WEBVTT 1 00:00:02.940 --> 00:00:09.660 HC Webinars: Hello, everyone. Thanks for joining us today. My name is Laura Martin, and I will be your host for today's webinar. 2 00:00:09.810 --> 00:00:14.700 HC Webinars: The presentation we will be covering for you today is empowering Acos. 3 00:00:14.730 --> 00:00:18.619 HC Webinars: leveraging quality management tools for MIPS, and beyond 4 00:00:18.640 --> 00:00:25.100 HC Webinars: presented by Shannon Campbell, senior manager of the Regulatory measures program here at health, catalyst 5 00:00:25.360 --> 00:00:29.380 HC Webinars: and Hayes. Will Morrison, measurable product manager with health catalyst. 6 00:00:30.120 --> 00:00:34.800 HC Webinars: Before we begin, I want to couple. Cover a couple of housekeeping items. 7 00:00:34.810 --> 00:00:40.750 HC Webinars: All attendees have been placed on mute, and cameras are off to eliminate background, noise and distractions. 8 00:00:41.040 --> 00:00:46.929 HC Webinars: Please use the QA. Panel to ask questions and interact with our speakers throughout the presentation. 9 00:00:47.350 --> 00:00:54.269 HC Webinars: The slides and the recording of this presentation will be emailed tomorrow as well as published on our website. 10 00:00:54.620 --> 00:00:58.759 HC Webinars: And as a reminder, ceus are not provided for today's webinar. 11 00:00:58.960 --> 00:01:03.499 HC Webinars: That is all I have for now, so I will hand it over to our presenters. Janet and Hazel. 12 00:01:03.950 --> 00:01:16.310 Shannon Campbell: Thank you, Laura. My name is Shannon Campbell, and I've spent the last 17 years or so managing compliance and Cms quality, reporting across healthcare settings, including clinics, hospitals. 13 00:01:16.620 --> 00:01:20.039 Shannon Campbell: Ascs and regional healthcare system. 14 00:01:20.320 --> 00:01:28.670 Shannon Campbell: And while I wouldn't quite call it a hobby, I thoroughly enjoy reading the Cms. Rules, so I feel that this position is perfect for me. 15 00:01:28.740 --> 00:01:37.830 Shannon Campbell: I love this work, and I love helping providers make the most of their efforts within the regulatory guidelines, so they can reap the full rewards available to them. 16 00:01:39.560 --> 00:01:44.086 Shannon Campbell: We'll get started before we dive into the regulatory aspects. 17 00:01:46.260 --> 00:01:49.240 Shannon Campbell: of the Aco. Quality measures. 18 00:01:53.410 --> 00:01:56.429 Shannon Campbell: sorry I wasn't prepared to cover the agenda. 19 00:01:57.860 --> 00:02:07.720 Shannon Campbell: I'll cover the agenda during today's slide presentation. You'll learn the regulatory requirements for Acos how to avoid common pitfalls for Acos 20 00:02:07.990 --> 00:02:11.860 Shannon Campbell: and use the measurable tool for MIPS and beyond. 21 00:02:13.710 --> 00:02:29.989 Shannon Campbell: I'll be covering the regulatory requirements for Acos, and before we dive into the regulatory aspects of the Aco quality measures. We have a poll question, and we'd like to get an idea of how actively you currently monitor your quality performance throughout the year. 22 00:02:30.100 --> 00:02:32.420 Shannon Campbell: Do you monitor it annually? 23 00:02:32.850 --> 00:02:33.880 Shannon Campbell: Quarterly 24 00:02:34.390 --> 00:02:38.919 Shannon Campbell: monthly? Or is your monitoring more active or continuous? 25 00:02:41.650 --> 00:02:45.199 Shannon Campbell: We'll leave this open for a few seconds, so everyone can participate. 26 00:02:51.020 --> 00:02:53.199 Shannon Campbell: Got about a 3rd of our responses. 27 00:03:01.600 --> 00:03:08.179 Shannon Campbell: and the responses are just trickling in, so maybe give it another 5 seconds. 10. I'll Laura. I'll let you choose. 28 00:03:18.400 --> 00:03:29.740 Shannon Campbell: Looks like, there's some easy division, and that's great that a 3rd of quarterly, a 3rd monthly, a 3rd actively or continuously, roughly, they're about 30% to 34%. 29 00:03:30.130 --> 00:03:31.070 Shannon Campbell: That's great 30 00:03:33.710 --> 00:03:42.409 Shannon Campbell: with that idea of monitoring quality performance in mind. Let's dig into the intention of the quality payment program and why the MIPS measures are important. 31 00:03:43.070 --> 00:03:44.650 Shannon Campbell: The Qpp measures 32 00:03:45.390 --> 00:03:47.480 Shannon Campbell: are often categorized as 33 00:03:47.490 --> 00:03:57.240 Shannon Campbell: needless, burdensome tasks that cms forces on healthcare organizations, but they should be seen in a different light, one that benefits the organizations. Instead. 34 00:03:57.840 --> 00:04:05.890 Shannon Campbell: the measures focus on established, evidence-based clinical practices which represent the basic care patients should receive. 35 00:04:05.920 --> 00:04:11.220 Shannon Campbell: These practices are standards that are likely already being followed by Qpp participants. 36 00:04:11.280 --> 00:04:15.919 Shannon Campbell: Why not capitalize on quality practices? You're already following 37 00:04:16.209 --> 00:04:21.569 Shannon Campbell: measures should be viewed as opportunities to fund even more quality improvement. 38 00:04:21.970 --> 00:04:23.959 Shannon Campbell: We look at it like a layer cake. 39 00:04:24.160 --> 00:04:28.450 Shannon Campbell: Consider the foundational layer is the accurate capture of E. Hr. Data. 40 00:04:28.570 --> 00:04:34.230 Shannon Campbell: accurate documentation by healthcare providers and the accurate mining of that data 41 00:04:34.780 --> 00:04:39.030 Shannon Campbell: by submitting these data to Cms in the form of QP. Measures. 42 00:04:39.050 --> 00:04:44.040 Shannon Campbell: Success in these established clinical practices can maximize incentive payments. 43 00:04:44.050 --> 00:04:45.410 Shannon Campbell: reimbursement 44 00:04:45.510 --> 00:04:51.580 Shannon Campbell: to drive continuous improvement leading to better quality, improve patient outcomes and cost reduction. 45 00:04:51.850 --> 00:05:02.860 Shannon Campbell: This will improve measure results further, seeking the cycle by increasing revenue and driving continuous improvement to support the quality improvement efforts implemented in clinics 46 00:05:02.960 --> 00:05:04.870 Shannon Campbell: to achieve healthcare excellence. 47 00:05:07.100 --> 00:05:23.849 Shannon Campbell: Some Qpp participants simply make the annual measure submission to Cms and nothing more. While that's technically allowed, it doesn't meet the intention of the program. And it's not a a wise use of the resources invested into the Ehr and the data collection. 