Provider Peer Grouping
Monthly Updates
May 14, 2012
Stefan Gildemeister
Director, Health Economics Program
Outline
• Overview of the Provider Peer Grouping
system
• Legislative update
• Progress update of hospital analysis
– RRT discussions
– Advisory group discussions
• Progress report on physician clinic analysis
• Estimated timeline
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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)
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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)
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Stakeholder Involvement
• Provider Peer Grouping Advisory Group
• Rapid Response Team
• Reliability Workgroup
• Feedback during review period & at public meetings
• Monthly conference calls
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Legislative Update
(2012 Regular Session, Chapter 169, SF1809)
• Providers will have more time to review their data – 120 days
instead of 90 days before publication
• There will be more formalized advisory processes:
– Advise the commissioner of health about selecting quality measures,
scoring methodologies and other technical decisions; and
– Make recommendation on dissemination and sharing of the data to
providers for verification of accuracy and representativeness.
• Health plan use of the data is now optional rather than
mandatory
• Appeals process was further clarified
• Changes go into effect July 1, 2012 and with existing resources
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Progress Update:
Hospital Total Care
Analysis
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Upcoming Topics for RRT Review
• MDH is planning to obtain input on the following
analytic decisions with the Rapid Response Team
(RRT)
– Scoring of topped-out and other quality measures
– Addressing the potential for a small number of measures
to determine scores of quality subdomains
– Testing alternative risk adjustment mechanisms
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RRT Process
• MDH will provide the issue and supporting
documents to the RRT for review and feedback
• MDH will hold initial calls and follow-up calls during
which to discuss findings
RRT membership
–
–
–
–
–
–
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
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Progress Update:
Physician Clinic Total Care
Analysis
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Timeline for Physician Clinic Analysis
• MDH is preparing to restart the clinic analysis when
2009 Medicare data is available, likely in July 2012
– Build on previous work of the RRT (quality compositing, attribution,
risk adjustment)
– Let advisory group discussions inform other topics
– Work w/RRT & reliability workgroup as physician clinic analysis moves
forward
• 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
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Timeline for the Upcoming Months
• Hold RRT discussions on hospital topics (May/June)
• Provide revised confidential data to hospitals in early
summer & summary report later on
– Work with facilities on data validation
– Hold regional meetings
• Establish advisory group to review methodological
decisions and look for improvements (June/July)
• Proceed with physician clinic analysis with updated data
from 2009 (July)
• Obtain 2010 Medicare data to construct research data
files for version 2 of PPG results (May/June)
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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
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Next Call
June 11, 2012
7:30 a.m.
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