As healthcare continues to transition into the digital space, we’re adapting our data strategy to follow suit.
We announced in June that Patient Profile and the PIP_70 report will be retired with the close of the 2023 PIP performance year. Beginning with the 2024 performance year, we’ll accept only the following supplemental data sources for quality gap closure:
- Claims
- CPT II codes
- Direct data feeds (HL7 or APS)
- MiHIN
- MICR (immunizations)
- Epic Payer Platform (EPP)
- Disease registry
- Continuity of Care Documents (CCDs)
Our records show that Corewell Health South/Lakeland uses Patient Profile and/or PIP_70 for gap closure. This work will need to transition to one or more of the data sources listed above by January 31 for 2024 dates of service to avoid any potential impact to your PIP, quality index, and APM performance.
Our teams are here to help. Please let me know if you’d like to pursue a direct data feed with us or need additional support through this transition.
Additionally, your HEDIS Gaps in Care - PIP_11C report will soon show by measuring how a gap was closed so you can monitor and make adjustments if needed.
Why are we making this change?
Retiring Patient Profile and PIP_70 and focusing on the data sources listed above allows us to:
- Improve data quality exchanges
- Enable workflows and processes that support our ACNs’ EHRs
Patient Profile and PIP_70 submissions often contain errors which impact our reporting and performance. We’ve historically performed poorly in supplemental data audits, which could put our members, your patients, at risk of higher costs and reduced services.
Additionally, NCQA continues to expand its implementation of Electronic Data Source (ECDS) measures, preferring digital supplemental data sources to close care gaps.
Therefore, transitioning to a digital first strategy is paramount as we approach the 2024 performance year.
Wrapping up the 2023 performance year
We’ll continue to accept Patient Profile and PIP_70 report for gap closures for 2023 dates of service through Jan. 31, 2024.
Get more information
See our Digital First Resources & FAQ for details on:
- Supplemental data sources listed above
- Submitting exclusions in the absence of Patient Profile
- How to set up a direct data feed with us