clarify health CMS qualified entity public report 2021

Clarify Health is a certified national Qualified Entity (QE) of the Centers for Medicare & Medicaid Services (CMS), which enables us to receive 100% of Medicare Fee-for-Service claims data through the QE Program (also known as the Medicare Data Sharing for Performance Measurement Program). As a QE, we use these data to deliver precision insights via the Clarify Atlas Platform and to evaluate and publicly report on national quality of care measures each year. Additionally, Clarify has a proprietary data set, including Commercial, Medicare Advantage, and Managed Medicaid claims for patients across all 50 states, Puerto Rico, and the District of Columbia. Combined, our data sets include 300M+ unique patient lives, offering a breadth and depth of information with which to gain insights into the quality of care in the United States.

Our 2021 public QE 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 QE report evaluates four HEDIS® quality of care measures (HEDIS® quality measures are developed and maintained by the National Committee for Quality Assurance (NCQA)) for disease monitoring and management in years 2018, 2019, and 2020, among patients with 1) diabetes, 2) both diabetes and mental illness, and 3) both cardiovascular disease and mental illness. 1

The analysis showed:

  • The rate of hemoglobin A1c testing for diabetic patients decreased in 2020.
  • Nephropathy screening rates for diabetic patients declined in 2020.
  • Diabetes monitoring for patients with schizophrenia decreased in 2020.
  • The rate of cardiovascular monitoring for people with cardiovascular disease and schizophrenia decreased in 2020.

Read the full QE report here.


1The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.