Chair:  Viet NguyenYan Heras

Scribe: Phung Matthews
 

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






HL7 Process Update

FHIR Risk Adjustment PSS 

  • Currently under eVote by the Clinical Steering Division
  • The CDS WG is interested in becoming at least an interested party, if not a co-sponsor (minutes)
    • Suggested Wed Q5 at WGM for discussion

eVote still going on and ends this week. 

CDS WG reviewed the PSS and are interested in this use case and would like to become an interested party and perhaps a co-sponsor. They would like to meet with us on Wed Q5 at the WGM. 



Discussion

Continue discussing Risk Adjustment Report data elements requirements from Payer to Provider and operation requirements

FHIR analysis discussion

Last discussion on the Initial Diagnosis state- we had thought to remove this, as it may not be required. 

Start looking to see how to represent this in FHIR. Added new column in the report confluence page to list FHIR Analysis. 

Patient- decide to see which of these US Core Patient, QI-Core Patient, ATR patient may work best.


Member ID- This comes through the Payers as identifier and would be mapped on the provider side.

  • may need to include the MBI for the medicare advantage
  • provider can have its own identifier and may mask the MBI
  • payers may mainly send patient name, birthday and MBI if medicare related
  • payers may use subscriber ID but will be more geared with commercial insurance
  • Mother/newborn ID under Medicaid may temporarily use the Mother ID
  • all of these ID have effective dates- does that get communicated in the report?
    • may be needed to look at effective gap report, ie looking back at previous gaps or historically

HCC can come in within a 25 months period and can trickle in for a long time. 

Chat comment: 

fyi, the current APIs for CMS, e.g. Blue Button ,BCDA, etc provide historical and current MBIs in the identifier element of the patient resource (for cases where the MBI has switched due to fraud, etc) 

If MemberID is changed during the evaluation period, may need to know effective time of the memberID. 

May need to review how CARIN Blue Button. CMS Blue button API (FHIR R3) does it, actually as an extension- codeable concept that says if code is historic or current) 

this is the url for the extension: https://bluebutton.cms.gov/resources/codesystem/identifier-currency/






ManagementNext Agenda

Cancel meeting 5/27/21 due to HL7 WGM.


Adjournment
Adjourned at  PM ET

Attendees

Present

Name

Affiliation


PresentNameAffilitation
PresentNameAffiliation
  •  
Stratametrics
  •  
Dale Davidson

  •  
Rachel Foerster
  •  


  •  
Karl EverittEpic
  •  
Tim McNeil
  •  
BCBS Alabama
  •  
Thomson Kuhn

  •  
Leah Hannum
  •  
Providence St. Joseph
  •  
Patty Craig

  •  
Dave Foster
  •  

Peter Muir



  •  
Nick Radov

  •  


  •  
Optum
  •  
William Harty

  •  


  •  

Brian Murta

Centene
  •  
Deidre Sacra

  •  


  •  
POCP
  •  
Jay Baker

  •  


  •  
POCP
  •  
Joseph QuinnHSX
  •  


  •  
Phranil MethaHealow
  •  
Cigna Evernorth
  •  


  •  
MultiCare
  •  
Mariel Brechner

  •  


  •  
BCBST
  •  
Christopher Marchand




  •  


  •  
Peter Muir




  •  
Availity
  •  
Kira Whitworth




  •  
Brent ZenobiaNovillus
  •  
Travis Hendrix




  •  
Optum
  •  
Zahid




  •  
Frank

  •  
Khushwinder Singh





Action items

  •  Re-evaluate the name of this use case as "Risk Adjustment" does not define the payment aspect of the primary focus. Need to discuss with CQI WG as well.  
  •  Add to Phase 2 - Ability to remove and provide a reason for status change. e.g. the patient no longer has the condition.

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