48 00:05:24.230 --> 00:05:30.959 Shannon Campbell: It also leaves unclaimed incentive dollars on the table. And most importantly, it risks patient care 49 00:05:31.000 --> 00:05:32.829 Shannon Campbell: instead, participants 50 00:05:32.860 --> 00:05:50.569 Shannon Campbell: should monitor their data during the performance period so they can identify gaps and close them before the end of the performance period. This way they can improve the quality of care their patients receive and have more control over their performance scores over previous years, and as a result. 51 00:05:50.700 --> 00:05:52.229 Shannon Campbell: the financial incentives. 52 00:05:52.520 --> 00:06:09.440 Shannon Campbell: So as Acos, you'd be best served by embracing a culture that aligns with the quality payment program one in which you actively monitor your Acos performance and the quality measures providing clinicians the opportunity to close performance gaps. 53 00:06:09.710 --> 00:06:15.930 Shannon Campbell: Not only will this make you more agile in the field C of Cms quality reporting 54 00:06:16.210 --> 00:06:27.750 Shannon Campbell: and better equipped to adjust to changes that Cms makes to the program, but it'll also improve your quality scores and maximize the financial incentives awarded to your Aco. 55 00:06:28.250 --> 00:06:37.910 Shannon Campbell: also, the data sharing aspect of Qpp measures inherently supports the Aco's goal to share in the accountability of the care of patients 56 00:06:38.500 --> 00:06:44.050 Shannon Campbell: where one clinician may not meet a measure, another clinician may close the gap during a subsequent visit. 57 00:06:44.630 --> 00:06:46.840 Shannon Campbell: not only improving the measure performance. 58 00:06:46.900 --> 00:06:48.740 Shannon Campbell: improving the patient's care 59 00:06:51.700 --> 00:06:52.889 Shannon Campbell: at this point. 60 00:06:52.930 --> 00:06:54.800 Shannon Campbell: Have a second poll question 61 00:06:55.030 --> 00:06:59.610 Shannon Campbell: to ask how actively you manage your performance in quality measures. 62 00:06:59.670 --> 00:07:01.270 Shannon Campbell: Responses are 63 00:07:01.645 --> 00:07:07.829 Shannon Campbell: the options are, we do not have any care. Gap closure processes. We just submit the data through Cms 64 00:07:08.520 --> 00:07:11.460 Shannon Campbell: notify member organizations about care gaps. 65 00:07:12.520 --> 00:07:18.330 Shannon Campbell: We identify patterns in care gaps and provide member organizations with insights for improvement. 66 00:07:19.200 --> 00:07:24.659 Shannon Campbell: We actively work with member organizations to improve their processes, related to care gaps 67 00:07:24.820 --> 00:07:26.170 Shannon Campbell: or other. 68 00:07:38.250 --> 00:07:39.940 Shannon Campbell: We have about a quarter 69 00:07:40.320 --> 00:07:45.949 Shannon Campbell: responses so far, but they're still flowing in pretty quickly. So I say, we leave it open for a few more seconds here. 70 00:07:50.400 --> 00:07:56.899 Shannon Campbell: And then, as soon as I said that, it began to trickle. So Alura maybe give it. Yeah, there we go. Thank you. 71 00:07:57.910 --> 00:08:16.609 Shannon Campbell: Okay, so great, 45% actively work with member organizations to improve their processes related to care gaps. It's great. Second, even better. Second, we we identify patterns and care gaps and provide member organizations with insights for improvement. That is wonderful. Thank you very much for that. 72 00:08:20.390 --> 00:08:37.980 Shannon Campbell: Prior to the calendar year 2021 physician fee schedule, MSP. Acos submitted their required data, their quality data, anyway, through the 10 measures collected via the Cms. Web interface method with this method Cms 73 00:08:38.090 --> 00:08:43.950 Shannon Campbell: sent the Aco a list of patients for which the Aco then submitted the 10 measure values 74 00:08:44.444 --> 00:08:49.269 Shannon Campbell: the patient list came from Cms. So the measures only applied to Medicare patients. 75 00:08:51.190 --> 00:08:58.329 Shannon Campbell: The calendar year 2021 physician fee schedule, however, aligned the shared savings program with MIPS reporting 76 00:08:58.870 --> 00:09:10.450 Shannon Campbell: which meant the Mss. Pacos would have to transition from the web interface to the Apm. Performance pathway or the Ap. P. By submitting 3 specific myth measures. 77 00:09:10.480 --> 00:09:13.250 Shannon Campbell: diabetes HBA, one C poor control 78 00:09:13.610 --> 00:09:15.960 Shannon Campbell: screening for depression and follow up plan 79 00:09:15.980 --> 00:09:17.860 Shannon Campbell: controlling high blood pressure. 80 00:09:18.820 --> 00:09:28.489 Shannon Campbell: A vast departure from the Mss. Paco measures in the Cms. Web interface is that the mids Ap. Measures, whether CQM. Or ECQM. 81 00:09:28.790 --> 00:09:32.159 Shannon Campbell: Require that all patients, regardless of payer. 82 00:09:32.210 --> 00:09:38.089 Shannon Campbell: be included in the measure population. This means that the measures have to include Medicare patients 83 00:09:38.180 --> 00:09:42.349 Shannon Campbell: as well as patients with commercial payers, and even self pays 84 00:09:42.690 --> 00:09:43.849 Shannon Campbell: all patients 85 00:09:43.900 --> 00:09:45.400 Shannon Campbell: regardless of pair. 86 00:09:45.840 --> 00:09:47.059 Shannon Campbell: The reason for this 87 00:09:47.170 --> 00:09:58.860 Shannon Campbell: is that Cms. Doesn't want Msf Pacos to focus only on Medicare patients, but to apply best practice and quality monitoring to all the patients that they treat 88 00:10:00.020 --> 00:10:02.770 Shannon Campbell: this calendar. Year 2021 89 00:10:02.850 --> 00:10:10.540 Shannon Campbell: Pss. Rule also announced the sun setting of the Cms. Web interface as of the 2022 performance period. 90 00:10:11.296 --> 00:10:15.579 Shannon Campbell: Subsequent Pfs rule, though delayed the termination of the web interface 91 00:10:15.600 --> 00:10:18.940 Shannon Campbell: until the end of the 2024 performance period. 92 00:10:18.970 --> 00:10:25.789 Shannon Campbell: giving MSS. Pacos 3 additional years to transition to the All patient, all payer requirement 93 00:10:26.590 --> 00:10:32.399 Shannon Campbell: in the rules. Since then Cms. Has received feedback, leading them to 94 00:10:32.410 --> 00:10:33.670 Shannon Campbell: announce 95 00:10:33.710 --> 00:10:37.189 Shannon Campbell: in the calendar year 2024 Pfs. Rule 96 00:10:37.330 --> 00:10:46.939 Shannon Campbell: the creation of a new transitional data collection method, Medicare, Cqm. Which is an option available only to MSS. Pacos. 