GROUP BY + HAVING:

By /

The GROUP BY clause groups rows with the same values in specified columns into summary rows. The HAVING clause filters those groups based on conditions — similar to WHERE, but applied after grouping.

Basic Syntax

SELECT column, Aggregate_Function(column)
FROM table
GROUP BY column
HAVING condition;

Why Important in Healthcare Analytics?

  • Summarizing large datasets (claims, members, costs)
  • Finding patterns like high-cost providers or frequent diagnoses
  • Filtering aggregated results

Healthcare Examples

1. Basic GROUP BY – Average RAF Score by Age Group

SELECT 
    AgeGroup,
    COUNT(*) AS MemberCount,
    AVG(RAF_Score) AS AvgRAF
FROM Risk_Adjustment_Members
GROUP BY AgeGroup
ORDER BY AvgRAF DESC;

2. GROUP BY + HAVING – Providers with High Denial Rates

SELECT 
    ProviderID,
    ProviderName,
    COUNT(*) AS TotalClaims,
    SUM(CASE WHEN Status = 'Denied' THEN 1 ELSE 0 END) AS DeniedClaims
FROM Claims
GROUP BY ProviderID, ProviderName
HAVING SUM(CASE WHEN Status = 'Denied' THEN 1 ELSE 0 END) > 50;

Finds providers who had more than 50 denied claims.

Key Takeaways

  • GROUP BY is used with aggregate functions (COUNT, SUM, AVG, MAX, MIN)
  • WHERE filters individual rows before grouping
  • HAVING filters groups after grouping
  • Very useful for risk adjustment reporting, cost analysis, and quality metrics
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