Provider Peer Grouping Monthly Updates

Transcription

1 Provider Peer Grouping Monthly Updates May 14, 2012 Stefan Gildemeister Director, Health Economics Program

2 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 2

3 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

4 What Types of Provider Peer Grouping 1. Total care Need to be Developed? 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

5 Stakeholder Involvement Provider Peer Grouping Advisory Group Rapid Response Team Reliability Workgroup Feedback during review period & at public meetings Monthly conference calls 5

6 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 6

7 Progress Update: Hospital Total Care Analysis 7

8 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 8

9 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 9

10 Progress Update: Physician Clinic Total Care Analysis 10

11 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 11

12 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) 12

13 Resources Additional information on PPG is available online: Information on Minnesota s health care market can also be found online: Questions may be sent to: Stefan Gildemeister at Stefan.Gildemeister@state.mn.us or

14 Next Call June 11, :30 a.m. 14