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Chair:  Viet Nguyen , Gay DolinGini McGlothin

Scribe: Linda Michaelsen
 

Attendees

Present

Name

Affiliation

  •  
Viet NguyenStratametrics
  •  
BCBS AL
  •  
Linda MichaelsenOptum
  •  
Namaste Informatics
  •  

  •  
Providence St. Joseph
  •  
NCQA
  •  
Chris JohnsonBCBS AL
  •  
BCBS AL
  •  
Dave FosterEdifecs
  •  
Grace StambaughVeradigm
  •  
BCBSM
  •  
Veradigm
  •  
Cigna
  •  
Cigna
  •  
Kamal TayalDrFirst
  •  
Leslie SmartHumana
  •  
Edifecs
  •  
Iris Health Solutions
  •  
CDC
  •  
Carradora
  •  

  •  
Peter Muir
  •  
Centene
  •  
MITRE
  •  
Optum
  •  
Optum
  •  
Availity
  •  
BCBS FL
  •  
Tom WillisMoxe Health
  •  
Express Scripts
  •  
Cindy MonarchBCBSM
  •  
Eric Haas
  •  
Jason TeepleCigna
  •  
Cigna
  •  
Diameter Health
  •  
Andrea KentCoverMyMeds
  •  
Bob HarringtonAllscripts
  •  
Anthem
  •  
Independent Health
  •  
eClinicalWorks
  •  
ZeOmega
  •  
UHC
  •  
Epic
  •  
Bart CarlsonAzuba Health
  •  
Edward CastagnaAltarum
  •  
Cigna
  •  
Humana
  •  
Rachel E. FoersterCAQH Core
  •  
Ryan WeberUHC
  •  
Sandy BeggsIBC
  •  
Optum
  •  
BCBST
  •  
Sutter Health
  •  
Chuck GalliIBC
  •  
iParsimony
  •  
Sreekanth
  •  
WPS Health Solutions
  •  
eClinicalWorks
  •  
Dani Hochleutner
  •  
ZeOmega
  •  
Christopher MarchandDiameter Health
  •  
Joe Bormel
  •  
BCBSM
  •  
Matt AdamsonZeOmega
  •  
Steven BenjaminRegence
  •  
Epic
  •  
ZeOmega
  •  
Edifecs
  •  
Tibco
  •  
Intersystems
  •  
SachinZeOmega
  •  
Douglas Ansel
  •  
Joseph Bormei
  •  
Dynamic Health IT
  •  
Beverly BucktaPfizer
  •  
Jason RankinAthenahealth
  •  
Kenneth Salyards
  •  
NCQA
  •  
Dynamic Health IT
  •  
Telligen
  •  

  •  
TanyaCigna
  •  
Adrianna Preston-SicariAthenahealth
  •  
Denise
  •  

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 ANSI Anti-Trust Policy



Review Gaps in Care Report (Colorectal Cancer Screening example)
  • Potential extension for Relevant Resource
    • Point to the resource you're looking at with an expression in the measure
    • Relevant resources point back to the patient
    • Not clear how we can tell if that puts them in the numerator or denominator if you have multiples
  • 3 ways in which patient may meet numerator criteria, and all are acceptable though each one can have a different timeframe
    • What if there's a colonoscopy within the last year and an FOTB and a ?
    • Does one take precedence over the other? Or does it not matter because as long as one qualifies them for numerator?
    • If patient is compliant today, but will they be compliant X days/months from now dependent upon their last screening
    • Which one 'wins' if we're going to send that next date - if they had colonoscopy 9 months ago, FOTB 6 months ago
      • Due date would probably be based on the colonoscopy
    • They would have a relevant period - the longest relevant period overlap would be the answer for when they'd next be due
    • This needs to go back to measure developers - tell us which takes priority in determining in what needs to be done and determining priority
    • Which one keeps you in compliance the longest?
      • But which one is the gold standard?
      • Payer does not want to determine that, they base it on NCQA HEDIS specs
      • What is evidence-based approach? It may not be which one is the longest
    • This is out of scope for Gaps in Care IG, but a call-out for measure developers
    • Potentially a note to balloters in the IG as well
  • Never use DiagnosticReport for clinical decision support when you really should be looking for an Observation
    • You don't know all the different Diagnostic Reports you might be looking for - you know the Observation within it
    • A lot of measures are written based on what exists, but should look at modeling based on vendor/user feedback
    • This is a problem with the measure
    • Fix the measure examples in the IG to fit the expected data model
  • EHR world - don't look to see if you have a PDF or text message of the actual report - the provider gets the information from a guidelines table - procedure, date it was done, date it was next due
  • Perhaps need an updated measure example for the IG - would also potentially need to update DEQM if change measure example as well
  • Would be helpful to know how EHRs represent it in FHIR 
  • Need to support hierarchy, for example patient had colonoscopy, as well as diagnosed with colon cancer during the measure period
  • Need to include a caveat in the IG that the measure example was based on a snapshot in time
  • Sydney feedback: individual IGs, sometimes same people working on more than one; not clear that any one of the projects is aligning with the other projects - IGs should reference each other
    • No so much an issue with DEQM, Gaps in Care guides
  • Current plan is that Gaps in Care will become another scenario in the DEQM guide
    • Concern that payers have gaps in care that may not be a quality measure - how do these fit into the DEQM framework?
    • Pointing to whatever logic that's being reported on - could point to payer's specific logic which is not a specified quality measure
    • Could update IG to make this clear that you don't have to be reporting on a quality measure
  • Describe how you develop what patients are part of the provider's organization so you have the attribution - planning to refer to RBC Member Identification IG
    • DEQM call taking place at 3pm ET today - the Risk Based Contract Member Identification team will be providing an overview of that IG (member attribution list)

ManagementNext Agenda

Adjournment
Adjourned at 2:49pm ET

Supporting Documents

Outline Reference

Supporting Document

Minute Approval
Meeting Presentation Materials
Kick-Off Recording (11/21/19)Kick-off recording (11/21)


Action items


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