2021-08-05 Risk Adjustment Use Case Meeting

Looking to construct the narrative on the IG and moving forward to building it.

 continue discussion on whether to use the operation or simple return call for the report. This was brought up at the CQI meeting. Their suggestions were instead of having specific return, have it be generic operation, can be applied for the evaluated measure. 

Added parameters for the Get report operation. 

Not all parameters may be supported by all vendors. Then we can use the overload for the scenarios. Identify the list of parameters for the overload,

These are the parameters for the ones who are submitted. 

The overloads are for the servers to use, due to some parameters being optional. 

Any number of overloads is a call to the same methods or functions but with different sets of parameters

• example searching for patient- can find it with patient ID, social number, first name or last name. 
• basically have the same goal but can use different parameters
• examples of the overload- would be how to call the API with the various parameters

Organization- may be harder to use as parameter since data quality on that is not accurate

For HCC- may need to pull list of codes for patient report as outreach. 

Member Attribution IG may be used to find your list of members. 

Generally, if you are a specialist, you would still need a PCP license to be attributed to the patient. 

If provider wants to pull a report, is there a time where he would pull patients he is not attributed to? Rather than adding which patients to pull report from. Most likely would have a list of patients to pull patient from. 

Which then may mean that practitioner or organization may not be needed as a parameter.

Also need to consider sensitive information shared among other providers. 

May still require NPI to know who is requesting the data. Could we use the log in as identification/credentials? 

Think of other roles that may need to pull risk reports, such as self insured employers and patients.

Use of reportID or measureID to restrict the information on what is on the report.

Other parameters to look for: Model versions (that is active during the clinical period, add to the Model parameter), hcc code (to allow passing multiple HCC codes)

Remove model and version as a parameter, as it would be placed in the results and the provider can filter it on their end/UI. 

also remove evidence status and suspect type- as it should fall under the provider

Can we leave them and not state that the API should support them?

Yan Heras

Peter Muir

Linda Michaelsen

Brian Murta

Phung Matthews

Vanessa Candelora

Ezequiel Morales

Khush Singh