global risk
glbl_rsk_indDefinition
ISO-11179 Definition
A boolean indicator identifying a value based care arrangement in which a provider organization or health plan accepts full financial responsibility for the total cost of all healthcare services for an attributed population, receiving a fixed capitation payment that covers all covered services regardless of actual utilization. Global risk is the most advanced form of value based payment, transferring essentially all insurance risk from the payer to the provider organization. Under global risk arrangements, provider organizations act as quasi-insurers — they profit when they deliver care efficiently below the capitation rate and lose money when care costs exceed the capitation amount.
Global risk requires sophisticated actuarial capabilities, robust care management infrastructure, and adequate financial reserves to withstand adverse utilization experience. Healthcare data teams build global risk financial management systems that track capitation receipts, aggregate all attributed member claims costs, calculate monthly and quarterly profit and loss positions under the global risk arrangement, and model reserve requirements based on actuarial projections of potential loss scenarios.
Standard Abbreviation
glbl_rsk_ind
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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