"v24_coef": 1.46,
"v28_coef": 1.5
},
"HCC135": {
"drug_classes": [],
"dual_multiplier": 1.2,
"hierarchy_group": "RENAL",
"hierarchy_rank": 2,
"label": "Acute Renal Failure",
"n_typical_dx": 2,
"prevalence_base": 0.04,
"v24_coef": 0.43,
"v28_coef": 0.4
},
"HCC136": {
"drug_classes": [
"ESA",
"PHOSPHATE_BINDER"
],
"dual_multiplier": 1.3,
"hierarchy_group": "RENAL",
"hierarchy_rank": 3,
"label": "Chronic Kidney Disease, Stage 5",
"n_typical_dx": 1,
"prevalence_base": 0.018,
"v24_coef": 0.29,
"v28_coef": 0.28
},
"HCC137": {
"drug_classes": [],
"dual_multiplier": 1.25,
"hierarchy_group": "RENAL",
"hierarchy_rank": 4,
"label": "Chronic Kidney Disease, Stage 4",
"n_typical_dx": 1,
"prevalence_base": 0.025,
"v24_coef": 0.29,
"v28_coef": 0.2
},
"HCC138": {
"drug_classes": [],
"dual_multiplier": 1.15,
"hierarchy_group": "RENAL",
"hierarchy_rank": 5,
"label": "Chronic Kidney Disease, Stage 3",
"n_typical_dx": 3,
"prevalence_base": 0.105,
"v24_coef": 0.1,
"v28_coef": 0.1
},
"HCC157": {
"drug_classes": [],
"dual_multiplier": 1.5,
"hierarchy_group": "WOUND",
"hierarchy_rank": 1,
"label": "Pressure Ulcer of Skin, Stage 4",
"n_typical_dx": 1,
"prevalence_base": 0.003,
"v24_coef": 1.93,
"v28_coef": 1.8
},
"HCC158": {
"drug_classes": [],
"dual_multiplier": 1.45,
"hierarchy_group": "WOUND",
"hierarchy_rank": 2,
"label": "Pressure Ulcer of Skin, Stage 3",
"n_typical_dx": 1,
"prevalence_base": 0.006,
"v24_coef": 0.97,
"v28_coef": 0.95
},
"HCC159": {
"drug_classes": [],
"dual_multiplier": 1.4,
"hierarchy_group": "WOUND",
"hierarchy_rank": 3,
"label": "Pressure Ulcer of Skin, Unstageable / Other",
"n_typical_dx": 1,
"prevalence_base": 0.012,
"v24_coef": 0.51,
"v28_coef": 0.5
},
"HCC161": {
"drug_classes": [],
"dual_multiplier": 1.2,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Chronic Ulcer of Skin, Except Pressure",
"n_typical_dx": 1,
"prevalence_base": 0.025,
"v24_coef": 0.45,
"v28_coef": 0.4
},
"HCC162": {
"drug_classes": [],
"dual_multiplier": 1.2,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Severe Skin Burn or Condition",
"n_typical_dx": 1,
"prevalence_base": 0.002,
"v24_coef": 0.5,
"v28_coef": 0.45
},
"HCC166": {
"drug_classes": [],
"dual_multiplier": 1.2,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Severe Head Injury",
"n_typical_dx": 1,
"prevalence_base": 0.003,
"v24_coef": 0.51,
"v28_coef": 0.5
},
"HCC169": {
"drug_classes": [],
"dual_multiplier": 1.2,
"hierarchy_group": "FRACTURE",
"hierarchy_rank": 2,
"label": "Vertebral Fractures w/o Spinal Cord Injury",
"n_typical_dx": 1,
"prevalence_base": 0.018,
"v24_coef": 0.46,
"v28_coef": 0.42
},
"HCC17": {
"drug_classes": [
"INSULIN",
"BIGUANIDES"
],
"dual_multiplier": 1.4,
"hierarchy_group": "DIABETES",
"hierarchy_rank": 1,
"label": "Diabetes w/ Acute Complications",
"n_typical_dx": 3,
"prevalence_base": 0.02,
"v24_coef": 0.36,
"v28_coef": 0.3
},
"HCC170": {
"drug_classes": [],
"dual_multiplier": 1.25,
"hierarchy_group": "FRACTURE",
"hierarchy_rank": 1,
"label": "Hip Fracture / Dislocation",
"n_typical_dx": 2,
"prevalence_base": 0.012,
"v24_coef": 0.4,
"v28_coef": 0.55
},
"HCC176": {
"drug_classes": [],
"dual_multiplier": 1.15,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Complications of Specified Implanted Device or Graft",
"n_typical_dx": 2,
"prevalence_base": 0.02,
"v24_coef": 0.55,
"v28_coef": 0.5
},
"HCC18": {
"drug_classes": [
"BIGUANIDES",
"SGLT2",
"GLP1",
"INSULIN",
