ACO Assignment Data

[Jeff Solomon]

Hi All,

I've been looking through some of the documentation around the BCDA, and it sounds like the primary focus in on making available the claims data for beneficiaries.  Within our current reporting structures using CCLF and other data sources, we also place a focus on ACO assignment -- in particular, which beneficiaries are/were assigned to the ACO at a given point in time, and into which cohort they fall (Aged/Dual, Aged/Non-Dual, ESRD, and Disabled) as well as whether they have opted out of data sharing.  

Currently we use the HASSN, QASSGN, and BNEXC files for MSSPs and NGALIGN, MNGREB, and DPREF files to do so.  Is there a plan to make this data available via the BCDA? That would be tremendously helpful, in particular given the complexity of getting this data out of the myriad Excel, XML, and other files that the process currently requires and the maintenance required to keep up with changes to these files. 

Thanks,

Jeff

[Katherine C]

Just following up on this - I have the exact same concern.  Having the CCLF data available via API is great, but without the availability of the assignment files as well, it doesn't remove the need for us to regularly download data from the MFT and then manipulate it.

[Liani Lye]

Hello Katherine and Jeff!

Currently, we are focusing on building the BCDA to achieve parity with the CCLF data.  We may explore including other types of data later in our development process.

To guide our exploration, a few questions about how your ACO uses assignment files:

• How do you currently use assignment files in your overall process?
• How do you feel about the current assignment files process?
• If the BCDA were to include assignment data, how can we make the process of retrieving assignment data more frictionless for you?

Our research team is willing to jump on a 15-20 minute call if you or anyone else if that is more convenient, or if you want to elaborate further!

All my best,

Liani

-- 

Liani Lye
Community Manager

Beneficiary Claims Data API

[Michael]

The beneficiary assignment lists are currently manually loaded into a table in our organization's database and are then used to determine which claims our ACO needs to query and analyze. The CCLF files we receive from CMS include claims data for beneficiaries assigned to our ACO and also additional claims data for beneficiaries not in our ACO. The amount of distinct beneficiaries in the CCLF claims data we receive is more than double the amount of beneficiaries in our ACO. So it essential that we restrict our claims data related queries, reports, and analysis to the appropriate beneficiary assignment list for our organization.

It would be very beneficial to include the all of the data and columns in the quarterly and annual beneficiary assignment lists as part of the data that is sent through BCDA.

Note: The beneficiary assignment list files have variously been called QASSGN, HASSGN, and QALR. They are probably more names I am missing.

[Shea Parkes]

Liani,

Here are some quick responses to your questions:

The CCLF data source includes information about many, many beneficiaries that are only "potentially assignable".  Although good to have for many use cases, there is a big need to understand current outcomes for the actually assigned beneficiaries.

The current assignment file process is clunky compared to the modern API approach of BCDA.  The current mechanism exhibits frequent, infuriating schema changes such that it is painful to maintain an ETL pipeline.

For starters even just some kind of current assignment indicator on the Beneficiary record.  However, a more complete solution would include historic assignment information as well (e.g. assignment status by time period).  Additional "nice-to-haves" that are on the current assignment sources include the most common ~PCP and HCC risk scores and flags.

As mentioned in other threads, I'd love to have some visibility into the BCDA backlog to know where items like this sit.

Thanks,

Shea

[Charlotte Jackson]

Hi Liani, 

Just wondering if this call ever happened or if there has been any other discussion around this! Apologies if there's been more discussion I missed.

On Friday, August 16, 2019 at 11:24:15 AM UTC-4, Liani Lye wrote:

[Liani Lye]

Hello Charlotte!

Yes, the BCDA team did have these calls and were able to gather some information about assignment files and what our ACO partners need from them. We heard a few key things from ACO's:

• Processing assignment files is especially difficult for small-to-mid-sized ACO's because of the frequent formatting changes.
• Assignment files do not contain demographic data, but linking demographic data (from CCLF8) to assignment files would be greatly helpful.

If you would like to call out anything about how assignment files that are critical to you or your organization, we would love to hear it and add it to our takeaways!

We understand how important this is to our ACO partners, so the BCDA team is currently exploring the work it would take to deliver assignment files, but we are unable to offer a specific timeline or promise of this feature at this time.

All my best,
Liani

--

Liani Lye

BCDA Community Manager

[Ankur Garg]

Hi Liani,

I totally agree on the constant changing of assignment files format has been challenging for us for the ingestion especially when even the column names change. There has been inconsistency in format and number of columns too. We have to create a legacy mapping every single time to keep the consistency in our internal databases. I do think they have been improving over the past 3 years but it is completely manual ingestion process. We can't automate it. 

Our ACO doesn't have any issues with demographics information coming in CCLF8 as we have created a process to align the demographics from all sources to a beneficiary even if there HICNO or MBI changes. 

We would like the assignment files to be delivered a little early though as currently there is about a 2 month lag. 

Regards,

Ankur Garg 

[Liz Blair]

Hello,

I realize this thread is quite old now, but the topic is still relevant. In order to mimic how CCLF 8 works, we've started to pull a FULL list of beneficiaries (no __since parameter) at the beginning of the month and essentially keeping track of the historical assignment ourselves. With the delay in receiving 2022 data this year; however, we were unable to pull that full list in January. So we are now lacking visibility into assignables for January. Does BCDA have a recommendation on how we could determine this list?

Thanks

Liz

[Beneficiary Claims Data API (BCDA) Community]

Hi Liz,

Thank you for your patience! Our team is working to get you a response and we'll get back to you shortly.

Thanks,

The BCDA Team

[Liz Blair]

Hello,

I wanted to follow-up on this thread as I never heard back and this continues to be an issue. We're getting different bene counts month over month between CCLF8 and BCDA. From what we've been told, BCDA's patient resource pulls from CCLF8 so they should be identical. I'm wondering if there's something in the way we're pulling this data that may be causing the discrepancy. We'd be happy to set-up some time to walk you through what we're doing.

Thank you!

Liz

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[Beneficiary Claims Data API (BCDA) Community]

Thank you for the follow-up, Liz.

We are sorry to hear of these ongoing discrepancies being experienced. Thank you for the offer to meet; please share some meeting time options via email to bc...@cms.hhs.gov starting the week of 27 June 2022, so that we can see how your team is handling the data and for us to discuss further. In the meantime, we will confirm and verify the CCLF8 information and potential nuances related to assignment data.

We also want to acknowledge the correlation of this work with the previously expressed desire for Assignment List Report data endpoints. 

Thank you for your continued support of BCDA,

The BCDA Team

[Arjun subramaniyan]

Hi Is there a mapping of the assignment files to FHIR that's currently present, would like to follow up or set up a call to understand how assignment file information maps to the data that we recieve on the Group resource as part of the BCDA API

[Beneficiary Claims Data API (BCDA) Community]

Hello,

Assignment data is not directly available via BCDA at this time.

Each time you make an $export request with BCDA's /Patient or /Group/all endpoints, only data for the enrollees in the latest CCLF-8 file for your ACO or KCE is returned. To check the last time BCDA received updated attribution information for your organization, please use the /attribution_status endpoint.

A Medicare enrollee's data may be suppressed from BCDA based on their data sharing preferences. As BCDA updates beneficiary data sharing preferences daily, this can lead to discrepancies between the enrollees included in monthly CCLF-8 files and data returned by BCDA.

Please let us know if you have any additional questions or reach out to us at bc...@cms.hhs.gov if you'd like to set up a call with our team. Please also feel free to share more about your organization's needs for assignment data.

Thanks,

The BCDA Team