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BHCAG, 5 th Employer Leadership Summit February 23, 2012

Transparency on Cost and Quality: Understanding Value in Health Care Through Provider Peer Grouping. BHCAG, 5 th Employer Leadership Summit February 23, 2012 Stefan Gildemeister, Director Health Economics Program. Overview. Trends in health care cost and quality – what do we know?

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BHCAG, 5 th Employer Leadership Summit February 23, 2012

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  1. Transparency on Cost and Quality:Understanding Value in Health Care Through Provider Peer Grouping BHCAG, 5th Employer Leadership Summit February 23, 2012 Stefan Gildemeister, Director Health Economics Program

  2. 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

  3. 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

  4. Quality Variation: Diabetes Optimal Care Source: Statewide Quality Reporting System, Health Economics Program MHCP are Minnesota Health Care Programs, which include Medicaid and MinnesotaCare

  5. Health Care Growth Exceeds Growth in Income & Wages Source: HEP analysis of annual health plan reports, preliminary

  6. Trends in Cost Sharing in Minnesota’s Private Market Source: HEP analysis of annual health plan reports, preliminary

  7. 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)

  8. What Types of Provider Peer Grouping Needs to be Developed? • Total Care • 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

  9. Information Calculated by Provider Peer Grouping

  10. Results for Consumers – Example 1 Low Cost

  11. Results for Consumers – Example 2

  12. Results for Consumers – Example 3

  13. Results for Consumers – Example 4

  14. 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

  15. 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

  16. 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/healtheconomicsContact information: Stefan.Gildemeister@state.mn.us or 651-201-3554

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