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Clarify Health Renews Certification as a CMS Qualified Entity and Publishes Report on National Provider Performance Measures

Clarify will continue to receive 100% of Medicare Fee-for-Service claims data, further expanding the breadth, depth, and longitudinality of its patient-level data sets for industry-leading analyses and insights

Clarify Health, a leading enterprise analytics platform company serving healthcare organizations across the US, announced that it has been granted renewal of its certified status in 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). Clarify’s status as a QE, which first became active in March 2018, is extended as the company continues to uphold its rigorous data security and privacy requirements. Clarify will continue to receive 100% of Medicare Fee-for-Service claims data under Parts A, B, and D, further enriching the breadth, depth, and longitudinality of its data sets, containing over 300 million sequenced, de-identified patient care journeys from which its platform analytics draw upon.

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“As one of only a handful of software companies in the QE Program we value being entrusted to use Medicare claims data to provide more precise insights into the quality of care in the United States to the public and to our customers,” said Todd Gottula, President, Clarify Health. “By ingesting these Medicare data into our platform and combining them with our proprietary data sets at the patient-level, we are able to continuously enhance what is already one of the largest, longitudinal, patient-level data sets in the industry.”

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The Clarify platform aggregates traditionally siloed CMS claims data with commercial claims, electronic health records, prescription, and social and behavioral data at the patient-level and enriches it to a standard suitable for machine learning, at a scale heretofore unseen in healthcare analytics. This allows its models to be trained on large cohorts and a more complete picture of each patient’s healthcare journey, delivering insights with unmatched precision to health systems, physician groups, ACOs, and health plans.

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In compliance with the requirements of an active QE status and furthering its mission to power better healthcare, Clarify has 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 evaluates six standard, HEDIS® and Serious Mental Illness quality measures (developed and maintained by the National Committee for Quality Assurance (NCQA)) for disease monitoring and management in years 2017, 2018, and 2019, among patients with diabetes, both diabetes and mental illness, and both cardiovascular disease and mental illness. The 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).

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