Provider Peer Grouping
Monthly Updates
August 9, 2010
Katie Burns
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 risk-adjusted 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 riskadjusted cost of care and quality of care, and for
specific conditions… (M.S.§62U.04, Subd. 3)
Stakeholder Input on Peer Grouping
Methodology
• MDH convened the Provider Peer
Grouping Advisory Group in JuneSeptember 2009
• MDH convened the Rapid Response
Team in May 2010 to provide ongoing
input on critical issues as project
progresses
Updates on
Methodological Issues
Treatment of “Non-Users”
• Not all enrollees have medical claims
in the most recent calendar year
• These enrollees are called “non-users”
• Sufficient prior year claims data must
be available to credibly attribute these
patients to a provider
Treatment of Non-Users
• Stakeholders have different perspectives on
whether they should be included, but most agree we
lack sufficient data to credibly attribute non-users to
providers this year
• MDH has decided to exclude non-users in the first
peer grouping analysis
• MDH will reconsider this issue in future rounds of
peer grouping
Scope of Total Care Analysis
• Total care analysis will focus on
primary care clinics, but will include all
care, regardless of whether care was
provided by primary care physician or
specialist.
Scope of Total Care Analysis
• For total care, only clinics or medical groups offering
primary care will have patients attributed to them
• When analysis is publicly reported, consumers
need information on comparable cohort of
providers
• Specialists provide unique array of services
• On balance, “total care” quality metrics relate
more to primary care than specialty care
• If specific specialists are certified as health care
homes in future years, they would be included in
total care
Scope of Specific Condition Analysis
• Both specialists and primary care physician
clinics will be included in the specific
condition analysis
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Pneumonia
Total knee replacement
Congestive heart failure
Coronary artery disease
Diabetes
Asthma
Stakeholder Communications and
Input Additional Opportunities
• Monthly call
• Soliciting feedback from providers about
mock provider reports
• Workgroup on reliability thresholds
PPG: Progress to Date
• Clarifying key methodological issues
• MDH and Mathematica Policy Research
working to understanding available data
• Working through technical data collection
issues from major data submitters
• Timeline will be delayed somewhat due to
these issues; MDH making progress where
possible and working with test data
Next call
Monday, September 13, 2010
7:30-8:30 am