Transparency on Cost and Quality:Understanding Value in Health Care Through

Provider Peer Grouping

BHCAG, 5th Employer Leadership SummitFebruary 23, 2012

Stefan Gildemeister, Director Health Economics Program

Overview

• Trends in health care cost and quality – what do we know?

• What is Provider Peer Grouping?• What information is calculated by Provider Peer

Grouping?• What are challenges with performing (and

displaying) analysis results?• Next steps

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Role of the Health Economics Program

• Monitor health care market and provides unbiased analysis– Study trends and characteristics of the uninsured– Perform empirical research on health care cost, quality,

coverage, and access– Assist in the development and analysis of health policy and

health reform

• Implement aspects of the 2008 Minnesota health reform law

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Quality Variation: Diabetes Optimal Care

Source: Statewide Quality Reporting System, Health Economics ProgramMHCP are Minnesota Health Care Programs, which include Medicaid and MinnesotaCare

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Health Care Growth Exceeds Growth in Income & Wages

Source: HEP analysis of annual health plan reports, preliminary

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Trends in Cost Sharing in Minnesota’s Private Market

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Source: HEP analysis of annual health plan reports, preliminary

What is Provider Peer Grouping?

• A system for providing comparative information to consumers on variation in health care cost and quality across providers:– …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)

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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 risk-adjusted cost of care and quality of care, and for specific conditions… (M.S.§62U.04, Subd. 3)

•Both types of analysis are to be done annually for hospitals and for physician clinics

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Information Calculated by Provider Peer Grouping

Results for Consumers – Example 1

Low Cost

Results for Consumers – Example 2Process of Care Score: 27

Process of Care Number of Patients

Perfor-mance Rate

Quality Points Earned

Heart Attack Care

AMI-1 (CMS)

Heart attack patients given aspirin at arrival

54 100% 10

AMI-2 (CMS)

Heart attack patient given aspirin at discharge

40 95% 7

AMI-3 (CMS)

Heart attack patients given ACE inhibitor or ARB for left ventricular systolic dysfunction

5 100% n/a

AMI-4 (CMS)

Heart attack patients given smoking cessation advice/counseling

9 100% n/a

AMI-5 (CMS)

Heart attach patients given beta blocker at discharge

42 93% 7

AMI-8a (CMS)

Heart attack patients given PCI within 90 minutes of arrival

0 n/a n/a

Results for Consumers – Example 3Readmission Score: 27

Care Outcome Number of Patients

Risk Adjusted Readmission

Quality Points Earned

Readmission Measure

READM-30-AMI (CMS)

30-day readmission rate of hospital discharge (heart attack)

68 20% 4

READM-30-HF (CMS)

30-day readmission rate of hospital discharge (heart failure)

206 27.4% 2

READM-30-PN (CMS)

30-day readmission rate of hospital discharge (pneumonia)

270 20.2% 0

Results for Consumers – Example 4Total Care Costs, by Payer and Type of Service

Number of Discharges

Total Costs per Discharge

Price Standardized Payments per Discharge

Ratio of Total Costs to Standardized Payments per Discharge

Total 9,015 $7,744 $8,667 0.89

Payer Type

Medicare 2,366 $7,818 $8,312 0.94

Medicaid 632 $5,234 $6,607 0.79

Commercial 6,017 $8,071 $9,209 0.88

Service Type

Medical 6,990 $6,567 $7,461 0.88

Surgical 805 $20,919 $23,032 0.91

Newborn 1,176 $3,215 $3,544 0.91

Challenges• Methodology

– Scoring / relative vs. absolute ranking– Sufficient measures for scoring– Adequacy of actionable / meaningful measures (process / outcome /

functional status?)

• Completeness and timeliness of data• Validation of data by providers• Display of results

– Platform– Ability to search (dig down / compare)– Context

• Adequate staffing and funding for analytic intense efforts

Next Steps, 2012• Finalizing (revised) first version for confidential review by

hospitals• Preparing summary information of hospital results• Advisory group process informing methodology• Performing clinic level analysis• 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 second version of hospital data intended for

hospital-specific public release

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

Contact information: Stefan.Gildemeister@state.mn.us or 651-201-3554

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