Provider Peer Grouping
Monthly Updates
April 9, 2012
Stefan Gildemeister
Director, Health Economics Program
Outline
• Progress update hospital analysis
– Workshop
– RRT discussions
– Advisory group discussions
• 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
Need 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
Hospital Workshop
• MDH/MHA jointly hosted a Provider Peer Grouping
workshop on March 13, 2012
• Some goals of this meeting were to provide hospitals
with more details on
– Cost data source for PPG
– Data validation & understanding potential gaps in data
– Identifying data useful for improvement in cost & quality
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Upcoming Topics for RRT Review
• MDH is planning to obtain input the following
analytic decisions with the Rapid Response Team
(RRT) during the spring
– Scoring of topped-out and other quality measures
– Addressing the potential for a small number of measures
to determine scores of quality subdomains
– Risk adjustment modifications
8
RRT Process
• MDH will provide the issue and supporting document
to the RRT for review and feedback
• MDH will hold initial calls and follow-up call during
which to discuss findings
RRT membership
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–
–
–
–
–
Michele Kimball, AARP
Susan Knudson, Health Partners, Inc. (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
9
Progress Update:
Physician Clinic Total Care
Analysis
Timeline for
Physician Clinic Analysis
• MDH is preparing to restart the clinic analysis when
2009 Medicare data is available
• 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
Timeline for the Upcoming Months
• Hold RRT discussions on hospital topics (April/May)
• Provide revised confidential data to hospitals in early
summer
• Establish advisory group to review methodological
decisions and look for improvements (May/June)
• Begin physician clinic analysis with updated data
from 2009 (May/June)
• Obtain 2010 Medicare data to construct research
data files for version 2 of PPG results (May/June)
Resources
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 may be sent to:
Stefan Gildemeister at
[email protected] or 651-201-3554
Next Call
May 14, 2012
7:30 a.m.