97 00:10:47.290 --> 00:10:56.669 Shannon Campbell: These measures are calculated the same way as the traditional Cqms. You see listed here, except they don't require all pay or all patient data. 98 00:10:57.260 --> 00:11:02.290 Shannon Campbell: They only require data to be reported for all medicare patients 99 00:11:02.480 --> 00:11:06.110 Shannon Campbell: keep in mind that this requirement isn't for all Medicare patients 100 00:11:06.140 --> 00:11:15.690 Shannon Campbell: attributed to the Mss. Paco. It means all patients who have medicare part B and receive care from a provider in the aco. 101 00:11:16.720 --> 00:11:25.859 Shannon Campbell: These Medicare Tqms are intended to be transitional, meaning that Cms. Will remove them at some point in the future. But they haven't announced when 102 00:11:26.299 --> 00:11:34.200 Shannon Campbell: the goal of the Medicare Cqm's is to transition Msf. Paco to the all pay or all patient version of these measures. 103 00:11:34.630 --> 00:11:42.240 Shannon Campbell: Cms. Can provide a quarterly cumulative list of Medicare Cqn. Patients. Your Aco. Is required to report. 104 00:11:42.480 --> 00:12:03.729 Shannon Campbell: but we haven't seen that this Medicare, Cqm. Option will be very helpful to any of our Acos. The resources needed to pull the list of patients from the Quarterly Cms. Report and aggregate those results into the submission tool are better served, being applied to the ultimate goal of pulling all patients regardless payer. 105 00:12:04.410 --> 00:12:13.560 Shannon Campbell: and therefore setting up the Aco for success with the traditional Cqm. It's kinda like, why bother using training wheels if you can ride a 2 wheeler without them. 106 00:12:13.750 --> 00:12:19.490 Shannon Campbell: So, to summarize the Mss. Paco options for submitting quality data to Cms. 107 00:12:19.940 --> 00:12:26.070 Shannon Campbell: The last year the Cms web interface method will be available. Is the current 2024 performance year. 108 00:12:26.380 --> 00:12:30.469 Shannon Campbell: as of the 2025 performance period MSS. Pacos 109 00:12:30.510 --> 00:12:33.360 Shannon Campbell: must submit quality data via CQM. 110 00:12:33.530 --> 00:12:36.979 Shannon Campbell: The Ecqms. Or the New Medicare, Cqm. 111 00:12:37.420 --> 00:12:41.389 Shannon Campbell: Those will be your only options for this, for the foreseeable future 112 00:12:43.390 --> 00:12:46.560 Shannon Campbell: addition to the all patient, all payer requirement. 113 00:12:47.100 --> 00:12:48.190 Shannon Campbell: the shift 114 00:12:48.230 --> 00:12:54.700 Shannon Campbell: of Mss. Pacos to the app measure. Submission brought up another topic needing clarification 115 00:12:55.020 --> 00:12:56.310 Shannon Campbell: data completeness. 116 00:12:57.050 --> 00:12:58.560 Shannon Campbell: Cms requires 117 00:12:59.291 --> 00:13:04.710 Shannon Campbell: a measure, level data completeness threshold of 75% for the 118 00:13:04.770 --> 00:13:13.049 Shannon Campbell: 2024 quality measures which includes the 3 Mspac aco measures. You see here, it doesn't mean that 119 00:13:13.450 --> 00:13:17.449 Shannon Campbell: has to submit 75% of the data required for the measures. 120 00:13:17.580 --> 00:13:21.500 Shannon Campbell: The Aco is expected to submit 100% of the data. 121 00:13:21.540 --> 00:13:24.350 Shannon Campbell: 100% of its participants 122 00:13:24.430 --> 00:13:27.980 Shannon Campbell: to feed the measure populations and the measured denominator 123 00:13:28.580 --> 00:13:31.630 Shannon Campbell: data. Completeness applies to the numerator action. 124 00:13:31.660 --> 00:13:35.100 Shannon Campbell: and each measure must meet the 75% threshold. 125 00:13:35.250 --> 00:13:39.299 Shannon Campbell: This means that 75% of the denominator cases 126 00:13:39.380 --> 00:13:46.200 Shannon Campbell: must have a quality action. Whether that's performance met, performance not met, or in the case of depression screening here. 127 00:13:46.860 --> 00:13:48.610 Shannon Campbell: denominator exception. 128 00:13:49.320 --> 00:13:55.720 Shannon Campbell: If the data completeness threshold isn't met for a measure, no points will be awarded to the Aco for that measure. 129 00:13:55.960 --> 00:13:59.159 Shannon Campbell: So here we see the data completeness, calculation 130 00:13:59.230 --> 00:14:04.950 Shannon Campbell: from the measure, specifications for the depression screening measure, which is number 1, 34. 131 00:14:05.130 --> 00:14:15.459 Shannon Campbell: You can see that the the data completeness rate is calculated by starting with the eligible population in the denominator, which in this example is 80 patients. 132 00:14:15.540 --> 00:14:21.160 Shannon Campbell: Again, this is calculated from the entirety for 100% of the Acos data. 133 00:14:21.560 --> 00:14:24.519 Shannon Campbell: Looking at the numerator for the data completeness rate. 134 00:14:24.760 --> 00:14:29.159 Shannon Campbell: You see in this example that 40 patients have enumerator action of performance met. 135 00:14:29.390 --> 00:14:36.910 Shannon Campbell: 10 patients have a denominator exception, and 20 patients have enumerator action of performance not met totalling 70. 136 00:14:37.630 --> 00:14:44.930 Shannon Campbell: This means that 70 of the 80 patients in the denominator have a numerator action or complete data. 137 00:14:45.580 --> 00:14:47.810 Shannon Campbell: 10 have incomplete data. 138 00:14:48.470 --> 00:14:50.420 Shannon Campbell: 70 out of 80 patients 139 00:14:50.600 --> 00:14:52.000 Shannon Campbell: with complete data 140 00:14:52.010 --> 00:14:58.290 Shannon Campbell: results in a data completeness rate of 87.5%, which exceeds the 75% threshold. 141 00:15:02.810 --> 00:15:10.160 Shannon Campbell: As for the performance categories in waiting, the Qvp has 4 performance categories for which data is traditionally submitted. 142 00:15:10.270 --> 00:15:15.220 Shannon Campbell: quality cost improving activities and promoting interoperability. 