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

CMS HL7 Connectathon July 20-22, 2021. 

  • Free Event. Registration ends July 1st, 2021.
  • Confluence page: CMS 2021 - 07 Connectathon 2
  • Risk Adjustment information session: July 22nd 4:15-5pm ET

Attend the free event for CMS connectathon. If planning to participate, please fill out the pre-survey. 

CMS may be a co-presenter, still waiting to see if they wish to be part of the RA informational session. 


HL7 Process Update

Da Vinci Risk Adjustment FHIR IG Proposal

  • FMG postponed the review/approval to 6/23/2021

FHIR IG proposal being moved to next week on the FMG agenda. 


Discussion

Recording

Continue with requirement gathering and FHIR analysis discussion

Risk Adjustment MeasureReport profile example

Risk Adjustment Storyline

Risk Adjustment Resource diagram example

Met with Bryn Rhodes to discuss how to model this via FHIR and how to represent these resources. 

Risk Report example

  • Patient has visit with MD. MD sent a claim to payer noting amputated below the knee right leg. 

Report will include model and version number for each measure report. Include date period for the clinical evaluation. 

Example of measureReport profile

  • measure- would point to the CMS HCC calculations
  • reporter- which organization that reports it
  • group- where we will have the HCC reported on, can be repeated
    • id for the group as needed for referencing
    • historic diagnosis- made it 0 to many
    • status- confirmed, non confirmed, pending
    • type- historic/suspected
  • code - will the the HCC 
  • supporting evidence- may have the same information used

HCC codes that roll up- one code may be dropped based on diagnosis and hierarchy. Would both be on the report or only one of the HCC.

See here for the information placed into FHIR resource

Encounters as supporting evidence, can be sent once rather than multiple copies, as it is referenced in the group id as an extension. This allow it be used in several places. 

Medication Dispense- will point to the medication resources, that would include the RxNorm, dose, etc...

US Core patient profile- if can use it, will be used as most EHR are working on the building with the US Core

Example suggestions-

  • include an acute example to be suspected for the following year. Acute vs Chronic
  • include example of hierarchy, HCC 108 vs 189

Ask- review slide deck to see if there are any feedback or suggestions on the workflow/resources






ManagementNext Agenda

continue with requirement gathering


Adjournment
Adjourned at  03:55PM ET

Attendees

Present

Name

Affiliation


PresentNameAffiliation
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

  •  
Bryan Briegel
  •  

Linda Michaelsen

Optum
  •  
William Harty

  •  
Preston Lee
  •  

Brian Murta

Centene
  •  
Deidre Sacra

  •  
Gary Dickinson
  •  

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 Butt




  •  
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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