PBP Work Group 26
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26 Key Activities Establishing patient attribution and financial benchmarking standards Developing performance measurement guidelines Identifying data sharing requirements This group is identifying the most important elements of population-based payment models for which alignment across public and private payers could accelerate their adoption nationally, with a focus on data sharing, financial benchmarking, quality measurements, and patient attribution. Glenn Steele, Jr. Chairman, xG Health System, Immediate Past President and CEO of Geisinger Dana Gelb Safran , ScD Chief Performance Measurement & Improvement Officer, Senior Vice President Enterprise Analytics, Blue Cross Blue Shield of Massachusetts Chairs 16 Members Population-Based Payment (PBP) PBP Work Group
Transcript of PBP Work Group 26
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Key Activities Establishing patient attribution and
financial benchmarking standards Developing performance
measurement guidelines Identifying data sharing
requirements
This group is identifying the most important elements of population-based payment modelsfor which alignment across public and private payers could accelerate their adoptionnationally, with a focus on data sharing, financial benchmarking, quality measurements, andpatient attribution.
Glenn Steele, Jr.Chairman, xG Health System,Immediate Past President and CEO of Geisinger
Dana Gelb Safran , ScDChief Performance Measurement & Improvement Officer, Senior Vice President Enterprise Analytics, Blue Cross Blue Shield of Massachusetts
Chairs
16 MembersPopulation-Based Payment (PBP)PBP Work Group
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Hoangmai Pham, MD, MPHChief Innovation Officer, Center for Medicare & Medicaid Innovation
Thomas Raskauskas, MD, MMM, CHCQM Consultant, Population health and Practice Transformation, Former President and CEO of St. Vincent’s Health Partners
Andrew Sperling, JD Director of Federal Legislative Advocacy, National Alliance on Mental Illness
Jeff White, MBA/MS Director, Health Care Strategy and Policy, The Boing Company
Gretchen HammerDirector, Medicaid for Colorado
Steve Hamman, MBASenior Vice President, Provider Engagement and Enterprise Network Solutions, Health Care Service Corporation
Amy Nguyen Howell, MD, MBA Chief Medical Officer, CAPG
Kathleen Kinslow, CRNA, EdD, MBAPresident and Chief Executive Officer, Aria Health System
Sanne Magnan, MD, PhD President and Chief Executive Officer, Institute for Clinical Systems Improvement
Elizabeth Mitchell President and CEO, Network for Regional Healthcare Improvement
David Muhlestein, PhD, JDSenior Director of Research and Development, Leavitt Partners, LLC
Andrew Baskin, MD National Medical Director Clinical Professor of Health Care Policy, Aetna
Michael Chernew, PhDLeonard D. Schaeffer Professor of Health Care Policy, Harvard Medical School
Pamela French Vice President, Compensation and Benefits, The Boeing Company
Glenn Steele, Jr., MD, PhDChairman, xG Health System, Immediate Past President and CEO of Geisinger
Dana Gelb Safran, ScDChief Performance Measurement & Improvement Officer, Senior Vice President Enterprise Analytics, Blue Cross Blue Shield of Massachusetts
Member RosterPBP MEMBERS
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Final ReleaseMay 13, 2016
ReviseMarch 7 –May 16, 2016
Public CommentFebruary 8 –March 7, 2016
Draft ReleaseFebruary 8, 2016
DevelopmentNovember 2015 –February 2016
The draft white paper titled Accelerating and Aligning Population-Based Payment Models: Patient Attribution describes the method by which patient populations are assigned to providers who are accountable for total cost of care and quality outcomes for their designated populations in a PBP model. The paper recommends that active, intentional identification or self-reporting by patients should be considered first. The paper also outlines nine additional recommendations that payers and providers can use when making decisions on attribution in their PBP models.
Key Components• Recommendations• Flowchart• Comparison Table with CMS models
For population-based payment modelsPATIENT ATTRIBUTION
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for PBP modelsPatient AttributionPatient Self-
ReportGold standard
when it is available
Primary Care Providers
E&M codes for wellness and preventive care
Primary Care Providers
Other E&M codes
Primary Care Providers
Prescriptiondata
Specialty Care
E&M codes for specialty care (selected specialists)
1 2 3 4 5
Key Steps in Patient AttributionFLOW CHART
Verify attribution results with patient and provider
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PBP Work Group Recommendations
Medicare Shared Savings Program Tracks
1 and 2
Medicare Shared Savings Program Track 3
Pioneer ACOs
Next Generation ACOs
Patient Self-ReportGold standard when it is available
None None Patient SelectionTested 2015 onward
Patient SelectionBeginning 2016
Primary Care ProvidersE&M codes for wellness and preventive care
Primary Care ProvidersPlurality of primary careservices
Primary Care ProvidersPlurality of primary careservices
Primary Care ProvidersPlurality of primary careservices
Primary Care ProvidersPlurality of primary careservices
Primary Care ProvidersOther E&M codes
Primary Care ProvidersPrescription
N/A N/A N/A N/A
Specialty CareE&M codes for specialty care (selected specialists)
Non-Primary Care ProvidersPrimary care services
Non-Primary Care ProvidersPrimary care services
Non-Primary Care ProvidersPrimary care services
Non-Primary Care ProvidersPrimary care services
Prospective or
Concurrent Attribution
Either is AcceptableAs long as provider has timely, actionable data on the attributed patients
Concurrent Attribution Prospective AttributionLimited exclusions occur throughout the performance year and at the end
Prospective AttributionLimited exclusions occur throughout the performance year and at the end
Prospective AttributionLimited exclusions occur throughout the performance year and at the end
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2211
4
3
2
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Comparison of the PBP Work Group recommendations with CMS program approaches to attributionCOMPARISON TABLE
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Final ReleaseMay 13, 2016
ReviseMarch 7 –May 16, 2016
Public CommentFebruary 8 –March 7, 2016
Draft ReleaseFebruary 8, 2016
DevelopmentNovember 2015 –February 2016
The draft white paper titled Accelerating and Aligning Population-Based Payment Models: Financial Benchmarking describes approaches for setting an initial benchmark and updates over time and also addresses risk adjustment considerations. The white paper discusses the need to balance voluntary participation with the movement toward convergence in a market with providers at different starting points.
Key Components• Principles• Recommendations
For population-based payment modelsFINANCIAL BENCHMARKING
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Final ReleaseEarly June 2016
ReviseEarly June 2016
Public CommentApril 22 – May 23, 2016
Draft ReleaseApril 22, 2016
DevelopmentDecember 2015 –April 2016
The PBP Work Group’s draft White Paper, Accelerating and Aligning Population-Based Payment Models: Performance Measurement is grounded in the notion that payers, providers, purchasers, and patients should be collectively accountable for ensuring that the health care system delivers the highest possible value. The paper offers a way forward that could change how performance is measured across the board in order to enable effective population-based payments. The paper makes recommendations for immediate action steps, describing four key performance measurement principles and seven recommendations for building and sustaining a performance measurement system that supports and encourages collaboration among stakeholders.
For Population-Based Payment ModelsPERFORMANCE MEASUREMENT
33COMPONENTS OF MEASUREMENT SYSTEMS
Calculate Overall Performance Scores
Connect Payment Levels to Performance Scores
Specify Measures
34MEASURES BY PURPOSE AREA
