Risk score YoY delta distribution
AVG_RISK_SCORE delta by county · source: derived
Risk score growth vs. expenditure efficiency ratio
X: YoY delta (%) · Y: PER_CAPITA_EXP / AVG_RISK_SCORE ($/unit) · source: derived
OC-cut stability — risk score across data cuts
Operational cut → Final · a large cut-to-final delta is a late-coding pattern (single-source HCC proxy) · source: derived
Top flagged counties — RADV risk composite ranking
Illustrative weights — pending empirical validation against RADV audit outcome data. Sensitivity: test 0.5/0.3/0.2 and 0.33/0.33/0.33 per v5 spec.
Counties with YoY risk score growth >10% AND expenditure growth exceeding the national trend factor show HCC concentration patterns consistent with RADV audit targeting criteria. For ESRD enrollment type, a positive V28 delta signals CKD coding specificity opportunity — CHF+CKD combinations rewarded under V28 when documented at Stage 4/5. Aged Non-Dual counties showing negative V28 delta face vascular disease and metabolic HCC compression unrelated to actual health change.
ACO financial performance distribution
Simulated shared savings / loss · MSR threshold marked · source: derived
Benchmark vs. actual · by RAF quartile
Per-beneficiary · risk-adjusted · source: derived + constant ref
Benchmark version skew — V24 vs. V28
Methodology artifact vs. genuine performance change · per enrollment type · V28 full implementation CY2026 · source: external ref + constant
Directional estimates from CMS Announcement Tables VIII-1 / VI-1 — national V28 delta factors by enrollment type.
Shared savings by RAF band · with MSR filter
ACOs with RAF scores above 1.20 systematically exceed benchmark under Track A. The V28 adjustment column shows increasing negative skew at higher RAF bands — the version skew is largest exactly where financial pressure is already highest. The 0.86–1.00 band is the analytically interesting case: counties are generating savings but failing to clear MSR, meaning the benchmark methodology penalizes moderate-complexity populations. TEAM episode pricing will face the same dynamic for surgical patients with comorbidities in the 1.01–1.20 RAF range.
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Payer disclosure metrics
Request volume
CMS-required PA metric fields
MSSP-aligned populations show slightly elevated simulated denial rates vs. Medicare FFS, consistent with higher specialty utilization in ACO populations. Field 4 (appeal approval rate) shows the largest gap vs. MA benchmarks — suggesting ACO-adjacent populations face more defensible initial denials, or lower propensity to appeal. Field 5 (extended review) has no public benchmark — an analytical gap in the CMS-0057-F public reporting schema itself, not a data limitation of this simulation.