claims exhibit: utilization of palliative-relevant services in CCLF/synthetic claims #648
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Reference: homelab/stack#648
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Skin-subs (P29) pattern applied to the palliative code families: utilization of ACP, care-management, and APCM services in the CCLF/synthetic (Tuva) claims — who bills them, in what settings, how often per beneficiary, co-occurrence with serious-illness diagnoses (chronic-condition groupings already in cms_quality_measures value sets).
Scope honestly: synthetic claims support methodology exhibits, not empirical claims about real-world utilization — label accordingly in the notebook (same disclosure discipline as the CY2027 notebook uses for unweighted aggregates).
Done as notebook Section 5 (2026-08-20): palliative-relevant utilization over the synthetic Tuva CCLF (962 beneficiaries, medicare cclf source, 2016-2018), computed live from
input_layer.medical_claim. Families: CCM 175 lines/107 bene, TCM 84/70, ACP 65/57, Home E/M 30/26; PCM and APCM structurally absent (post-window codes — the exhibit says so). Serious-illness co-occurrence (crude ICD-10 groups: cancer, HF, COPD, dementia, ESRD, Parkinson's, cirrhosis): 75-91% of each family's users, against 611/962 in the population — care management concentrates in the seriously ill yet reaches ~1/7 of them (CCM). Scope disclosure per this issue's direction: methodology exhibit, not empirical utilization claims; identical SQL is ready for real CCLFs.