cost efficiency
cst_eff_scrDefinition
ISO-11179 Definition
A composite measure comparing a provider or health plan total cost of care for an attributed patient population against a risk-adjusted benchmark representing expected efficient spending, used to identify high-value providers and calculate performance-based payment adjustments in value based contracts. Cost efficiency scores typically express actual spending as a percentage of expected spending — scores below 100 percent indicate spending below the benchmark representing efficient care while scores above 100 percent indicate excess spending above benchmark. Cost efficiency is measured at multiple granularity levels including total cost of care, service category costs, and episode-specific costs to identify specific utilization patterns driving overall efficiency.
Healthcare data teams calculate cst_eff_scr by applying risk adjustment models to normalize population complexity, comparing risk-adjusted actual costs against expected benchmark costs, decomposing efficiency variance into service category drivers, and producing provider-level efficiency scorecards used in value based payment performance reviews and tiered network placement decisions.
Standard Abbreviation
cst_eff_scr
Category
Production DDL — FACT_QUALITY_MEASURE
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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