2021-06-03 Risk Adjustment Use Case Meeting

CMS HL7 Connectathon July 20-22, 2021. 

• Free Event. Registration ends July 1st, 2021.
• Confluence page: CMS 2021 - 07 Connectathon 2

Attend the free event for CMS connectathon. 

FHIR Risk Adjustment PSS 

• TSC approval

Still under review for TSC approval. 

Did have discussion with CDS group at the WGM to see if they will be a co-sponsor or interested party. They will be discussing it at their next CDS meeting and will let us know.

Review draft Da Vinci Risk Adjustment FHIR IG Proposal

Draft proposal will be taken to the CQI group for approval and then submit to the FHIR management group. Once that is approved, we will get a URL for the github repository so we can start building the IG

Overview of IG proposal

Short description will be found listed under the IG here :https://www.fhir.org/guides/registry/

• Be aware that risk adjustment for quality measure is different than the HCC risk adjustment- will make sure it is clear in the IG description
• suggest to remove = improve quality of care as HCC goal is more financially based as part of the HCC risk model

Long description- added 2 more paragraphs to provide future phases of the IG. 

Yan will bring this to the CQI meeting for approval before submitting.

Continue with requirement gathering and FHIR analysis discussion

For risk adjustment report- what would be the best FHIR resource?

Resource- MeasureReport- have lots of similarity that may work for RA. currently used for DEQM

• example- DEQM measure report profile
• has the following resources:
  • Subject- we can use for patient
  • Status- can use for meta data level, ie confirmed
  • Reporter- who is reporting the data
  • Period- when the report is generated, can use for clinical evaluation period for RA
  • ImprovementNotation- can be used to constraint information that is relevant for RA
  • Group- can be used for a group of things- for DEQM a select population
    • code- can be used for the HCC, if more than one, can be repeated
    • population- may not apply to us and we can constraint it out
  • may add extension for specific elements we need to support the use case
  • EvaluatedResource- data used to calculate measure score, can use this to point to or reference any resource, as supporting evidence
    • might be needed to be imbedded in another area of the MeasureReport

Caution to using the quality measure example as some of its terms may be universally used but not translate to RA 

CohortMeasure - use CQL to help identify one population

Suggest having an example of the measure report to see what we need and what we do not for RA compared to quality measure

continue with requirement gathering