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  1. QDM Issue Tracker
  2. QDM-173

Payer QDM Datatype

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    • Icon: New Feature New Feature
    • Resolution: Fixed
    • Icon: Moderate Moderate
    • QDM 5.3
    • Data Model
    • None
    • Enables greater measure expression and aligns with HL7 FHIR representation of relationships.

      Measure developers need to determine continuous enrollment in a health plan during the Measurement Period, i.e., all members enrolled in the plan from January 1 through December 31 of the measurement year. HEDIS measurement requires such a determination.
      Issue: Provider Characteristics is insufficient:
      Provider Characteristics is a generic description of a provider but it does not enable characteristics of the relationship between the provider and the patient.
      Provider Characteristics addresses the provider, not necessarily the provider’s organization, or another organization
      Goal: Enable specification that can identify a payer and attributes that represent a patient’s relationship with the payer.
      Ideally, address an “Organization” such that the same QDM Category / Datatype can be used for other representation, e.g., an Accountable Care Organization, an Ambulatory Surgicenter, a Hospital, an ambulatory care practice and characteristics of such an organization

      Recommend: "Organization" as a new QDM datatype. It aligns with HL7 FHIR and allows representation of "membership" or "participation" as an interval (period). Using "organization" allows application of the datatype to other use cases (e.g., relationship of a patient to an Accountable Care Organization, or other entities).

            FEisenberg Floyd Eisenberg
            FEisenberg Floyd Eisenberg
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              Created:
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