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aco benchmark

aco_bnchmark_amt
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

The risk-adjusted per capita expenditure target established for a specific Accountable Care Organization at the start of a performance year, representing the spending level below which the ACO must perform to generate shared savings. ACO benchmarks are calculated from three years of historical Medicare claims data for the attributed population, adjusted for changes in patient risk scores between the benchmark period and performance year, and updated with national trend factors. Benchmark rebasing occurs periodically to reset the spending target based on more recent data, which can significantly affect ACO financial performance especially for organizations that have successfully reduced costs below their historical baseline.

Healthcare data teams maintain ACO benchmark calculations that track year-over-year benchmark changes, model the impact of risk score fluctuations on benchmark adjustments, calculate projected shared savings at current spending run rates, and identify the cost reduction opportunities needed to achieve savings targets when actual spending trends above the benchmark.

Standard Abbreviation

aco_bnchmark_amt

Category

quality

Production DDL — FACT_QUALITY_MEASURE

FACT_QUALITY_MEASURE.sql
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
    qlty_key        INTEGER        NOT NULL  -- surrogate key,
    mbr_key         INTEGER        NOT NULL  -- FK to DIM_MEMBER,
    plan_key        INTEGER        NOT NULL  -- FK to DIM_PLAN,
    meas_yr         SMALLINT                 -- measurement year,
    hedis_meas_cd   VARCHAR(20)              -- HEDIS measure code,
    denom_ind       CHAR(1)                  -- denominator eligible,
    numer_ind       CHAR(1)                  -- numerator met,
    excl_ind        CHAR(1)                  -- exclusion indicator,
    gap_open_ind    CHAR(1)                  -- care gap open,
    star_rtg_nbr    DECIMAL(3,1)             -- star rating,
    qlty_scr        DECIMAL(5,2)             -- quality score,
    perf_thrsh_pct  DECIMAL(5,2)             -- performance threshold,
    raf_scr         DECIMAL(10,3)            -- risk adjustment factor,
    outreach_cnt    SMALLINT                 -- outreach attempts,
    load_dt         TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →

Why This Term Matters

Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.

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