edgedata - Datasets that Support the EDGE Server DIY Logic

Datasets from most recent Center for Consumer Information and Insurance Oversight (CCIIO) DIY entry in a tidy format. These support the Centers for Medicare and Medicaid Services' (CMS) risk adjustment Do-It-Yourself (DIY) process, which allows health insurance issuers to calculate member risk profiles under the Health and Human Services-Hierarchical Condition Categories (HHS-HCC) regression model. This regression model is used to calculate risk adjustment transfers. Risk adjustment is a selection mitigation program implemented under the Patient Protection and Affordable Care Act (ACA or Obamacare) in the USA. Under the ACA, health insurance issuers submit claims data to CMS in order for CMS to calculate a risk score under the HHS-HCC regression model. However, CMS does not inform issuers of their average risk score until after the data submission deadline. These data sets can be used by issuers to calculate their average risk score mid-year. More information about risk adjustment and the HHS-HCC model can be found here: <https://www.cms.gov/mmrr/Articles/A2014/MMRR2014_004_03_a03.html>.