143 00:15:15.590 --> 00:15:27.900 Shannon Campbell: Given the nature of an accountable care organization as part of the Ap. P. The Aco. As an Apm. Entity isn't scored on the cost performance category and is automatically await awarded 144 00:15:28.060 --> 00:15:36.180 Shannon Campbell: 100% of the improvement activities activities which is weighted at 20% of the Aco's final score. So that accounts for cost 145 00:15:36.360 --> 00:15:37.820 Shannon Campbell: and improvement activities 146 00:15:38.660 --> 00:15:40.252 Shannon Campbell: for the Ms. Paco 147 00:15:40.990 --> 00:15:43.530 Shannon Campbell: performance improvement category. 148 00:15:45.380 --> 00:16:06.079 Shannon Campbell: Excuse me, the promoting interoperability category is weighted at 30% of the Acos final score and oh, new to the 2024 performance period. Acos had the option to report this category at the Apm. Entity level. They previously dependent on the clinicians or groups to submit that data 149 00:16:06.460 --> 00:16:18.240 Shannon Campbell: also, speaking of changes, Qps or qualified participants and partial Qps. Participating in an aco were previously exempt from the promoting interoperability category. 150 00:16:18.370 --> 00:16:22.929 Shannon Campbell: The calendar year 2024 Pfs. Rule adopted a change 151 00:16:22.940 --> 00:16:27.460 Shannon Campbell: such that as of the 2025 performance period. 152 00:16:27.760 --> 00:16:32.810 Shannon Campbell: all MSS. Paco participants, including the Qps and partial Qps 153 00:16:33.070 --> 00:16:37.080 Shannon Campbell: included in the promoting interoperability data reporting requirements. 154 00:16:37.730 --> 00:16:52.029 Shannon Campbell: So if the Aco submits Pi data at the Aco level, Qps and partial Qps must be included. If the Aco doesn't submit pi data at the Aco level, the Qps and partial Qps will need to submit their data 155 00:16:52.200 --> 00:16:54.109 Shannon Campbell: at one of the other submission levels 156 00:16:56.420 --> 00:17:03.110 Shannon Campbell: for the quality performance category, which is 50% of the Aco's final score. 157 00:17:03.280 --> 00:17:07.359 Shannon Campbell: Mss. Pacos are required to submit either the 158 00:17:07.550 --> 00:17:15.019 Shannon Campbell: 10 web interface measures, or the 3 Cqm. Medicare, Cqm. Or Ecqm. Measures. 159 00:17:15.099 --> 00:17:16.629 Shannon Campbell: in addition to 160 00:17:16.800 --> 00:17:21.970 Shannon Campbell: the traditional caps, permits survey measure, and the 2 administrative claims measures. 161 00:17:24.690 --> 00:17:29.509 Shannon Campbell: I see we have a question that came in in regards to the hardship, exemption. 162 00:17:29.580 --> 00:17:33.680 Shannon Campbell: exception for small practices for pi, for 2025 163 00:17:34.068 --> 00:17:39.600 Shannon Campbell: you still have to apply for the exception, there is no automatic. I don't believe 164 00:17:39.630 --> 00:17:45.339 Shannon Campbell: there's an automatic exception, but that would need to be. Yeah, there might be an automatic 165 00:17:47.500 --> 00:17:49.370 Shannon Campbell: regret answering that one live. 166 00:17:50.300 --> 00:17:55.970 Shannon Campbell: But I think you still have to apply for the hardship, hardship, exception. I hope, Susie, that that answers your question. I'm sorry. 167 00:18:00.050 --> 00:18:01.910 Shannon Campbell: Aco. Clinicians 168 00:18:02.150 --> 00:18:08.059 Shannon Campbell: may submit data separately from the Aco, and they have a choice of submission and participation methods. 169 00:18:08.410 --> 00:18:13.300 Shannon Campbell: If submitting via the Ap. P. As an individual or part of a group. 170 00:18:13.410 --> 00:18:16.989 Shannon Campbell: The categories and weights mirror those of the aco. 171 00:18:17.790 --> 00:18:24.549 Shannon Campbell: if submitting via traditional maps, which is the self chosen quality measures, and such 172 00:18:24.620 --> 00:18:30.339 Shannon Campbell: all 4 categories must be submitted, and the weights of those categories differ from the Ap. Submission. 173 00:18:30.700 --> 00:18:34.849 Shannon Campbell: This traditional MIPS option also includes the subgroup 174 00:18:35.350 --> 00:18:43.489 Shannon Campbell: type, but a subgroup is only allowed to submit an Mvp. Which has to be registered with Cms. Before December second of this year 175 00:18:44.600 --> 00:18:59.340 Shannon Campbell: Aco clinicians, submitting outside of the Aco. Won't receive the automatic 100% for the improvement activities category. But they do enjoy a reduced reporting burden for improvement activities. Their Ia score will be at least 50%. 176 00:18:59.480 --> 00:19:03.189 Shannon Campbell: If the clinician attests to an improvement activity 177 00:19:03.250 --> 00:19:07.630 Shannon Campbell: or submits data for quality and promoting interoperability. 178 00:19:08.130 --> 00:19:14.589 Shannon Campbell: whatever submission or participation option is chosen, the highest submitted score will be attributed to the clinician. 179 00:19:16.990 --> 00:19:22.999 Shannon Campbell: We'll now review some common questions or concerns we hear from Ms. Pacos that I haven't already covered 180 00:19:24.129 --> 00:19:30.109 Shannon Campbell: the data. Completeness. Requirement is a new concept for some MS. Pacos. So a common question we get is. 181 00:19:30.280 --> 00:19:31.800 Shannon Campbell: what's its intention? 182 00:19:32.120 --> 00:19:40.360 Shannon Campbell: Right? So the data completeness threshold was adopted at the inception of the Cqm. Measures in 2020. Excuse me 2017. 183 00:19:40.500 --> 00:19:47.960 Shannon Campbell: The threshold was initially adopted at 50%, which matched the legacy. PQRS. Requirement. 184 00:19:48.060 --> 00:19:55.050 Shannon Campbell: though Cms initially proposed 90%. So you can see how far discrepant it was from the 90 they proposed 185 00:19:55.250 --> 00:20:03.989 Shannon Campbell: every year or so since then the threshold has increased, bringing it to the current. 75% we discussed earlier for the 2024 performance period 186 00:20:05.590 --> 00:20:14.680 Shannon Campbell: Cms. Intends to continue increasing the threshold over the coming years to bring it as close to 100% as possible. The intention is that every visit 187 00:20:14.960 --> 00:20:30.399 Shannon Campbell: or event or patient in a measures denominator should have a quality action documented. Whether that action is performance met, not met, or there's a denominator exception, the goal is to get as complete and accurate a picture of the submitter's performance 188 00:20:30.640 --> 00:20:35.189 Shannon Campbell: as possible, with all data points documented and accounted for. 189 00:20:35.690 --> 00:20:37.160 Shannon Campbell: the data. Completeness. 