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For Developers

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A healthcare developer’s guide to utilizing the Insight API for HCC risk profiling

Building HCC risk profiles or risk adjustment profiles (RAPs) no longer has to be labor intensive. Designed for use by developers computing HCC risk adjustment profiles, the Insight API ingests a FHIR bundle and calculates a risk score. The Insight API is part of CareEvolution’s Orchestrate platform, a set of cloud native APIs that extract actionable insights from large raw datasets such as FHIR bundles in a few simple steps.

Building an HCC Risk Profile with the Insight API involves:

  1. Creating a (free) account in our developer sandbox.
  2. Optional: Data Integration using the Convert API. Convert the data from CDA or HL7 to FHIR prior to using Insight, if needed.
  3. Optional: Combine FHIR bundles from multiple sources, if needed, into a FHIR R4 bundle containing data for a single patient for input into the Insight API.
  4. In the Insight API—use the Risk Profile operation to build the risk profile with FHIR bundles.

The Insight API processes this integrated data through its algorithm to identify trends, anomalies, and potential areas for intervention.

The output is a new FHIR R4 bundle detailing the CMS Hierarchical risk adjustment model, a roll-up of diagnoses into Hierarchical Condition Categories, and an overall HCC score. For a detailed breakdown of the output see our developer documentation. The Insight API can be used to calculate Risk Profiles for any number of patient records quickly and easily. Try the Insight API’s Risk Profile operation in our sandbox today.

Why to Consider Optional Steps 2 & 3

The Orchestrate APIs are designed to clean, standardize and consolidate patient data to make it more usable. With a simple API key (no software installation), developers and data managers can quickly compile consolidated patient records which can be used to build risk profiles. This data consolidation is described in the optional steps 2 & 3 outlined above.

How the Convert and Standardize APIs Can Enhance your RAP

Prior to using the Insight API, the Convert API and Terminology API can handle conversion to a consistent format, standardization of terminology, uplift of uncoded data, and deduplication which form enriched, longitudinal patient records. This allows more complete and comprehensive data to feed into the Insight API, for a more meaningful risk adjustment profile.

About the Orchestrate APIs

The Orchestrate platform is a set of cloud native APIs that extract actionable insights from large raw datasets such as FHIR bundles in a few simple steps. With no software to install or manage, and no set up or preconfiguration, developers can try the Orchestrate APIs in our sandbox for free.