hair: Viet Nguyen, Yan Heras
Scribe: Phung Matthews
Minutes Approved as Presented
This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."
Meeting Minutes from Discussion
|Decision Link(if not child)|
|Management||Review ANSI Anti-Trust Policy|
HL7 Connectathon 28 Sept 13-15
Visit the Da Vinci HL7 Connectathon page for quick highlights on each tracks.
If going to participate- please register before the end of the month.
|Risk Adjustment IG||Continuous Integration (CI) Build site: https://build.fhir.org/ig/HL7/davinci-ra|
Review on Guidance in the continuous build.
Using payer and providers currently- do we need more generic such as consumer/producers?
Discussion on provider vs practitioner- which is more appropriate?
When using the $report- the provider would know the patient id to pull the right patient. Logical ID for the payer system for that particular patient or group of patient, this will be a pre-condition. Before you can run the report, you will need to know the logical ID of the patient on the risk adjustment report side. How it is done, is not in the scope of this.
If you are using HCC, it implies that you have applied the hierarchy. Suggest to use CC, condition category instead. Use of condition code might be confusing to others and may be assumed to be a diagnosis code.
They are more like groupers, where it is pulling codes into categories.
Final suggestion= use risk adjustment category, example HCC.
If reference, you will everything in that bundle.
Question- currently Claim is not in US Core, would there be a need for claim FHIR resource to be returned as an evidence?
Use of attribution- some areas are using extensively, some are not. Depends on the reason for the risk adjustment. However reasonable to assume that there is an out of band process to pull the patient information and permit you to pull the report.
Risk Adjustment coding gaps
In US Core Condition- morbid obesity- date needs to be switch from 06012020 to 20200601.
Typically it has to be a face to face encounter between provider and patient.
In EvaluatedResource- is the supporting evidence.
Should there be three different encounters due to each date?
Can't use last year encounter as evidence. Need the encounter of this year if collecting this year.
Workflow example- has care management system.
Suggest to add cloud based picture to show we do not worry about how the payers are pulling the reports on the back end.
Daniel- suggest to not use the producer term as it can relate to brokers on the insurance end.
Linda- maybe have it as client FHIR server
Please review page and provide any feedback.
Need to represent condition category as a FHIR resource condition, other than just represent the codes for the condition and pointing it to the condition category. Example how to make HCC code 08 be a FHIR resource. How to document it and associate it with the patient.
Continue with business requirement and FHIR analysis discussion:
|Adjournment||adjourned at 03:57PM ET|
|Stratametrics||Dale Davidson||Rachel Foerster||Kimberly Bradbury|
|Karl Everitt||Epic||Tim McNeil||Steve Gasiorek|
|BCBS Alabama||Thomson Kuhn||Leah Hannum||Daniel Tam|
|Providence St. Joseph||Patty Craig||Dave Foster|
|Nick Radov||Bryan Briegel|
|Optum||William Harty||Preston Lee|
|Centene||Deidre Sacra||Gary Dickinson|
|POCP||Jay Baker||Rob Reynolds|
|Phranil Metha||Healow||Cigna Evernorth||Donielle Williams|
|BCBST||Christopher Marchand||Pranathi K|
|Madhurima Dhar||Cozeva||Vijay Sravani Thotakura|
|Availity||Kira Whitworth||Angie Finley|
|Brent Zenobia||Novillus||Travis Hendrix||Eric Liu|
|Optum||Zahid Butt||Kim Faison|
|Frank||Khushwinder Singh||Tushar Shah|
- 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.