190 00:20:37.230 --> 00:20:49.910 Shannon Campbell: Requirement also supports the prevention of cherry picking. Cherry picking is a the selective removal of unfavorable data to skew a participant's true performance. 191 00:20:49.940 --> 00:20:53.890 Shannon Campbell: and is an act explicitly forbidden by cms. 192 00:20:53.930 --> 00:20:54.960 Shannon Campbell: So this 193 00:20:55.000 --> 00:21:04.299 Shannon Campbell: data completeness threshold, by the way, only applies to Cqm's and Medicare Cqms. Due to the manual aspect of their collection. 194 00:21:04.630 --> 00:21:14.359 Shannon Campbell: The the Ec. Qms. Inherently have a 100% data completeness rate because their data are collected electronically without manual manipulation. 195 00:21:16.590 --> 00:21:24.389 Shannon Campbell: Another question that is sometimes asked is if the Msf incentive to report Ecqm or Cqm. 196 00:21:24.450 --> 00:21:27.170 Shannon Campbell: Also applies to Medicare, Cqm. 197 00:21:27.400 --> 00:21:28.720 Shannon Campbell: It does not. 198 00:21:28.910 --> 00:21:40.940 Shannon Campbell: Cms has explained that because Medicare Cqms only include medicare beneficiaries rather than all payers, all patients type of reporting. They aren't eligible 199 00:21:41.100 --> 00:21:42.350 Shannon Campbell: for the incentive. 200 00:21:45.400 --> 00:21:50.179 Shannon Campbell: Now I will pass it off to Hazel to cover the use of measurable for acos. 201 00:21:50.440 --> 00:21:51.230 Shannon Campbell: Hazel. 202 00:21:52.710 --> 00:21:54.569 Hazel Morrison: Beautiful. Thank you, Shannon. 203 00:21:59.700 --> 00:22:09.020 Hazel Morrison: So welcome everybody. I'm Hazel Morrison. I use Adam pronouns, and I'm the product manager for the measures. Portfolio of applications at health catalyst. 204 00:22:09.040 --> 00:22:13.059 Hazel Morrison: I've been in the qualified but registry space for about 5 years now. 205 00:22:13.250 --> 00:22:22.619 Hazel Morrison: and before that I worked at a pharmacy benefits manager on the payer side. I also began my career at epic. So I've seen measures from a lot of different angles. 206 00:22:22.650 --> 00:22:32.550 Hazel Morrison: and today I'll be walking through. How different features in our measurable application, support our Aco customers. So to start us off, I'd love to get a sense of how many of you are familiar with measurable already. 207 00:22:32.944 --> 00:22:42.359 Hazel Morrison: Your options are. I've never seen a measurable dashboard, which, if that's the case, that's wonderful. You'll get a little intro today. You've seen a demo, but you've never used measurable. 208 00:22:42.460 --> 00:22:47.719 Hazel Morrison: You use measurable to track performance, and you use measurable today to track performance and to submit. 209 00:22:52.690 --> 00:22:58.130 Hazel Morrison: So I see people are still seem to be answering. I'll give everyone another 5 seconds or so 210 00:23:02.400 --> 00:23:09.260 Hazel Morrison: great. So it looks like we have a lot of new faces, a lot of people who are new to measurable. So I'm really excited to share that with you today. 211 00:23:16.612 --> 00:23:25.669 Hazel Morrison: So as an intro really building off of what Shannon said earlier. We want to support you in meeting your regulatory requirements, but we also want to go beyond that. 212 00:23:26.331 --> 00:23:29.910 Hazel Morrison: We want you to use your performance 213 00:23:29.980 --> 00:23:55.500 Hazel Morrison: and monitor it continuously and and really dig into the insights that will help you and your member organizations perform those important improvement activities and ultimately receive better compensation. So it's kind of a seamless process that should be happening continuously over time. I was really pleased to see earlier in this presentation with one of our 1st polls. But many of you are doing that already. So we wanna continue to support that you and that 214 00:23:55.774 --> 00:24:02.920 Hazel Morrison: and I'll be sharing some different features in our application that support each of these activities. So if we could go to the next slide, please. 215 00:24:04.310 --> 00:24:18.259 Hazel Morrison: so as an overview of the measurable dashboard. It's broken down into 5 main screens. Starting off with the program level that gives you an overall picture of your performance. For the whole organization or program. 216 00:24:18.540 --> 00:24:28.990 Hazel Morrison: Then, moving on to the group and provider level, you can drill down and see how your groups and providers are performing relative to each other which in an aco context, can provide a lot of valuable insights. 217 00:24:29.406 --> 00:24:52.819 Hazel Morrison: Further insights can be gleaned from the next screen. Which is a summary or index of patients who fall into the different populations for the different measures. This is a really rich source of information, and it's an area where I really encourage our customers to spend a lot of time. So you can see the list of patients who are in different options or populations. Even within a measure, you can say, Okay, well, who met 218 00:24:52.820 --> 00:25:20.259 Hazel Morrison: the numerator requirements for this reason versus this reason, who was a gap for this reason versus this other reason. And that can help, you know, spur a lot of ideas for process improvements for your member organizations. Finally, you can drill down even further at the individual patient level and get actionable information about how each patient met the requirements or did not for each measure. You can see the individual records that were used to make those calculations. 219 00:25:20.567 --> 00:25:24.260 Hazel Morrison: And that can help inform a lot of care. Gap closure processes. 220 00:25:26.190 --> 00:25:38.080 Hazel Morrison: Could we? Yeah. Next slide, please. Okay. So our next poll is what are your submission plans for performance year 2024. The 1st option is, we don't plan to submit the Aco level. 221 00:25:38.495 --> 00:25:42.519 Hazel Morrison: The second option is we plan to submit using traditional Cqms. 222 00:25:42.910 --> 00:25:46.380 Hazel Morrison: 3, rd we plan to submit using Medicare Cqms. 223 00:25:46.540 --> 00:25:53.560 Hazel Morrison: 4, th we plan to submit using Ecqms. And then, finally, we plan to submit via the Cms web interface. 