Provider Peer Grouping
Monthly Updates
September 10, 2012
Stefan Gildemeister
Director, Health Economics Program
Outline
• Advisory committee discussion
• Progress update hospital analysis
– RRT 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)
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)
4
Stakeholder involvement
•
•
•
•
•
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
5
Progress Update:
Advisory Committee
6
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:
–
–
–
–
–
–
–
Health care providers
Health plan companies
Consumers
State agencies
Employers
Academic researchers
Organizations that work to improve health care quality in Minnesota
• Materials including charter, membership, and meeting materials are
available online:
www.health.state.mn.us/healthreform/peer/advisorycommittee.html
7
Discussion Topics for 2012
• Meeting One:
– Timeliness of data
– Definition and number of peer groups
– Provider definition
• Meeting Two:
– Creating quality composite scores
– Reporting to consumers & providers
• Meeting Three:
– Attribution for clinic analysis
• Meeting Four:
– Risk adjustment
8
First Meeting: September 7, 2012
• Introduction by Commissioner Ehlinger
• Provider Peer Grouping background information
– Context for Provider Peer Grouping
– Progress to Date
• Role of Advisory Committee
• Discussion of issues for consideration by the advisory group
(2012)
• September 7 issues:
– Timeliness of data
– Definition & number of peer groups
– Provider definitions (not discussed)
• Public comment (none received)
9
Progress Update:
Hospital Total Care
Analysis
10
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 September
– Feedback and decision in September or October
11
Progress Update:
Physician Clinic Total Care
Analysis
12
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
13
Timeline Update
14
Timeline for the Upcoming Months
• This Advisory Committee process informing the methodology refinements
and revisions
• Version 1 of Hospital PPG Results
– Engaging with RRT on two open methodological issues
– Confidentially submitting results to hospitals and obtaining feedback
– Preparing a summary report with these results
• Version 1 of Clinic PPG Results
– Conducting PPG analysis with input from Advisory Committee
– Releasing first version for confidential review by clinics
– Preparing summary information of clinic results
• Developing public reporting platform with input from stakeholders and
consumers
• Developing version 2 of hospital and clinic analysis using 2010/2011
calendar year cost data
15
And more…
In addition, in the next 12 months MDH is committed to:
– Working to develop educational materials for consumers
and providers, in collaboration with MHA, MMA, providers,
others
– Discussing with providers and payers how to make PPG
results as actionable as possible
– Convening a provider workgroup to design methods for
validation and exchange of data
16
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
17
Next call
October 8, 2012
7:30 a.m.
18