Provider Peer Grouping
Monthly Updates
February 13, 2012
Stefan Gildemeister
Director, Health Economics Program
Outline
• Overview of Provider Peer Grouping
• Progress update hospital analysis
– Method changes
– RRT discussions
– Data validation
– Timeline
• Progress report clinic analysis
– timeline
2
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 riskadjusted 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)
Stakeholder Involvement
• Provider Peer Grouping Advisory Group
• Rapid Response Team
• Reliability Workgroup
• Feedback during review period & at public meetings
• Monthly Conference Calls
Progress Update:
Hospital Total Care
Analysis
Legislative Testimony on PPG
• On Tuesday, January 24, 2012 MDH provided
information to the Health and Human Services
Reform Committee.
– This testimony included an update on the Hospital
Total Care Analysis.
• Progress to date
• Future plans
7
Modification to the Analysis and
Methodological Progress
Cost Composite
– Improved data set
– Corrected grouping software
– Revised managed care claims allocation
– Risk adjustment modifications
Quality Composite
– Topped-out measures handled differently
– Considering imputation for PPS hospitals with few measures in a subdomain
– Considering creating one outcome sub-domain
Upcoming Topics for RRT Review
• MDH is planning to vet the following analytic
decisions with the Rapid Response Team (RRT)
– Scoring of topped-out and other quality measures
– Combining of the quality measure outcome subdomains
– Risk adjustment modifications
9
RRT Process
• MDH will provide the issue and supporting
document to the RRT for review and feedback.
RRT Membership
– Michele Kimball, AARP
– Susan Knudson, Health Partners, Inc. (representing the MN Council of
Health Plans)
– Beth McMullen, Minnesota Business Partnership
– Janet Silversmith, Minnesota Medical Association
– Mark Sonneborn, Minnesota Hospital Association
– Marie Zimmerman, Minnesota Department of Human Services
10
Upcoming Hospital Workshop
• In the near future MDH and MHA will host a
workshop for hospitals.
• Some goals of this meeting are to provide
hospitals with more details on
– Data source for PPG
– Previous analytic decisions
– Data validation
11
Estimated Timeline for Hospital PPG
Analysis, 2012
Public
meeting
with
hospitals
re: modifications
Jan
Feb
Confidential
release of
modified v.1
data to
hospitals
Mar
Feb to
May:
development of
summary
report
Apr
30-day
review of
v.1 results
by
hospitals
May
Obtain
2010
data for
v.2 of
hospital
PPG
Jun
30-day
review
period
Confidential release
of v.2 data
to hospitals
Jul
Aug
Sep
Oct
Nov
Dec
Public
release 90
days after
confidential release
of v.2
results
Jun to Aug:
call technical
advisory group
for method
discussion
12
Summary Report of PPG v.1 Results
• A narrative discussion of the results for the
state overall:
– Hospital quality in national context
– General trends on cost & quality performance
– Trends by region and hospital characteristics
– Patterns by certain conditions
• No individual hospitals will be identified
• Opportunity to start public discussion about
value in health care
13
Advisory Group Discussion, 2012
• Provider Peer Grouping initiative was informed by
an initial advisory group and a technical panel to
it
• We have initial results showing how the
recommended methodologies performed:
– What revisions should we consider?
– What new evidence is there available to inform our
methodology?
– What issues should we consider on topics of public
reporting and communication?
14
Progress Update:
Physician Clinic Total Care
Analysis
Timeline for
Physician Clinic Analysis
• This analysis has been under-prioritized while MDH was
finalizing the hospital analysis
• Currently, MDH is evaluating ways to restart the clinic analysis
with refreshed data
• As with the hospital total care analysis, MDH will not publicly
report results by clinic until the analysis can be reported on
the basis of more recent and more actionable data.
• MDH will continue to provide more concrete updates on
timing in the near future
Estimated Timeline for Physician Clinic
PPG Analysis, 2012
Clinic analysis
to clinics for
confidential
review
Jan
Feb
Return
focus to
clinic
analysis
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Clinic
analysis
& RRT
discussions on
method
17
Nov
Dec
Additional information on PPG is available online:
www.health.state.mn.us/healthreform/peer/
Information on Minnesota’s health care market can
also be found online :
www.health.state.mn.us/healtheconomics
Questions maybe sent to:
Stefan Gildemeister at
[email protected] or 651-201-3554
Next call
Monday, March 12, 2012
7:30 am