Colorado Medical Society

http://dev.cms.org/articles/practice-data/

Practice data

Wednesday, July 01, 2015 12:18 PM

Data drives change. It serves as a foundation for better understanding of comparative performance and identifying opportunities for improvement. In our rapidly changing health care landscape, data is becoming more and more important to providers and is most valuable when it is accessible and actionable. Until now, primary care physicians (PCPs) have lacked access to information that demonstrates the value and efficiency of care provided relative to that of their peers.

For the past 18 months, the Center for Improving Value in Health Care (CIVHC) has been participating in an initiative led by the Network for Regional Healthcare Improvement and funded by the Robert Wood Johnson Foundation. A main goal is to provide actionable information that allows PCP groups to understand their own cost and efficiency (or resource use) performance compared to other similar practices in Colorado. The data is intended to help PCP groups identify opportunities to bring about meaningful change and contribute to realizing the triple aim goals of better health, better quality and lower cost.

The initial pilot included five states/regions – Colorado, Maine, Midwest Health Initiative (based in St. Louis, Mo.), Minnesota and Oregon – working together to achieve the following objectives:

• Generate Total Cost of Care (TCoC) and Relative Resource Use (RU) measures based on a common methodology.
• Develop regional, statewide and national benchmarks to facilitate meaningful comparisons.
• Report results directly to PCP groups and engage them in using this information to help reduce health care costs and improve care.

CIVHC conducted analysis based on 2013 commercial claims data from the Colorado All Payer Claims Database (CO APCD). In May 2015, CIVHC provided 50 Colorado PCP groups with TCoC and RU reports reflecting patients from their respective practices. This initial distribution of reports is a modest but meaningful first step toward partnering with physicians to create actionable information based on the CO APCD.

For the first time, PCPs across the state are able to see how costs and resources used in treating their patients compare to broader statewide averages. The reports are intended to 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.

A scatterplot graph (tinyurl.com/civhc-graph) illustrates the practice-level variation in cost and resource use based on the TCoC and RU measures uncovered by this initial analysis. Each point on the graph reflects the cost and resource use of an individual PCP group compared to (normalized) state average values. In general, low resource use index scores reflect greater efficiency in the delivery of health care and 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). Moving forward, we would expect to see less variation among practices relative to statewide normalized values. Opportunities for improvement can be identified by looking at what PCP practices falling into the lower left quadrant are doing to provide relatively efficient and low-cost care.

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

CIVHC meets on a regular basis with the Colorado Medical Society Committee on Physician Practice Evolution to discuss issues related to the Colorado APCD both in general and for the TCoC and RU measurement project more specifically. Physicians interested in being more directly involved and providing ideas on how to make this information as useful as possible are encouraged to contact Chet Seward, senior director of health care policy, at chet_seward@cms.org.

As administrator of the CO APCD, CIVHC is committed to making this resource as valuable as possible for all stakeholder groups. As we embark on the next phase of this project, CIVHC plans to expand the number of PCP practices receiving these reports as well as provide additional granularity in service categories such as inpatient, outpatient, professional services and prescription drug utilization. Over the next 18 months, we welcome your engagement, feedback and input regarding how to make the reports as helpful and actionable as possible.

If you have other suggestions on how we can improve the use of this valuable state resource or if you have specific questions regarding the APCD or TCoC project, please contact Jonathan Mathieu, vice president of research and compliance, at jmathieu@civhc.org.