HealthNexus™
PurpleLab’s Medical Terminology Platform
Overlaying HealthNexus™
Onto our Claims Repository enables PurpleLab to recognize healthcare events, including various diagnoses by anonymized patient.
HealthNexus™
Platform
HealthNexus™ is PurpleLab’s Master Data Management platform for managing medical relevant for Claim-based events. 100 plus Vocabularies used to codify Claim transactions. Includes relevant ICD9 and ICD10 CM Vocabularies. We manage all versions of ICD9 and ICD10 CM Vocabularies to track Adds, Changes and Deletes at the concept level
ICD9 CM & ICD 10 CM
aggregated to HCCs
16,000 ICD9 and ICD10 CM or diagnosis codes were mapped to the 90 CMS Hierarchical Condition Category (HCCs). CMS HCCs are “assigned” to anonymized patients based on the presence of an ICD9 or ICD10 CM code being observed in a patient’s record. Coronavirus appears to have increased morbidity and mortality related to certain CMS HCCs. Specifically those suggestive of underlying immuno-compromise and/or cardio-respiratory compromise.
HealthNexus™ is PurpleLab’s medical terminology master data management platform. The HealthNexus™ API enables you to maximize identification of encounters, exposures & events across structured and unstructured healthcare data.
The HealthNexus™ API enables centralized governance and management of concept groups. Concept groups are a semantic abstraction that HealthNexus™ supports. Each concept group is made up of multiple concepts from one or more vocabularies. Concepts are the codes contained and defined by a given vocabulary. These concepts, in turn, appear in both the medical and pharmacy claim transactions. Concept groups harmonize disparate codes that record semantically similar events, such as diagnoses, procedures, medications and tests. in health care.
HealthNexus™ comes pre-populated with more than 85,000 concept groups build for more than 100 vocabularies across more than 30 domains of interest. Vocabularies are updated on a daily, weekly, monthly or quarterly basis.
HealthNexus™ supports multiple versions of two of the most used vocabularies to codify healthcare-related claims:
a. International Classification of Disease 9th Edition ICD-9
(https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/Risk2014)
b. International Classification of Disease 10th Edition ICD-10
(https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/Risk2020)
The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9 CM) and The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD10 CM) vocabularies were originally developed by the World Health Organization (WHO) to classify diagnosis associated with claims transactions, including ICD11 CM (which is currently in use in other countries). PurpleLab systematically updates these vocabularies as new versions are released within HealthNexus™. Currently, HealthNexus™ stores: (i) the latest version 32 and older versions of ICD9 CM; and (ii) the current 2020 and older versions of ICD10 CM vocabularies.
Both ICD9 CM and ICD10 CM vocabularies are mapped to the Hierarchical Condition Categories (HCC) developed by CMS (https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors-Items/Risk2020). CMS HCCs are validated concept groups that can be used to calculate a risk score of the expected medical costs of patients in the coming year. HealthNexus™ stores both the current and older versions of CMS HCC. The current version 24 comprises 86 CMS HCC categories. Since the model was first proposed, four categories have been either replaced or phased out.
Because ICD9 CM and ICD10 CM vocabularies are natively mapped to CMS HCCs and maintained within HealthNexus™ on an ongoing basis, PurpleLab did not have to build anything to observed diagnoses or interest within its Claims Repository and assign CMS HCCs to anonymized patients where appropriate. HealthNexus™ provides PurpleLab the benefit of extreme efficiency in the face of the maximum uncertainty presented by the COVID-19 pandemic.
