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shared losses

shrd_loss_amt
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

The financial obligation owed by healthcare providers participating in two-sided risk value based care arrangements when their total cost of care for the attributed population exceeds the established expenditure benchmark by more than the minimum savings or losses threshold. Shared losses represent the downside financial risk that distinguishes advanced two-sided risk tracks from one-sided savings-only arrangements. In MSSP two-sided tracks, ACOs must repay a percentage of losses above the minimum loss rate up to a maximum loss sharing limit.

The decision to accept downside risk is significant for provider organizations and requires sophisticated financial modeling of potential loss scenarios and risk mitigation strategies. Healthcare data teams calculate projected shared losses by measuring the gap between actual and benchmark expenditure, applying the applicable loss sharing rate from the contract, monitoring in-year spending trends to project final settlement amounts, and modeling risk mitigation interventions including care management programs and utilization management initiatives.

Standard Abbreviation

shrd_loss_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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