224 00:25:53.760 --> 00:26:00.909 Hazel Morrison: And of course, as Shannon mentioned, this is the last year that the web interface is going to be available. So I'm interested to see how that all 225 00:26:01.080 --> 00:26:02.800 Hazel Morrison: pans out for this group. 226 00:26:05.590 --> 00:26:10.219 Hazel Morrison: still seeing some movement here. So I think we'll give another 5 seconds or so 227 00:26:15.540 --> 00:26:16.560 Hazel Morrison: perfect. 228 00:26:16.890 --> 00:26:35.679 Hazel Morrison: Alright. So I'm seeing A lot of folks who are not planning on submitting at the Aco level, and a lot of people using the Cms web interface, some using traditional Cqms. So I'll be happy to cover all of the options that we support and maybe that can spur some ideas for what you might want to do in future years 229 00:26:38.980 --> 00:26:51.519 Hazel Morrison: on this next screen. Here you can see what it looks like to track your performance on an Msp program. So we do support traditional Cqms. Medicare, Cqms and Ecqms. 230 00:26:51.840 --> 00:27:09.759 Hazel Morrison: As Shannon mentioned the data pipeline for Medicare Cqms can sometimes be a little tricky to set up, but the application absolutely supports it from a technical perspective. And that's a determination you can make as to whether that implementation work is valuable or whether you would just like to use the traditional Cqms 231 00:27:10.261 --> 00:27:30.819 Hazel Morrison: on the screen. You can see your performance. You can see your estimated points based on that performance, as I'm sure all of you know. Your overall numerator and denominator is part of the picture, but it's not exactly how those points are determined. So we actually use the desiles provided by Cms to estimate how many points you can expect for each measure. 232 00:27:32.566 --> 00:27:53.099 Hazel Morrison: If we could have the next slide here. Great. And then, if you're using traditional Cqms or Medicare Cqms, you can submit through our qualified registry. So able health has been a qualified registry since 2,017. And this we have an Api connection to Cms that allows us to submit 233 00:27:53.384 --> 00:28:07.629 Hazel Morrison: on your behalf without you having to leave the dashboard. So you can use the actions, menu, to open up that submission, Wizard, and then you'll be guided through a step by step process to fill out all the configuration elements and attestations that are needed for your submission. 234 00:28:08.322 --> 00:28:33.729 Hazel Morrison: Then you can sign off on the submission with an electronic signature. And of course, you know, just like any other qualified registry would tell you ultimately you the Aco or your member health organizations, if they're submitting at that level, are kind of legally responsible for the completeness and accuracy of the data behind the submission. So you'll sign off of that during the submission process. 235 00:28:34.044 --> 00:28:46.950 Hazel Morrison: And then, because we have an Api connection, you'll get immediate feedback. About the success of the submission and the message that was received by Cms. And then you'll be able to download all the documentation related to that submission 236 00:28:48.410 --> 00:28:57.530 Hazel Morrison: next slide. Please thank you for those of you who are interested in using Ecqms. As I mentioned, we support those as well. All of the Ecqms in our library are certified. 237 00:28:58.223 --> 00:28:58.886 Hazel Morrison: And 238 00:28:59.570 --> 00:29:20.529 Hazel Morrison: The submission process is a little bit different. The Api that all qualified registries use does not permit for Ecqm submissions. So what we recommend instead is to export your da 3 files which contain the results of these measures. And once you've exported those files, you can download them, using a secure link that will be emailed to you. 239 00:29:21.060 --> 00:29:27.980 Hazel Morrison: You'll need to log into the Qpp Web portal using your harp account, and then you can go ahead and upload those Qrda 3 files 240 00:29:28.330 --> 00:29:44.320 Hazel Morrison: keep in mind. This is different from the Cms web interface. The Cms web interface process is a different portal. Different process, and a different way of thinking about the measures. But this is how you you would use our dashboard to facilitate Ecumm submission. 241 00:29:44.799 --> 00:30:00.619 Hazel Morrison: And if you're interested in submitting pi measures as well, promoting interoperability on top of your Ecqms. You can certainly mix and match we support a submission of the pi measures only, and then you can separately go through the web portal and submit your Ecqms that way. 242 00:30:02.230 --> 00:30:13.009 Hazel Morrison: Great. So what does promoting interoperability look like that's our screen here. This allows you to perform the self attestations. For example, if you know you're doing that security risk analysis, you can check that off 243 00:30:13.438 --> 00:30:20.670 Hazel Morrison: and then we also provide a space for you to enter in the numerator and denominator for your e-prescribing measures. 244 00:30:21.289 --> 00:30:24.879 Hazel Morrison: And make choices about your health information, exchange measures. 245 00:30:25.400 --> 00:30:29.374 Hazel Morrison: So this is self attestation, and then that will be included in your 246 00:30:29.830 --> 00:30:33.129 Hazel Morrison: submission. Wizard Api submission. If you choose to use that 247 00:30:33.680 --> 00:30:40.849 Hazel Morrison: on our next slide, Shannon will show you how we represent improvement activities and costs for our Aco groups. 248 00:30:41.380 --> 00:30:55.799 Hazel Morrison: So if if your dashboard is set up for Aco level reporting, you'll see that improvement activities will automatically receive full credit in 2024, and that cost is automatically waited at 0 for Acos. 249 00:30:56.300 --> 00:31:18.949 Hazel Morrison: So, pulling together all that information, we estimate a composite score for you with the appropriate waiting, and with all the information we've calculated, and all the information you've entered. That modeled composite score which you see on the left is our best estimate of what Cms may give you. It's certainly not a guarantee right? Cms has been known to change benchmarks. And you know 250 00:31:18.950 --> 00:31:34.280 Hazel Morrison: they ultimately are responsible for calculating that score, but based on the information we have. We hope that this provides you with a way of anticipating what your likely score might be, and help you make those decisions about improvements that you may want to engage in before submitting. 