Feedback requested for improvements to Performance Year Transitions

[Beneficiary Claims Data API (BCDA) Community]

Hi BCDA community,

Our team is working on improvements to our Performance Year (PY) Transition and we’d like your feedback! At the end of each year, BCDA undergoes a maintenance period to check whether beneficiaries are still attributed to the correct model entities. We’re proposing the following changes for 2025 and would like your feedback. Please reply to this thread directly if you have feedback on these proposed changes or have other ideas on how to improve the PY transition:

• Provide historical data more quickly – Typically, historical data for newly-attributed beneficiaries is not available until mid-February after all entities' files are received. However, BCDA will now leave the "all" Group endpoint active during PY transition to provide historical data (through 12/31 of the prior year) for newly-attributed beneficiaries as soon as a historical CCLF8 file has been received for your entity in the current year. This can be as soon as early January, depending on when we receive the historical file.  Once the first current PY file is received, BCDA will also return new claims on a rolling basis.
• Allow runouts to be pulled continuously – BCDA will allow runouts to be pulled continuously, rather than limiting it to the 180 days after the end of the performance year, by utilizing previous runout attributions.
• Replace the Attribution_status endpoint with Group Read/Search – To improve conformance with the Bulk FHIR implementation guide, the attribution_status endpoint will be replaced by Group resources used for triggering job kickoffs. BCDA will move data from the endpoint into these Group resources, which are accessible using Group Read and Search requests for entities looking for updates on attributions used by both the "runout" and "all" groups.

– The BCDA Team

[Maddy Blakeslee]

Hi all, 

Thank you for flagging improvements you all are considering. Providing historical data more quickly is Aledade's top request out of the list you provided. 

For additional improvements to consider:

• Making data available as quickly as possible is our top concern, especially for our new (PY1) ACOs. I would like to request decoupling the various programs within the API code. This past year the MSSP and REACH claims data was delayed because the required attribution data was not available for shared savings programs that Aledade is not a part of. This delays patient care and outreach at a critical time. 
• Enabling linking between CCLF and BCDA claims with a shared claim identifier is always a top request from our end users. This would help us trouble shoot patterns in why we are seeing patients and claims available in one source and not another so that we can help troubleshoot issues. 
• Add additional patient demographic information to the patient end point - preferred language, race, ethnicity and SDOH information if any is available
• Add additional financial fields such as the items that are captured in the weekly claims reduction files for ACO REACH
• Enabling partially adjudicated claims across all programs. Specifically, I'm interested in MSSP and ACO REACH.
• Providing historic data for the coverage end point
• Enable claims for PY0 ACOs - the DPC API was supposed to do this, however, there have not been any updates about the onboarding process and program starting back up for a year.

[Beneficiary Claims Data API (BCDA) Community]

Hi Maddy,

Thanks for the feedback and providing additional suggestions for enhancements to the API. We've circulated this with a few team members and have some clarifying questions for you and additional info to share on each of these topics.

• Making data available as quickly as possible for new (PY1) ACOs
  • With the proposed changes to the 2024/2025 PY Transition, BCDA aims to share data from the latest performance year with a model entity as soon as we receive their updated attribution information. We're removing a previous dependency which required us to wait for the latest attributions for each model entity across all 3 supported models.

• Enabling linking between CCLF and BCDA claims with a shared claim identifier

• • Our team will be investigating this in the upcoming months to identify possible solutions to more consistent deterministic approaches to linking CCLF and BCDA claims.
• Additional patient demographic information
  • Patient demographic information is an area our team is still searching for a suitable, quality data source. Our previous investigation into preferred languages hit a stopping point after analysis of a potential data source revealed poor data quality.
  • Could you provide more details here on if/how your team accesses social determinants of health information today?
• Additional financial fields
  • Our team's next step here will be to determine which, if any, available fields contain financial information most like the weekly CRFs for ACO REACH.

• Enabling partially adjudicated claims across all programs

• • We encourage you to reach out to the Model leads at SharedSavi...@cms.hhs.gov with your interest in accessing partially adjudicated claims data through BCDA.
• Providing historic data for Coverage resources
  • Could you please share more details on your team's use cases for coverage history? Additionally, are there any specific fields in the Coverage resource which would be most helpful for your team's purposes?

• Enable claims for PY0 ACOs

• • We understand this as a request to provide bulk FHIR claims access to health care organizations which have been approved for one of BCDA's supported models in an upcoming performance years, but not the current PY. Is that a correct interpretation?

As always, we appreciate your feedback!
The BCDA Team

[Neil Copeland]

We would like to have:

• Historical Coverage Data.  Currently we only receive current year.  So, being in 2024, we only receive coverage for 2024.  We would like to receive at least two years of Coverage.
• Faster Downloading of Historical Data
• Partially Adjudicated Claims for all Share Savings Program Models
• Partially Adjudicated Claims are thin on the number of institutional claims (Inpatient, Outpatient, etc).  We would like to have a greater volume.
• On Partially Adjudicated Claims we are missing a lot of the same fields that we get on Adjudicated and I am referring to fields that come on an 837.  Fields include Place of Service Code as well as others.

For the user above, a link between the CCLF and BCDA can be done through the Claim Control ID.  It was NULL on several claims for a while, but now it is consistently populated and the CCLF A now has it.

Thank you!