Chair:  Viet Nguyen, Yan Heras

Scribe: Phung Matthews
 

Minutes Approved as Presented 


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Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy






Announcement

Meeting next week will be cancelled due to HL7 May 2021 Working Group Meeting: May 24-28, 2021. 

  • May 26th, Wed. Q5 (2pm-3:30pm ET) CQI host CDS: Risk Adjustment project

Reminder next week call is cancelled due to WGM.

If you are attending WGM, join the CDS WG discussion on Risk Adjustment. They are interested in being an interested party or co-sponsor.


HL7 Process Update

FHIR Risk Adjustment PSS 

  • Approved by the Clinical Steering Division (eVote)

Project Insight

PSS continue to go through HL7 process. Approved to Clinical steering and then move to the Technical steering. 

HL7 assigned a new Project insight number 1705- can move forward to start the FHIR IG proposal and the implementation guide will be tied to this insight number. 




Discussion

Continue with requirement gathering and FHIR analysis discussion

From last discussion- focusing on Patient Data element- see page 

Identifier- 

  • Member ID - more used within medicare and medicaid
    • change to unique MemberID- similar to MPI
  • Subscriber ID- more used within commercial care
  • Could this be found in the Coverage Resource- where subscriberID is located and dependent attribute for suffix or person ID
    • use definition of subscriber ID from coverage resource
    • use dependent- may be unique identifier
    • may be optional 
  • newborns- are risk adjusted for newborns? Unclear but may remove it, as they can use whatever identifier they have in the system.

Coverage

  • Is not to communicate entire coverage plan but more of an individual
  • Coverage resource- points to a single patient, but can have multiple coverage
  • If dual coverage (medicare/medicaid)- all risk adjustments would fall under medicare
  • Medicaid identifier- another form of subcriberID for coverage

Birthtime- included in QI core profile but not US core. Would this be needed? Only add if there is a case for risk adjustment for newborns. 






ManagementNext Agenda

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


Adjournment
Adjourned at  03:58PM ET

Attendees

Present

Name

Affiliation


PresentNameAffilitation
PresentNameAffiliation
  •  
Viet Nguyen
Stratametrics
  •  
Dale Davidson

  •  
Rachel Foerster
  •  

Yan Heras



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

  •  
Leah Hannum
  •  
John Graham
Providence St. Joseph
  •  
Patty Craig

  •  
Dave Foster
  •  

Peter Muir



  •  
Nick Radov

  •  


  •  

Linda Michaelsen

Optum
  •  
William Harty

  •  


  •  

Brian Murta

Centene
  •  
Deidre Sacra

  •  


  •  

Phung Matthews

POCP
  •  
Jay Baker

  •  


  •  

Vanessa Candelora

POCP
  •  
Joseph QuinnHSX
  •  


  •  
Phranil MethaHealow
  •  

Ezequiel Morales

Cigna Evernorth
  •  


  •  
Anna Taylor
MultiCare
  •  
Mariel Brechner

  •  


  •  
Susan Langford
BCBST
  •  
Christopher Marchand




  •  
Floyd Eisenberg


  •  
Peter Muir




  •  
Susan Bellile
Availity
  •  
Kira Whitworth




  •  
Brent ZenobiaNovillus
  •  
Travis Hendrix




  •  
Amy Neftzger
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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