251 00:31:34.580 --> 00:31:39.800 Hazel Morrison: So again, just trying to help with that kind of proactive approach to improving your performance. 252 00:31:41.680 --> 00:31:55.550 Hazel Morrison: So with that, here's some wonderful resources. If you want to learn more, the slides for this presentation will be available online, and so that these will be clickable links, those external resources. But just wanted to highlight those here. 253 00:31:55.810 --> 00:32:00.780 Hazel Morrison: And at this point I will open it up to questions. 254 00:32:13.130 --> 00:32:23.609 Hazel Morrison: So I do see one question here for you, Shannon. Can. Groups and providers within an aco also do their own submissions. If an aco is submitted on their behalf. 255 00:32:25.650 --> 00:32:33.639 Shannon Campbell: They can. The clinicians and groups and subgroups, for that matter, may choose to submit any number of 256 00:32:34.095 --> 00:32:43.470 Shannon Campbell: measures appropriate to that submission method, and the highest score attributed to that particular provider will be attributed to them. So you can submit 257 00:32:43.630 --> 00:32:49.000 Shannon Campbell: 3 4 different ways, and the highest will be the one that gets awarded to that particular provider. 258 00:32:50.440 --> 00:32:58.259 Hazel Morrison: Great answer. Thanks, Shannon, and I'll add to that. We facilitate that in the dashboard you can certainly do submissions at different levels. 259 00:32:58.629 --> 00:33:08.820 Hazel Morrison: You know the Aco level, the group level provider level and then you can track and see your progress on. On each of those submissions. We do have many customers who do 260 00:33:09.280 --> 00:33:16.779 Hazel Morrison: multiple types of submissions in the same submission here. And that, you know, really can benefit you with that higher score. As Shannon said. 261 00:33:25.060 --> 00:33:31.269 Hazel Morrison: okay, I see another question, how does your product support Ecqms when an Aco has numerous emrs? 262 00:33:32.037 --> 00:33:53.120 Hazel Morrison: That's a great question. And that is the benefit of the health catalyst platform. Right? Our absolute bread and butter is pulling together multiple data sources, standardizing normalizing that data and then providing that in a cohesive way to our measures engine. So most of our customers have multiple emrs that are sending us data. 263 00:33:53.424 --> 00:34:02.850 Hazel Morrison: And most of our customers are also pulling in data from other sources besides, just the clinical data from the Emrs. So that's something that we not only support but encourage 264 00:34:04.050 --> 00:34:05.170 Hazel Morrison: great question. 265 00:34:27.110 --> 00:34:32.340 Hazel Morrison: Okay, so here is another question about Ecqms and Cqms 266 00:34:32.420 --> 00:34:39.959 Hazel Morrison: asking in in this Aco, there's both paper practices and Emrs. So 267 00:34:40.683 --> 00:34:46.719 Hazel Morrison: could this Aco. Submit both Cqms and Ecqms. Or 268 00:34:47.089 --> 00:34:52.659 Hazel Morrison: will they be penalized for the paper practices? If they decide on Cqm. Or on Ecqms. I see. 269 00:34:57.570 --> 00:34:59.160 Shannon Campbell: So on this one. 270 00:34:59.530 --> 00:35:03.699 Shannon Campbell: That's a little difficult. Because if you're gonna report via Ecqm. 271 00:35:04.000 --> 00:35:09.889 Shannon Campbell: the implication is, you have full electronic access. So to your point, Crystal. You can have the papers 272 00:35:10.040 --> 00:35:14.200 Shannon Campbell: electronic access, right? That defeats the purpose. Now it's when it comes to 273 00:35:14.280 --> 00:35:15.670 Shannon Campbell: penalizing. 274 00:35:16.126 --> 00:35:23.050 Shannon Campbell: I i i don't think there's a penalty involved in it. But you're not really meeting the intention of the Ecqm. So if you can't 275 00:35:23.340 --> 00:35:29.109 Shannon Campbell: fully get all the electronic data, the expectation is that the Aco will submit to Cms 276 00:35:29.290 --> 00:35:35.450 Shannon Campbell: all of the possible data. And if that can't be done electronically, I don't think electronic Cqm's are going to be 277 00:35:36.060 --> 00:35:40.470 Shannon Campbell: right choice for you. It Cqms. May be the best choice at that point. 278 00:35:40.870 --> 00:35:42.600 Shannon Campbell: I hope that helps you. Sorry. 279 00:35:51.140 --> 00:35:56.032 Shannon Campbell: See? A question popped in of what are the Ecqm requirements for calendar year 2024. 280 00:35:57.680 --> 00:36:04.720 Shannon Campbell: Not sure exactly what the question is intending or the context of it. There is no requirement to submit an ECQM. 281 00:36:05.030 --> 00:36:10.680 Shannon Campbell: But if you choose to submit your Ap. P. 3 measures the depression 282 00:36:10.880 --> 00:36:13.642 Shannon Campbell: HBA, one C, and controlled blood pressure. 283 00:36:15.268 --> 00:36:19.919 Shannon Campbell: If you choose to submit via that method, you have the choice of ECQM. S. 284 00:36:20.300 --> 00:36:23.629 Shannon Campbell: You can also choose to submit by Cq. End 285 00:36:25.406 --> 00:36:31.623 Shannon Campbell: either met or or you can choose to submit a measure via ECQM. And other measures via Cqm. 286 00:36:32.550 --> 00:36:48.800 Shannon Campbell: You can maximize your scores, let's say your Ec. Qm. Score is higher for one particular measure, because keep in mind the benchmarks are going to be different for each of the measures right and our our tool allows you to analyze which is the most advantageous for your particular organization. So, although you're 287 00:36:49.210 --> 00:37:03.320 Shannon Campbell: Cqm score, you know you, you may see that you have a higher numerator. It depends on the benchmark. If the Ecqm's benchmark is that significantly lower than the Cqm. It may be advantageous to submit the ECQM. Version of that particular measure. 288 00:37:04.370 --> 00:37:05.809 Shannon Campbell: So requirement. 289 00:37:06.000 --> 00:37:18.823 Shannon Campbell: there is no requirement. Necessarily, there are specification requirements. But I don't think that's what you're speaking to. So I hope that answers your question as well. That least elucidates it otherwise. Feel free to 290 00:37:19.740 --> 00:37:24.689 Shannon Campbell: elucidate the the question a bit more. And and if I didn't get the detail that you were looking for, thank you. 291 00:37:35.710 --> 00:37:42.250 Hazel Morrison: Okay, I'm seeing another question here about what data sources we recommend to ensure that we're capturing all payers and all patients. 