Clarify Health is a CMS Qualified Entity (QE)

Today, we announced that Clarify will continue to receive 100% of Medicare Fee-for-Service claims data through the Qualified Entity (QE) Program (also known as the Medicare Data Sharing for Performance Measurement Program) by the Centers for Medicare and Medicaid Services (CMS). Being a CMS Qualified Entity means that we will continue to expand the breadth, depth, and longitudinality of our industry-leading national data sets, containing over 300 million sequenced patient care journeys from which our platform analytics draw upon.

Our data science team also published a public report on national quality measures. The report titled, “Quality measures: monitoring and management of chronic disease in patients with mental illness” will help providers and public health workers better understand gaps in preventative care and disease management for all Americans, including the higher-risk, sub-population of those living with a chronic disease and mental illness.

The report describes research that used Medicare data and our other payer data sets to assess six standard, HEDIS® and Serious Mental Illness quality measures among patients with diabetes, both diabetes and mental illness, and both cardiovascular disease and mental illness.

Key findings include:

  • Diabetic patients with a serious mental illness received HbA1c testing at a lower rate than all diabetic patients, regardless of whether they were Medicare or commercially insured.
  • Medicare patients with diabetes and a serious mental illness had similar rates of nephropathy screening to all Medicare diabetics, while commercially insured patients with diabetes and a serious mental illness had higher rates of nephropathy screening than all commercially insured diabetics.
  • Medicare patients with diabetes and schizophrenia received diabetes monitoring (LDL-C and HbA1c testing) at a higher rate than those with commercial insurance.
  • Medicare and commercially insured patients with cardiovascular disease and schizophrenia received similar rates of cardiovascular monitoring (LDL-C testing).

Read the full press release here.