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Chair:  

Scribe: Dana Marcelonis
 

Attendees

Present

Name

Affiliation

  •  
Robert DieterleEnablecare
  •  
Stratametrics
  •  
Nita ThingalayaIBC
  •  
Cambia Health Solutions
  •  
Gregory MagazuCaseNet
  •  
Jeanie SmithBCBSFL
  •  
Corey SpearsInfor
  •  
Optum
  •  
Ashley SteddingCMS
  •  
Barbara AntunaAIM Specialty Health/ Anthem
  •  
Mary Kay McDanielCognosante
  •  
Michael GouldIBC
  •  
Laurie BurckhardtWPS Health Systems
  •  
Serafina Versaggi
  •  
Sreenivas MallipeddiMCG Health
  •  
Susan BellileAvaility
  •  
Susan LangfordBCBST
  •  
BCBSAL
  •  
Tracey McCutcheonKPMG
  •  
Dawn PerreaultBCBSM
  •  
CMS
  •  
Anupam ThakurBCBS FL
  •  
Anthem
  •  
Allscripts
  •  
BCBSM
  •  
Chris JohnsonBCBSAL
  •  
MITRE
  •  
ZeOmega
  •  

  •  

  •  
Cigna
  •  
eClinicalWorks
  •  
Tibco
  •  
Eddy NievesEpic
  •  
Christopher Gracon


  •  
Centene
  •  
Andrea KentCoverMyMeds
  •  
BC Idaho
  •  
Keya ShahCasenet
  •  
Neena Dakua
  •  
Cara BerryAvaility

Present

Name

Affiliation

  •  
John BialowiczBCBSM
  •  
Nandini GangulyScope Info Tech/ EMDI
  •  
Peter Muir
  •  
CAQH
  •  
Pallavi TalekarScope Info Tech
  •  
Kelly TaylorCMS
  •  
Karen L. ZapataAnthem
  •  
Brandon RaabAnthem
  •  
Cindy MonarchBCBSM
  •  
Michael CabralCMS
  •  
Nick RadovUHC
  •  
Epic
  •  
James Derrickson
  •  
Laurie WoodromeLabcorp
  •  
Ric LightHumana
  •  
Harvey KuangExpress Scripts
  •  
BCBS AL
  •  
Gevity
  •  
Julia ChanCW Global Consult
  •  
Ken Lord
  •  
Edifecs
  •  

  •  
Roland Gamache
  •  
Alberto S. LlanesAnthem
  •  
Mark ScrimshireNew Wave
  •  
EMR Direct
  •  
Patrick MurtaHumana
  •  
Ranjith KandurAnthem
  •  
MITRE
  •  
Joe MinieriMITRE
  •  
Dave Foster
  •  
Providence
  •  
Betty SullivanAllscripts
  •  

  •  
June Bronnert
  •  
Cynthia GinsburgCMS
  •  
Eshaa DhalleClinicalWorks
  •  
Ronald MacDurmon
  •  
Cigna
  •  
Edifecs
  •  
Cigna
  •  
Mona ChandrapaleClinicalWorks
  •  
Sonja ZieglerOptum
  •  
Celine LefebvreAMA 
  •  
 Ben Largley
  •  
Dawn PerraeultBMBSMI 
  •  
Emily TenEyck CAQH
  •  
Joe QuinnOptum 
  •  
Lindee Chin Edifects 
  •  
Lorraine Doo CMS 
  •  
Padame Metal Solutions 
  •  
Rajesh g
  •  
Josh Lamb
  •  
Jamie StampsEdifecs


Minutes Approved as Presented 


This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."


Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview https://www.hl7.org/events/cms/2020/01/index.cfmANSI Anti-Trust Policy



Connectathon

HIMSS scenario and supplemental examples
  • Review diabetes use case - add step therapy
  • Need some payer input to flesh out HIMSS use case
    • Nick Radov volunteered to review and assemble questions to bring back to the CMO organization at United
  • We chose to use Care Plan, and there's an attribute for Care Plan Intent which is required (order, plan, or proposal)
    • Treatment should always be a plan - should be fixed value
  • Old payer data would be services focused but to create a plan, it tends to be disease first
    • Is onus on payer to identify cluster of ICD-10 codes that identify diagnosis (e.g., hypertension)
    • Intention for things to be grouped, and there will be manual intervention/review
      • Could pick overall code that represents the condition
      • In future, there might be software to do that for you
      • 3 care plan instances might all be dealing with the same problem but person deciding what data to send didn't group them all into one
      • New plan has to add that intelligence
    • Manual processing on producer side to determine how to group things, what to include, etc. and manual processing on consumer side to determine what to do with the data they received
  • May Terry will add JIRA tickets if she catches other questions/potential IG issues to be addressed
  • Spreadsheet for review from 12/27 PCDE meeting is posted in Confluence: PCDe Supplemental Guide Planning
  • Should PCDE include a summary sheet? 
    • Current meds, problem list, recent labs, etc.
    • Summary of where patient is at the moment, and not necessarily current treatment
    • Stay with original intent to focus on items related to current, active care
  • Mapping spreadsheet and FHIR examples are both helpful
  • Example prioritization
    • HIMSS Scenario
    • COPD, Diabetes (original/existing examples)
    • Congestive Heart Failure (CHF)
  • If data often received as PDFs, unstructured data please let the team know - focus for examples will be structured data
  • May Terry will share some examples next week

ManagementNext agenda

Review mapping, FHIR examples


 Adjournment

Adjourned at 2:45pm ET


Supporting Documents


Action items


Create Decision from template