Details
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Change Request
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Resolution: Persuasive with Modification
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Highest
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US Da Vinci DEQM (FHIR)
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2.1.0 [deprecated]
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Clinical Quality Information
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Gaps in Care Reporting
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2.5.1
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Gay Dolin/Floyd Eisenberg: 18-0-0
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Clarification
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Non-substantive
Description
Present wording is confusing. Bringing up clinical reasons after launching into informatic reasons for gaps in care does not make sense. This section is addressing how improving the flow of information improves care. While distinct concepts, clinical gaps and informatic gaps are not mutually exclusive so a more coherent introduction can be made.
Existing Wording:
A gap in care is defined as a discrepancy between recommended best practices and the services that are actually provided and documented. Gaps in care can adversely affect member outcomes and contribute to inappropriate costs…Gaps in care may be caused by several potential reasons. The most straight forward reason is that the care needed has not yet been provided for the patient. While providers cannot always control closing the gaps, most scenarios can be easily remedied with an office visit, lab order, prescription or other clinical care practices.
Proposed Wording:
A gap in care is defined as a discrepancy between recommended best practices and the services that are actually provided and documented. Gaps in care can adversely affect member outcomes and contribute to inappropriate costs. There are several factors that contribute to gaps in care. The most straightforward is that the care needed has not yet been provided for the patient. While providers cannot always control closing the gaps, most scenarios can be easily remedied with an office visit, lab order, prescription or other clinical care practices. However, to fully address this, providers need to have complete information. Identifying, anticipating, and communicating gaps in care to provider practices, at the point of care, is critical for providing opportunities to improve quality of care and reduce cost of care. To succeed in the population health and value-based care, gaps in care must be addressed efficiently and in a timely manner.
For providers and payers to improve population health and value-based care, the following two items must be addressed: gaps in care information and incomplete healthcare information.
Attachments
Issue Links
- is voted on by
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BALLOT-13606 Affirmative - Karin Frank : 2020-Sep-FHIR IG QMEXCHANGE R1 STU
- Closed