Provider Peer Grouping
Monthly Updates
July 9, 2012
Stefan Gildemeister
Director, Health Economics Program
Outline
• Advisory committee
• Progress update hospital analysis
– RRT discussions
• Progress report clinic analysis
• 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
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Provider Peer Grouping Advisory Group
Rapid Response Team
Reliability Workgroup
Feedback during review period & at public meetings
Monthly conference calls
• Advisory Committee
• Data validation Work Group
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Progress Update:
Advisory Committee
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PPG Advisory Committee
• As required by MN Laws, 2012, Regular Session, Chapter 164—SF1809,
sec. 4, Commissioner of Health will convene an Advisory Committee
• Membership will include representatives of:
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Health care providers
Health plan companies
Consumers
State agencies
Employers
Academic researchers
Organizations that work to improve health care quality in Minnesota
• Call for nominations w/due date of July 11, 2012:
www.health.state.mn.us/healthreform/peer/advisorycommittee.html
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Advisory Committee, contd.
• Committee will meet no fewer than 3 times per year
• Committee will provide advice on developing and
administering the Provider Peer Grouping System:
– Establishing peer groups
– Selecting quality measures
– Recommending thresholds for completeness of data and statistical
significance
– Considering methods for risk adjustment, including whether certain
provider characteristics should be included
– Including or excluding certain cost information in the analysis
– Adopting patient attribution
– Performing scoring on quality and costs
Progress Update:
Hospital Total Care
Analysis
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RRT Progress
• MDH obtained comments from the RRT on
– Scoring of topped-out and other quality measures
– Addressing the potential for small number of measures to determine
scores for quality subdomains.
– MDH decision is in development
• MDH will seek comments on choosing between alternative
risk adjustment mechanisms
– Call RRT in late July
– Feedback and decision in August
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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 (late August 2012)
– Build on previous work of the RRT (quality compositing, attribution,
risk adjustment)
– Obtain input from newly formed advisory committee
– Work w/RRT & Reliability Workgroup as 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
• Establish advisory group to review methodological decisions
and look for improvements (July)
• Complete hospital RRT discussion (July/August)
• Provide revised confidential data to hospitals (late summer)
and summary report later on
– Continue to work with facilities on data validation before and after
confidential release
– Hold regional meetings and webinars
• Proceed w/physician clinic analysis with updated data from
2009 (late summer)
• Finalize data sharing agreements to obtain Medicare data in
more timely manner
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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
August 13, 2012
7:30 a.m.
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