HCCs correlate with which attributes of member care?

HCCs correlate with which attributes of member care?

• A. Patient satisfaction scores
• B. Pharmacy rebates
• C. Hospital bed occupancy
• D. Relative severity and projected costs of providing medical care

Answer: (D)

Hierarchical Condition Categories are designed to quantify a patient’s medical complexity by grouping diagnoses in a way that reflects how severe their illnesses are. This severity and mix of conditions feed into a risk score that forecasts how much care a member will typically need and what those costs will be. So the strongest link is between the burden of illness (relative severity and combination of conditions) and the projected costs of providing medical care. That’s why this option best captures what HCCs correlate with. Notes on the other ideas: patient satisfaction scores measure perceptions of care rather than the clinical burden or expected costs; pharmacy rebates are financial negotiations not tied to an individual’s health status; hospital bed occupancy reflects capacity and utilization, not the underlying severity or cost of a patient’s health conditions.

Hierarchical Condition Categories are designed to quantify a patient’s medical complexity by grouping diagnoses in a way that reflects how severe their illnesses are. This severity and mix of conditions feed into a risk score that forecasts how much care a member will typically need and what those costs will be. So the strongest link is between the burden of illness (relative severity and combination of conditions) and the projected costs of providing medical care. That’s why this option best captures what HCCs correlate with.

Notes on the other ideas: patient satisfaction scores measure perceptions of care rather than the clinical burden or expected costs; pharmacy rebates are financial negotiations not tied to an individual’s health status; hospital bed occupancy reflects capacity and utilization, not the underlying severity or cost of a patient’s health conditions.