Provider Peer Grouping
Reliability Workgroup
June 23, 2011
What is Provider Peer Grouping?
• A system for publicly comparing provider
performance on cost and quality
– …a uniform method of calculating providers' relative
cost of care, defined as a measure of health care
spending including resource use and unit prices, and
relative quality of care… (M.S.§62U.04, Subd. 2)
– a combined measure that incorporates both provider
risk-adjusted cost of care and quality of care…
(M.S.§62U.04, Subd. 3)
What Types of Provider Peer
Grouping Needs to be Developed?
1. Total Care
2. Care for Specific Conditions
The commissioner shall develop a peer grouping system
for providers based on a combined measure that
incorporates both provider risk-adjusted cost of care and
quality of care, and for specific conditions…
(M.S.§62U.04, Subd. 3)
Recap of December 2010 Meeting
• Provided an overview of PPG
• Reviewed charter for this workgroup
• Discussed reliability and characteristics of
reliable data
• Follow up: provide information on various
methods for addressing outliers and
potential reliability thresholds and their
implications
Discussion on Reliability
• Reliability means results should be
consistent over time, assuming no major
changes have occurred in care delivery or
pricing that would influence results
• Reliability will be influenced by how we
manage outliers, sample size, and types of
care that is included or excluded
Discussion on Reliabilitiy
• Reliability standards depend on uses of the
data
• We are really interested in gauging face
validity from a variety of perspectives
Discussion on Reliability
• We are interested in understanding what drives
variation
• Outliers may be mitigated by changes in market
over time
Today’s Agenda
• Discuss reliability issues associated with
the Hospital Total Care analysis
– Options and recommendations for treatment
of outliers
– Options for reliability thresholds and their
implications
Next Steps
• Reliability Workgroup members are invited
to submit any additional thoughts on the
hospital analysis by Monday afternoon by
5:00 pm via email to Katie Burns at
[email protected]
• A future meeting related to similar
information is planned for the physician
clinic analysis in late summer/early fall