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Focus Areas

Total Cost of Care Project

For the past 18 months, CIVHC has participated in phase two of an initiative to generate Total Cost of Care (TCoC) and Resource Use (RU) measures and report results to Primary Care Physician (PCP) groups to support a better understanding of their cost and resource use patterns relative to broader averages.*

Through a number of recent initiatives, including the Medicare Access and CHIP Reauthorization Act (MACRA) and Comprehensive Care for Joint Replacement (CJR) model, the Centers for Medicare & Medicaid Services (CMS) is signaling a shift away from traditional fee for service (FFS) payment and toward value-based purchasing. To assist in this transition, PCP groups will need to understand how their cost, efficiency and quality performance compares to that of their peers. CIVHC believes that the TCoC and RU measures in these reports will help your practice better understand performance relative to other PCPs and prove essential in successfully navigating the transition from traditional FFS payment toward value-based reimbursement.

The TCoC initiative is led by the Network for Regional Healthcare Improvement (NRHI) and funded by the Robert Wood Johnson Foundation (RWJF). This initiative includes seven states/regions that have worked closely together to generate standardized measures of TCoC and RU that will be informative, meaningful, and actionable for physicians, and that can also be compared across regions. TCoC and RU measures are based on a National Quality Forum (NQF) endorsed methodology developed by HealthPartners of Minnesota.

Through both regional and national collaborations, CIVHC is exploring a variety of options to make the TCoC reports as informative and actionable as possible for PCP groups. CIVHC continues to collaborate with partners and physician leaders to develop toolkits, educational materials and use cases that will help practices use this information to identify specific opportunities to improve care and lower costs.

In addition to the resources below, CIVHC is committed to holding in person meetings with PCP practices who have received these reports, to answer questions and assist with understanding the results. If you are interested in scheduling an in person meeting with CIVHC staff to discuss your TCoC report, please let us know by sending a request to TCoC@civhc.org.

Resources for TCoC report recipients:

*TCoC and RU reports have been distributed directly to individual practices and named practice-level results will not be made available to the public.