"DPP4"
],
"dual_multiplier": 1.35,
"hierarchy_group": "DIABETES",
"hierarchy_rank": 2,
"label": "Diabetes w/ Chronic Complications",
"n_typical_dx": 7,
"prevalence_base": 0.13,
"v24_coef": 0.3,
"v28_coef": 0.17
},
"HCC186": {
"drug_classes": [
"IMMUNOSUPPRESSANT"
],
"dual_multiplier": 1.1,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Major Organ Transplant Status (except Kidney/Pancreas)",
"n_typical_dx": 2,
"prevalence_base": 0.003,
"v24_coef": 0.84,
"v28_coef": 0.8
},
"HCC188": {
"drug_classes": [],
"dual_multiplier": 1.3,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Artificial Openings for Feeding or Elimination",
"n_typical_dx": 2,
"prevalence_base": 0.008,
"v24_coef": 0.61,
"v28_coef": 0.58
},
"HCC189": {
"drug_classes": [],
"dual_multiplier": 1.3,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Amputation Status (Lower Limb / Toes)",
"n_typical_dx": 1,
"prevalence_base": 0.006,
"v24_coef": 0.52,
"v28_coef": 0.5
},
"HCC19": {
"drug_classes": [
"BIGUANIDES",
"SGLT2",
"DPP4"
],
"dual_multiplier": 1.2,
"hierarchy_group": "DIABETES",
"hierarchy_rank": 3,
"label": "Diabetes w/o Complications",
"n_typical_dx": 2,
"prevalence_base": 0.14,
"v24_coef": 0.11,
"v28_coef": 0.1
},
"HCC2": {
"drug_classes": [
"ANTIBIOTIC_BROAD"
],
"dual_multiplier": 1.35,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Septicemia / Severe Sepsis",
"n_typical_dx": 4,
"prevalence_base": 0.02,
"v24_coef": 0.51,
"v28_coef": 0.65
},
"HCC21": {
"drug_classes": [],
"dual_multiplier": 1.6,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Protein-Calorie Malnutrition",
"n_typical_dx": 3,
"prevalence_base": 0.015,
"v24_coef": 0.55,
"v28_coef": 0.5
},
"HCC22": {
"drug_classes": [
"GLP1"
],
"dual_multiplier": 1.25,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Morbid Obesity",
"n_typical_dx": 2,
"prevalence_base": 0.075,
"v24_coef": 0.25,
"v28_coef": 0.2
},
"HCC23": {
"drug_classes": [
"THYROID"
],
"dual_multiplier": 1.1,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Other Significant Endocrine/Metabolic",
"n_typical_dx": 2,
"prevalence_base": 0.03,
"v24_coef": 0.2,
"v28_coef": 0.18
},
"HCC27": {
"drug_classes": [
"DIURETIC_K_SPARING"
],
"dual_multiplier": 1.4,
"hierarchy_group": "LIVER",
"hierarchy_rank": 1,
"label": "End-Stage Liver Disease",
"n_typical_dx": 3,
"prevalence_base": 0.01,
"v24_coef": 0.93,
"v28_coef": 1.1
},
"HCC28": {
"drug_classes": [],
"dual_multiplier": 1.3,
"hierarchy_group": "LIVER",
"hierarchy_rank": 2,
"label": "Cirrhosis of Liver",
"n_typical_dx": 2,
"prevalence_base": 0.013,
"v24_coef": 0.36,
"v28_coef": 0.4
},
"HCC29": {
"drug_classes": [
"ANTIVIRAL_HEP"
],
"dual_multiplier": 1.2,
"hierarchy_group": "LIVER",
"hierarchy_rank": 3,
"label": "Chronic Hepatitis",
"n_typical_dx": 2,
"prevalence_base": 0.015,
"v24_coef": 0.18,
"v28_coef": 0.2
},
"HCC34": {
"drug_classes": [
"PANCREATIC_ENZYME"
],
"dual_multiplier": 1.35,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Chronic Pancreatitis",
"n_typical_dx": 2,
"prevalence_base": 0.006,
"v24_coef": 0.3,
"v28_coef": 0.28
},
"HCC35": {
"drug_classes": [
"BIOLOGIC_TNF"
],
"dual_multiplier": 1.1,
"hierarchy_group": null,
"hierarchy_rank": 0,
"label": "Inflammatory Bowel Disease",
"n_typical_dx": 2,
"prevale
Full file: knobs.json
config_snapshot/ contains the verbatim source code of config/, engine/, core/, scripts/, versions/, reporters/, validate/ at run time.