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Comparative Performance Data for Physicians: An Important First Step for the Colorado APCD

As an economist, I know that credible information based on analysis of reliable data is worth its weight in gold. But, I also know that it is important not just to provide information, but to impart meaning and motivate action based on the results. To really make a difference, you have to engage all stakeholders in the health care community, get them to ‘take notice’ of the information and weave a story around the data to spark change.

The first step towards positive action is to make the data ‘real’ for people. This isn’t simply a matter of calculating the number of health care dollars used inefficiently, but identifying how these dollars could have been better used instead. The millions of dollars inefficiently allocated in health care each year could be used to fix our eroding infrastructure such as bridges and highways or to fund schools or after school programs. These investments can help make our regional and national economies more resilient as well.

For the past 18 months, CIVHC has been participating in a data analysis and reporting initiative led by the Network for Regional Healthcare Improvement (NRHI) and funded by the Robert Wood Johnson Foundation (RWJF). The purpose is to generate comparative Total Cost of Care (TCoC) and Relative Resource Use (RU) information for primary care physician (PCP) groups based on a National Quality Forum (NQF) endorsed methodology developed by HealthPartners of Bloomington, Minnesota.

The initial 18 month pilot was led by NRHI and included five states/regions – Colorado, Maine, Midwest Health Initiative (based in St. Louis, MO), Minnesota and Oregon – all working together to generate standard measures intended to be comparable across regions and actionable for PCP groups. The initial round of Colorado reports were generated based on analysis of fully-insured commercial health plan claims data for 2013 contained in the Colorado All Payer Claims Database (APCD).

CIVHC recently began providing the results to individual Colorado PCP groups as a starting point to help them understand how their practice patterns compare from a cost and resource use perspective. We view the distribution of this initial round of reports as a modest but meaningful first step in creating actionable information based on the APCD for Colorado physicians. For the first time, Colorado PCPs will be able to see how the costs and resources used in treating their patients compare to broader state-wide averages. The intent is that this will highlight areas where individual PCP practices are performing well and where opportunities may exist to make changes that ultimately improve population health and reduce costs. CIVHC is asking that PCP groups provide us with their feedback and let us know how we can improve the reports to make them even more valuable.

The scatterplot provides a sense of practice level variation in cost and resource use based on the TCoC and RU measures. Each point in the diagram reflects the relative cost and resource use performance of an individual PCP group compared to (normalized) state average values. In general, low resource use scores reflect greater efficiency in the delivery of health care whereas low price index scores indicate that care was delivered at relatively low cost. A practice in the upper left quadrant of the diagram is relatively efficient in delivering health care based on low resource use (compared to all PCP groups reflected in the analysis) but also has a relatively high price index (and thus costs). One take away from the scatterplot is that there is significant variation in both the cost of (based on total cost of care) and resources used in the delivery of health care across Colorado PCP groups.

This information becomes actionable when a PCP group digs deeper into the results to understand what is driving their comparative performance. For example, a PCP group may have high TCoC and/or RU in the Outpatient (OP) services category. The data generated in calculating the TCoC and RU measures can be used to identify whether minor surgical procedures, diagnostic testing, imaging procedures or other specific categories of OP services are driving this result. Armed with this information, the PCP group can alter practice patterns to address the underlying cause(s) and improve relative cost and resource use performance in the OP category.

With the passage of the SGR fix by Congress, the Centers for Medicare & Medicaid Services (CMS) is signaling a shift away from traditional fee for service (FFS) payment and movement toward value-based purchasing of health care services. This transition will require information and understanding of relative cost, efficiency and quality performance. From our work with the Colorado APCD and national partners, we believe that providing the TCoC and RU measures to practices will enable them to better understand relative performance and be of great value in the transition away from traditional FFS payment.

In our rapidly changing health care landscape, all stakeholders want and need information to help them determine what to do next. The real value of information lies in making it actionable and bringing it to stakeholders in a position to make a meaningful difference. If there is significant unexplained variation, we can work together to figure out why and do something about it. Practices performing well in specific areas can share their experience with others for the mutual benefit of all.
As administrator of the Colorado APCD, CIVHC is committed to making this resource – created for the benefit of all Coloradans – as valuable as possible for all stakeholder groups. If you have suggestions on how we can improve the use of this valuable state resource or if you have questions regarding the APCD or TCoC project, please contact the author at jmathieu@civhc.org.
 

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