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CCDA vs. QRDA1

CCDA vs. QRDA1. Take 3 diabetes measures: 1) Appropriate Testing , 2) Control <8 , 3) Out of Control >9. Claims Data Claimed diagnoses, procedures, medications. Patient Out of Pocket. Claims: Medicaid. Claims: Commercial 1. Medicare. Claims: Commercial 2. Claims: Commercial 4.

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CCDA vs. QRDA1

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  1. CCDA vs. QRDA1

  2. Take 3 diabetes measures: 1) Appropriate Testing, 2) Control <8, 3) Out of Control >9 Claims Data Claimed diagnoses, procedures, medications Patient Out of Pocket Claims: Medicaid Claims: Commercial 1 Medicare Claims: Commercial 2 Claims: Commercial 4 Claims: Commercial 3 Commercial Patient A Patient D EHR 1 7.6% Independent Pharmacies 8.6% 8.5% Public Health Department EHR 2 EHR 5 SureScripts Federal Source (VA/DoD/IHS) EHR 3 EHR 6 EHR 8 EHR10 EHR 7 EHR 4 EHR 9 9% 10% 12.1% 8% Patient C 7% 9.8% 10.5% 10% 8% Patient B 7.5% 6.9% 0% NA NA 33% 0% 100% 66% 50% 50% 100% 33% 33% 33% 100% 0% 100% 50% 0% 0% NA NA 50% 0% 100% 100% 0% 0% 50% 0% 100% 100% 50% 50%

  3. Take 3 Diabetes Measures: Payers will get multiple scores on the same patient– what do they do with that? Looking at populations, we cannot roll these up . . . Isn’t this what we really want to know?

  4. Pay for Value: Trusted 3rd Party Provider Payer Clinical Data Claims • Payer-specific Metrics • ER Utilization • Admissions • Prescription drug use • Etc. Value • Provider-specific Metrics • Clinical outcomes • BP mgmt • DM performance • Etc. MyHealth Analytics: Trusted Third Party $$

  5. Measurement for everyone No More Waiting for Quality Metrics:Real-Time Clinical Quality Calculation 4+, 3-, 3E = 4/7 = 57% 2+, 1-, 1E = 2/3 = 67% 5+, 4-, 3E = 5/9 = 56% 6+, 3-, 3E = 6/9 = 67% 3+, 1-, 1E = ¾ = 75% 4+, 1-, 2E = 4/5 = 80% Employer Provider 2 Provider 1 Specialist Payer 1 = patients that count positively to eCQM’s Geographic Region 1 = patients that count negatively to eCQM’s = patients that are excluded from eCQM’s + + + + + + + + + + + E E E E E E E + E E + + + - + - - - - - - - - E + + + - E + - - - E E + + - eCQM’s calculated in real time based on changes in a patients cross-community data by placing a box around any portion of a population.

  6. Data Quality: Chain of evidence EHR Vendor Provider/Practice MyHealth Access Network

  7. EHR SFTP Raw Data: HL7 CCD CDA Classification Engine TCP Messages Classified By: WS Source, Format & Type Classified Message Data Transformation Tool SFTP, etc. 3rd Party Application Data Access Layer Data Import Layer Measure Reporting Reporting Environment (Analytics) Risk Stratification Data Transformation Tool Master Person & Provider Index Population Health Clinical Data Repository HIE Portal

  8. Data Quality Improvement Identify Gaps in EMR Capability

  9. How important is comprehensive data? Accurate measures possible here.

  10. CCDA vs. QRDA1 vs. QRDA3

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