Physician / Concierge Medicine
A primary care or concierge practice managing patients across the senior care continuum. The Kareplexity angle: the same physician follows a patient through IL → AL → SNF → HH transitions; we stitch the longitudinal record together. HCC capture, AWV compliance, and TCM (Transitional Care) billing are the operational levers.
v0.1.27 — real CMS-HCC v28 lookup
As of v0.1.27, HCC eligibility is computed against the published CMS-HCC v28 ICD-10 → HCC crosswalk (16,389 rows, sourced via the medicare-reference-data project). The panel below scores every active resident across all 5 facilities — not hand-crafted illustrative cases.
Active residents
66
across portfolio
Residents with HCCs
58
88% of active panel
Avg HCCs / resident
2.8
13 distinct categories observed
Top HCC
329
39 residents
Reimbursement model
Standard
$0
annual retainer (none — Medicare Part B FFS only)
Concierge Basic
$1,800
annual retainer + FFS
Concierge Premium
$5,000
annual retainer + FFS
Top HCC categories across the panel
HCC 329
39
residents
HCC 127
38
residents
HCC 238
28
residents
HCC 226
21
residents
HCC 38
20
residents
HCC 280
8
residents
HCC 402
2
residents
HCC 199
2
residents
Top 15 residents by HCC burden (live)
HCC count = distinct CMS-HCC v28 categories that the resident's diagnoses map to. Higher count = higher Medicare Advantage premium adjustment. Capturing all applicable HCCs annually is the major revenue lever for concierge practices on capitated MA contracts.
| Resident | Vertical | Age | Payer | Total dx | HCC dx | Distinct HCCs | Top HCC categories |
|---|---|---|---|---|---|---|---|
Darnell Washington KaraDayDemo Houston SNF | SNF | 74 | medicare | 7 | 5 | 5 | 38238329127 |
Ruben Garza KaraDayDemo Hospice | Hospice | 87 | medicare | 6 | 5 | 5 | 15528022638 |
Robert Tyndall KaraDayDemo Houston SNF | SNF | 82 | medicaid | 6 | 4 | 4 | 238329127226 |
James Okafor KaraDayDemo Home Health | HH | 70 | medicaid | 8 | 4 | 4 | 37226329238 |
Darnell Watkins KaraDayDemo Houston SNF | SNF | 74 | medicaid | 6 | 4 | 4 | 127329226238 |
Evelyn Strickland KaraDayDemo Houston SNF | SNF | 88 | medicaid | 7 | 4 | 4 | 402329226127 |
Patricia Nguyen KaraDayDemo Home Health | HH | 72 | private | 8 | 4 | 4 | 22638329238 |
Patricia Guillory KaraDayDemo Houston SNF | SNF | 70 | managed_medicare | 7 | 4 | 4 | 38329238226 |
Margaret Holsworth KaraDayDemo Houston SNF | SNF | 78 | ltc_insurance | 7 | 4 | 4 | 329127226402 |
Linda Bergstrom KaraDayDemo Houston SNF | SNF | 72 | medicare | 7 | 4 | 4 | 12728038329 |
Earl Thibodeau KaraDayDemo Home Health | HH | 81 | medicare | 8 | 4 | 4 | 381226238329 |
Carlos Fuentes KaraDayDemo Houston SNF | SNF | 68 | managed_medicare | 7 | 4 | 4 | 23838280329 |
Sylvia Okafor KaraDayDemo Houston SNF | SNF | 70 | medicare | 7 | 4 | 4 | 32923838127 |
Darnell Bridges KaraDayDemo Houston SNF | SNF | 74 | managed_medicare | 7 | 4 | 4 | 22612732938 |
Yuki Tanaka KaraDayDemo Home Health | HH | 76 | managed_medicare | 8 | 4 | 4 | 226199238329 |
Visit type taxonomy
Reimbursement unit: Monthly retainer + per-visit FFS + AWV/CCM/TCM codes. HCC eligibility check via lib/verticals/physician/isHccEligible() which looks up the CMS-HCC v28 crosswalk loaded from lib/data/cms/hcc_v28_icd10_crosswalk.csv. v0.5 will add HCC weighting (each category has a CMS-published RAF coefficient that compounds into the total Medicare Advantage premium adjustment) and per-patient capture-ratio tracking against prior-year captured HCCs.