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. 


AnnouncementNew Da Vinci Use Case - Patient Cost Transparency Use Case

Patient Cost Transparency Use Case- Kick off public call June 25th, 2021

Fridays at 11AM Eastern- here for call details

Confluence page here


HL7 Process Update

Da Vinci Risk Adjustment FHIR IG Proposal

FMG had a packed agenda and it has been postponed to next week. 

New link for the repository- so we can start building our site. Will be official URL for the repository. 

Welcome contribute to it.


Discussion

Continue with business requirement and FHIR analysis discussion

Great discussion last week. visit last week meeting agenda- there are links for presentation and recording. 

Measure report mock up

extension added

  • to represent risk adjustment status
  • to represent suspect type

group-  can allow to repeat so it can send multiple HCC codes

Measure is a data requirement for the measureReport, and this is where we will tie to the risk adjustment model ID and version which will be required. 

Use case: HCC with or without hierarchies applied- moving to future call. 

Clinical Evaluation Period

  • has a start and end period and is tied to each model. the period determines which model you should use. 
  • for each model, you may get multiple reports
  • for each period, you apply the model so there could be multiple
  • make it simple- give me all the HCC that is applicable within the date period requested (all date of service within that period)

Data collection period date- depends on who is looking at the collection date, such as CMS

can always collect data but cannot always submit it. 

API response- what if plan effective date only apply to part of the data period, ie member had not been a member for all the data period and can only return HCC in part of the date. Should the provider assume that the missing information means no HCC available, or return information to state there is no information available. 

  • may use detected Issue to represent that the model does not apply to that period
  • may depends on how you define the organization

Responsibility on the provider and EMR to know whom to send the request for the report. 

  • need to know which plans members has been on and would need to submit multiple requests to all plans to get reports complete for entire data period. 





ManagementNext Agenda

continue with FHIR analysis discussions


Adjournment
Adjourned at  03:54PM 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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