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full risk

full_rsk_ind
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

A boolean indicator identifying a healthcare payment arrangement in which a provider organization accepts complete financial accountability for the total cost of care for a defined population, bearing both upside savings potential and full downside loss exposure without the risk corridor protections or loss sharing limits typical of intermediate value based payment models. Full risk arrangements represent the endpoint of the value based payment progression — organizations that accept full risk operate as risk-bearing entities similar to insurance companies and must comply with state insurance regulations in many markets. Medicare Advantage plans accept full risk from CMS through the capitation payment system.

Provider-sponsored organizations and integrated delivery systems with mature care management capabilities may accept full professional or global risk from health plans through delegated risk arrangements. Healthcare data teams supporting full risk organizations build comprehensive financial reporting systems that reconcile capitation receipts against claim costs, track medical loss ratios, calculate IBNR reserves for incurred but not yet reported claims, and produce actuarial analyses supporting regulatory capital adequacy requirements.

Standard Abbreviation

full_rsk_ind

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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