292 00:37:51.130 --> 00:37:59.859 Shannon Campbell: Well, in order to capture the all patients and all payers. Aspect of these particular measures which is required of both the Cqm. And the Ecqm. 293 00:38:01.350 --> 00:38:09.930 Shannon Campbell: We need to make sure that we get as close to the service as possible, because that's the driver of these measures right? The Cpt's the Hick picks the diagnoses. 294 00:38:10.200 --> 00:38:14.429 Shannon Campbell: the different criteria date of service that go into the charge 295 00:38:15.040 --> 00:38:16.979 Shannon Campbell: so as close to the 296 00:38:17.160 --> 00:38:22.320 Shannon Campbell: coding is possible. That could be your billing data. It could be your dropped charges. 297 00:38:22.757 --> 00:38:26.250 Shannon Campbell: You do want to make sure that you steer clear of 298 00:38:26.730 --> 00:38:34.849 Shannon Campbell: what's commonly called claims data. Now, what what I would call claims data from a Cms perspective is the data that goes on the claim. 299 00:38:35.730 --> 00:38:36.660 Shannon Campbell: I have 300 00:38:36.990 --> 00:38:43.169 Shannon Campbell: experience definitions of claims, data meaning the data that you get back from the payers 301 00:38:43.380 --> 00:38:48.419 Shannon Campbell: that are related to the claim. So the payer's response to the claim that's too far down the charge line. 302 00:38:49.280 --> 00:39:16.709 Shannon Campbell: So in that case, if you're using returned claims or acted upon claims from payers, it's too far down the charge line because you miss out on self pays. You also miss out on claims data pertaining to payers that you may never have billed before. Say, a patient from an outside State visits you well, their their payer may be in another state. You've never billed them before, but they still need to be in your population, so we want to stay as close as possible 303 00:39:16.750 --> 00:39:20.790 Shannon Campbell: to the actual charge as it's entered into. Your Emr, that 304 00:39:21.050 --> 00:39:39.840 Shannon Campbell: more solidly gets us all your patients, whether they're medicare, commercial or self pay, and all your patients, and or, excuse me, your payers, including those you may never have billed before. All patients all pays as close to the service charge dropping as possible is how we're going to achieve that. All patient, all pay data. 305 00:40:07.790 --> 00:40:10.000 Shannon Campbell: Do we have any more questions that have trickled in. 306 00:40:20.680 --> 00:40:32.650 Hazel Morrison: One more question here about the cert id you know, which, of course, is required for submission. The question is, how did they find the cert id how do they get that information and ensure that's included in the submission. 307 00:40:33.410 --> 00:40:50.500 Shannon Campbell: Oh, that's a good question. Yeah. So your cert id is going to be custom for your particular certified Ehr technology? Right? So you, it depends on the particular products that you have pieced together to satisfy your needs for that promoting interoperability requirement. 308 00:40:50.820 --> 00:40:54.790 Shannon Campbell: Therefore, the cert id is going to be unique to your particular, you know. 309 00:40:55.605 --> 00:40:59.260 Shannon Campbell: Mixing and matching of products, if you will right. So 310 00:40:59.720 --> 00:41:02.130 Shannon Campbell: your particular 311 00:41:02.390 --> 00:41:05.349 Shannon Campbell: vendor, your Ehr vendor, will be of help 312 00:41:05.680 --> 00:41:17.410 Shannon Campbell: by providing the different components that you have purchased to piecemeal together your Ehr. Each of those different products and their modules or versions of the particular EHR 313 00:41:17.540 --> 00:41:32.949 Shannon Campbell: can be entered into a chapel site. That's that's managed by Cms. And I would see where they bring together all the products, and as you enter your products and the modules that you use to make up your certified Ehr technology. 314 00:41:33.320 --> 00:41:37.289 Shannon Campbell: They all are joined together to create a cert. ID 315 00:41:37.980 --> 00:41:41.869 Shannon Campbell: in that chapel site, and you can simply Google, CHPL. 316 00:41:41.900 --> 00:41:43.650 Shannon Campbell: Chapel, C. Hpl. 317 00:41:43.900 --> 00:42:11.699 Shannon Campbell: You can go to that site, enter in your products. You can filter by vendor you can filter by version, you can then filter by the particular certification year that they have for your particular need. So you can customize your build of your certified Ehr technology, and by entering all of that build, then chapel will spit out a cert id for you to use in your promoting interoperability, attestation. 318 00:42:22.780 --> 00:42:25.309 HC Webinars: Any other questions, Hazel, that you see. 319 00:42:27.070 --> 00:42:31.980 Hazel Morrison: I don't see anymore. I think. Yes, we may be coming to the end of the questions from the audience. 320 00:42:31.980 --> 00:42:33.990 HC Webinars: Perfect. Okay, thank you. 321 00:42:34.366 --> 00:43:00.149 HC Webinars: Thank you. Shannon and Hazel. This great presentation for any other questions that we did not get to. We will get to those, we will get those answered offline and post them to our website. So continue to use that. QA. Panel. If you do have questions. We wanna thank all of you for joining us today, and we hope you enjoyed the presentation. I am launching a poll asking if you would like to learn more about health, catalyst products and services. 322 00:43:00.150 --> 00:43:13.640 HC Webinars: This poll should only take you about 2 min as a reminder. The on demand. Webinar recording and sites will be shared with you tomorrow. You can always reach out to us through email or our website. If you have further questions or comments 323 00:43:13.870 --> 00:43:28.120 HC Webinars: for anyone still filling out the poll. I'm gonna continue to leave it active for a couple of more minutes to give you time to complete it. Otherwise, on behalf of all of us here at health. Catalyst. Thank you again for joining us today and have a great rest of your day. 324 00:43:29.740 --> 00:43:30.200 Shannon Campbell: Thank you. 325 00:43:31.140 --> 00:43:31.693 Hazel Morrison: Thank you.