Total Cost of Care Reporting Jim Chase Health Care Financing Task Force October 2, 2015.
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Total Cost of Care Reporting Jim Chase Health Care Financing Task Force October 2, 2015
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Transcript of Total Cost of Care Reporting Jim Chase Health Care Financing Task Force October 2, 2015.
Total Cost of Care ReportingJim Chase
Health Care Financing Task ForceOctober 2, 2015
MN Community Measurement
Accelerating the Improvement of Health Through Public Reporting• The trusted source of information to improve health,
patient experience, cost and equity
• Used by patients and providers to improve care
• Our community works together on measurement
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MNCM by the Numbers
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Current Environment for Cost of Care Measures• Many medical groups have contracts with total cost
targets• Health plans are using different cost of care measures• MnSure, other new insurance products will highlight cost
differences to public• Recent Medicare release of physician payment data • State and federal health care programs likely to adopt
cost measures in near future• National Quality Forum (NQF) endorsed HealthPartners
Total Cost of Care and Resource Use measures4
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MNCM Cost of Care Measure
• In 2012, MNCM Board of Directors set goal to create a cost of care measure for public reporting
• Measure had to:• Support improvement in the Triple Aim • Align with local and national initiatives• Aim at recognition of variation in cost and utilization,
as well as opportunity to improve
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NQF Evaluation Criteria
• Importance to measure and report• Scientific acceptability of measure• Feasibility• Usability and use• Related and competing measures
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Purpose of Total Cost Measure• Public awareness of cost variation and opportunity to
increase value• Alignment across payers so they compete on results, not
information• Actionable information for medical groups
• Transparent, nationally-endorsed method• Timely data• Verifiable results
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What is Total Cost Of Care
• Measure of All Risk Adjusted Costs for All Patients compared to Overall State Average
• Patients are attributed to one and only one medical group• Primary Care activity
• All of the patient’s costs are assigned to that group• Insurance payment + patient responsibility
• Adjusted for patient risk and outlier costs removed• Medical group level reporting
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Key Public Comment Concerns
• Attribution of total costs to primary care• Reporting only on primary care and multi-specialty
groups• Comparison groups• Impact on referral centers
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Range of Results 2013
Based on 1,500,000 commercially insured patients and $8,000,000,000 in costs
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Impact of the range
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2015 Total Cost of Care Report
• Reports data on 132 medical groups with 954 clinics
• Stability over two years, similar range and distribution
• Paired with average paid per procedure (201 medical groups)
• Average paid up 6%, average cost up 3%
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Next Steps
• Review measure specifications for enhancements
• Include Relative Resource Use measure• Expand to Medicare and Public Programs• Align use with payers• Provide medical groups with additional
analysis
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Questions or Comments?Jim ChasePresident, MN Community [email protected]
Connect with us!MN Community Measurement websiteMN HealthScores WebsiteMN HealthScores on FacebookTwitter: @mnhealthscores 14
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