> For the complete documentation index, see [llms.txt](https://docs.lucernahealth.com/guide/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.lucernahealth.com/guide/consumer-360/consumer-profile/clinical.md). # Clinical Top opportunities, conditions, assessments, risk, care programs and care gaps. Select any value in the **Source System** column to see where that data originates.

Section	Field	What it means	Source System	Badge
Top Opportunities	Top Opportunities	Ranked list of the highest-value actions available for this consumer right now.	Derived in Leap	The first three are shown; View More reveals the rest.
All Conditions	All Conditions	Chronic and acute conditions on record. A condition appears once the payer's analytics have identified it, so a diagnosis made this morning will not show until the next data cycle.	Payer population health analytics	-
Sensitive Diagnoses	Sensitive Diagnoses	Conditions held behind restricted visibility, such as behavioral health and substance use.	Payer population health analytics	-
Assessments	HRA	Health risk assessment score and the flags driving it.	Self reported screenings	High: Red, 70% or above Medium: Yellow, 40-69% Low: Green, below 40%
	SDoH	Count of social needs identified in screening.	Self reported screenings	3+ needs: Red 1-2 needs: Yellow 0 needs: Green
	PHQ-9	Depression screening score and flags.	Self reported screenings	High: Red, 10-27 Medium: Yellow, 5-9 Low: Green, 0-4
Risk Profile	Risk Level	Risk profile is the composite risk snapshot: risk level, severity, ER frequent flyer status and payer cohort. Risk level is how much care this consumer is expected to need relative to an average member. Higher scores mean higher expected cost and utilization, driven by the conditions on their record.	Payer risk scoring	-
	Severity Level	How clinically advanced this consumer's conditions are.	Payer risk scoring	-
	ER Frequent Flyer	Whether this consumer has a pattern of repeated emergency department visits, and when. Historical (PY) means the pattern was in the prior year; Recent (CY) means the current year; Current means it's happening now.	Payer risk scoring	-
	Payer Cohort	The segment the payer has placed this consumer in for program purposes.	Payer risk scoring	-
Risk and Cost Predictions Next 12 Months	Preventable ER Risk	Risk and cost predictions are forward-looking predictions for preventable ER, preventable inpatient and high cost. Predictions about what may happen, not a record of what has. Preventable ER Risk is the predicted likelihood of an emergency visit in the next 12 months that timely outpatient care could have avoided.	ML model output	High: Red Medium: Yellow Low: Green
	Preventable Inpatient Risk	The same prediction for a hospital admission that timely outpatient care could have avoided.	ML model output	High: Red Medium: Yellow Low: Green
	High Cost - 10%	Whether this consumer is predicted to land in the most expensive 10% of members over the next 12 months.	ML model output	Yes: Red No: Green
	High Cost - 1%	Whether this consumer is predicted to land in the most expensive 1%.	ML model output	Yes: Red No: Green
Care Programs	Care Programs	Program eligibility and enrollment status, with the reason for the current status.	Care management program feed	Elligible: Blue, Enrolled: Green, Declined, Disenrolled: Red
Care Gaps	Care Gaps	Open and closed quality measures. A gap closes when the payer's quality engine sees the closing evidence, which lags the visit that closed it.	Payer quality and HEDIS engine	Complete: Green, Overdue: Red

{% hint style="info" %} **Why a care gap still says Overdue after the visit.** A gap closes when the payer's quality engine sees the closing evidence, which lags the visit that closed it. A service performed and charted may still show as overdue until it is adjudicated. {% endhint %} *** ### Data Lineage #### Top Opportunities

Top Opportunities

Source system	Leap table	UDM Source
Derived in Leap by rules run across care gaps, care programs and assessments	`top_opportunities`	consumer_factors, `fct_factor`, care_gaps, `fct_quality`, care_programs, `fct_care_program`, `agg_claim`, `fct_med_encounter_procedure`, `fct_appointment`, `fct_roster`, `dim_consumer`, `rpt_consumer_latest_insurance`, assessment_phq9, assessment_sdoh, top_opportunities_tenant_config

#### All Conditions

All Conditions

Source system	Leap table	UDM Source
Payer population health analytics	`health_conditions`	`fct_factor`

#### Sensitive Diagnoses

Sensitive Diagnoses

Source system	Leap table	UDM Source
Payer population health analytics	`health_conditions`	`fct_factor`

#### Assessments

HRA

Source system	Leap table	UDM Source
Self-reported health risk assessment, collected by the payer or through an outreach campaign	`assessment_hra`	`rpt_hra_combined`, `fct_hra_commercial_united`, `dim_consumer`

SDoH

Source system	Leap table	UDM Source
SDoH screening responses	`sdoh`	`fct_sdoh`

PHQ-9

Source system	Leap table	UDM Source
PHQ-9 screening responses	`assessment_phq9`	`fct_phq9`

#### Risk Profile

Risk Level

Source system	Leap table	UDM Source
Payer risk scoring	`consumer_profile`	`fct_factor`

Severity Level

Source system	Leap table	UDM Source
Payer risk scoring	`consumer_profile`	`fct_factor`

ER Frequent Flyer

Source system	Leap table	UDM Source
Payer risk scoring, with the frequent flyer flag derived in Leap from claims	`consumer_profile`	`fct_factor`

Payer Cohort

Source system	Leap table	UDM Source
Payer risk scoring	`consumer_profile`	`fct_factor`

#### Risk and Cost Predictions Next 12 Months

Preventable ER Risk

Source system	Leap table	UDM Source
ML model output	`consumer_profile`	`fct_factor`

Preventable Inpatient Risk

Source system	Leap table	UDM Source
ML model output	`consumer_profile`	`fct_factor`

High Cost 10%

Source system	Leap table	UDM Source
ML model output	`consumer_profile`	`fct_factor`

High Cost 1%

Source system	Leap table	UDM Source
ML model output	`consumer_profile`	`fct_factor`

#### Care Programs

Care Programs

Source system	Leap table	UDM Source
Care management program feed	`care_programs`	`fct_care_program`

#### Care Gaps

Care Gaps

Source system	Leap table	UDM Source
Payer quality and HEDIS engine	`care_gaps`	`fct_quality`