hair:  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

HL7 Connectathon 28 Sept 13-15 

  • Registration is now available here
  • Early Bird registration August 16th and last day to register is August 30th. 
  • Plan to hold a Risk Adjustment Track!

Please visit the connectathon page for videos on FHIR 101 and how to read an IG. 

Our first track for the Sept Connectathon, please let us know who will be joining for testing. 


Risk Adjustment IGContinuous Integration (CI) Build site: https://build.fhir.org/ig/HL7/davinci-ra

The CI build is now available. There are several placeholders within it as it would be added as we continue to build it. 

Under artifacts profiles, there are a couple examples, you may review and provide feedback. 

MeasureReport profile

  • Each HCC would be under group.
  • Extensions have been added as previously discussed to add supporting evidencce for the HCC code. 
  • Added Evidence.status to state if it is confirmed, not confirmed and include a codeable concept. 

Measure profile- MeasureReport is required to link to measure profile, can be used to include risk adjustment model and version

Glossary- we do have some definitions on it that is pulled from the confluence pages. 

If you are interested in writing a paragraph or content, let us know, we appreciate the help and feedback. 


Discussion

Continue with business requirement and FHIR analysis discussion:

  • Does Phase One of this IG need to specify an FHIR Operation? or what we need is to specify a list of APIs that can be used to query and return risk adjustment coding gap report? 
    • FHIR operation example: $care-gaps operation in the DEQM IG
    • APIs example: the ATR IG specifies a list of APIs and their expected results. 

Operation is where the server plays an active role in responding. For phase 1, we are not expecting the server to have an algorithm to generate the HCC gaps. It would be more for querying and getting a report back. 

What we need is similar to what the ATR IG includes, ie specify what API to use. 

Add number of API to pass the information, get evidence status as parameters and specify it as the API. 

Resources are managed by using the CRUD actions. Sometimes it is more effective to Execute. 

Risk adjustment API call- when it is made, the precompiled information will be returned in some manner. 

Depending on granularity of the response, may need to use some JSON to get the report. 

To define the specs- need to determine whether if it should an operation or query. 

Current- running risk model reports are not being pulled when requested but instead is already ran and stored to be retrieved. Possibly have periodic batch updates in near real time. 

When getting back the report as CRUD, you just get the measure report and references but not actual information within the reference

Must support- meaning the system has to be able to understand the process and be able to use it -and may not mean that you have to return the information

Risk adjustment model is complex and trying to determine whether we really need to have operations for phase 1, since with operations will need to be able to grab content which we do not have access since the algorithm is black box on the payer side.

If we do operations, we need to create sample of data and have a tool to pull the report. But the return of the bundle, it may be necessary. 

If we do _include in the query, the result can be a bundle with other resources. 

If adding operations, may need to add other parameters to use, such as evidence. 


Connectathon Planning

Review Track Proposal: 2021-09 Da Vinci Risk Adjustment

Discuss Track Schedule

See notes above- will continue to work through what is needed. 

Email Yan and Linda if you are planning on attending so we can start planning. 


ManagementNext Agenda

Review connectathon template for the track


Adjournment
adjourned at 3:58PM 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

  •  
Rob Reynolds
  •  

Vanessa Candelora

POCP
  •  
Joseph QuinnHSX
  •  
Shawn
  •  
Phranil MethaHealow
  •  

Ezequiel Morales

Cigna Evernorth
  •  
Donielle Williams
  •  
Anna Taylor
MultiCare
  •  
Mariel Brechner

  •  

Khush Singh


  •  
Susan Langford
BCBST
  •  
Christopher Marchand

  •  
Pranathi K
  •  
Floyd Eisenberg


  •  
Madhurima DharCozeva
  •  
Vijay Sravani Thotakura
  •  
Susan Bellile
Availity
  •  
Kira Whitworth

  •  
Angie Finley
  •  
Brent ZenobiaNovillus
  •  
Travis Hendrix

  •  
Eric Liu
  •  
Amy Neftzger
Optum
  •  
Zahid Butt

  •  
Kim Faison
  •  
Frank

  •  
Khushwinder Singh

  •  
Tushar Shah


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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