Posing A Framework To Guide Government’s Role In Payment And Delivery System Reform

In recent years there has been a significant expansion in the use of provider performance measures for quality improvement, payment, and public reporting. Using data from a survey of health plans, we characterize the use of such performance measures by private payers. We also compare the use of these measures among selected private and public programs. We studied twenty-three health plans with 121 million commercial enrollees-66 percent of the national commercial enrollment. The health plans reported using 546 distinct performance measures. There was much variation in the use of performance measures in both private and public payment and care delivery programs, despite common areas of focus that included cardiovascular conditions, diabetes, and preventive services. We conclude that policy makers and stakeholders who seek less variability in the use of performance measures to increase consistency should balance this goal with the need for flexibility to meet the needs of specific populations and promote innovation. D uring the past two decades there has been substantial growth in the availability and use of performance measures. The National Quality Forum, a nonprofit organization that establishes consensus standards for measuring performance, has endorsed more than 700 measures.1 The use of provider performance measures for quality improvement, payfor-performance, and public reporting purposes has become commonplace.Performance measures increasingly play an integral role in assessing the achievement of high-quality, efficient care in new health plan and Medicare payment and delivery models such as accountable care organizations, patient-centered medical homes, and bundled and global payment.2,3 Understanding performance measures and their use is vital to ensuring the availability of reliable performance information. 4 Information on measures that are used to assess providers' performance in Medicare is publicly available through the federal rule-making process. In contrast, we are aware of only a few reports that examine the use of performance measures in the private sector. The primary focus of these reports has been the use of measures endorsed by the National Quality Forum across a cross section of users, including community collaboratives, accrediting organizations, a few health plans, and the public sector.1,5 The National Quality Forum also has catalogued the performance measures used by the Aligning Forces for Quality communities. This existing body of work provides only a limited understanding of the measures used by health plans to assess providers' performance. Consequently, little is known about how performance measures used by health plans compare with those used in public-and other privatesector programs.To address this gap in knowledge, we conducted a study with the primary purpose of gaining a better understanding of health plans'

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“…In related work, we have discussed criteria for achieving harmony in the use of measures for payment purposes. 32 …”

Section: Discussionmentioning

confidence: 99%

Provider Performance Measures In Private And Public Programs: Achieving Meaningful Alignment With Flexibility To Innovate

2013

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“…Although Medicare has the potential to strengthen the impact of multipayer initiatives, there is a paucity of research on how Medicare participation influences multipayer collaboration . Understanding how CMS approaches multipayer initiatives—as the initiative convener, a large participating payer, or both—is important given its increasing involvement in multipayer initiatives and unique status among payers.…”

Section: Background On Cpcmentioning

confidence: 99%

Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative

Anglin

Liao

et al. 2017

Milbank Quarterly

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“…The lack of coordination and fragmentation of care potentially lower productivity. In response to those concerns, the Affordable Care Act included several Medicare reforms such as penalties for readmissions, “Accountable Care Organizations,” and “Bundled Payments” to improve care coordination, particularly after hospital discharge [14]. Since then, there has been an increase in “virtual” integration between hospitals and SNFs, meaning that some hospitals started to form a “preferred” SNF network and to discharge most of their patients to SNFs within their network [15].…”

Section: Introductionmentioning

confidence: 99%

Productivity growth of skilled nursing facilities in the treatment of post-acute-care-intensive conditions

Sood

Dunn

et al. 2019

PLoS ONE

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Background Health care is believed to be suffered from a “cost disease,” in which a heavy reliance on labor limits opportunities for efficiencies stemming from technological improvement. Although recent evidence shows that U.S. hospitals have experienced a positive trend of productivity growth, skilled nursing facilities are relatively “low-tech” compared to hospitals, leading some to worry that productivity at skilled nursing facilities will lag behind the rest of the economy. Objective To assess productivity growth among skilled nursing facilities (SNFs) in the treatment of conditions which frequently involve substantial post-acute care after hospital discharge. Methods We constructed an analytic file with the records of Medicare beneficiaries that were discharged from acute-care hospitals to SNFs with stroke, hip fracture, or lower extremity joint replacement (LEJR) between 2006 and 2014. We populated each record for 90 days starting at the time of SNF admission, detailing for each day the treatment site and all associated costs. We used ordinary least square regression to estimate growth in SNF productivity, measured by the ratio of “high-quality SNF stays” to total treatment costs. The primary definition of a high-quality stay was a stay that ended with the return of the patient to the community within 90 days after SNF admission. We controlled for patient demographics and comorbidities in the regression analyses. Results Our sample included 1,076,066 patient stays at 14,394 SNFs with LEJR, 315,546 patient stays at 14,154 SNFs with stroke, and 739,608 patient stays at 14,588 SNFs with hip fracture. SNFs improved their productivity in the treatment of patients with LEJR, stroke, and hip fracture by 1.1%, 2.2%, and 2.0% per year, respectively. That pattern was robust to a number of alternative specifications. Regressions on year dummies showed that the productivity first decreased and then increased, with a lowest point in 2011. Over the study period, quality continued to rise, but dominated by higher costs at first. Costs then started to decrease, driving productivity to grow. Conclusion There has been substantial productivity growth in recent years among SNFs in the U.S. in the treatment of post-acute-care-intensive conditions.

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Posing A Framework To Guide Government’s Role In Payment And Delivery System Reform

Cited by 5 publications

References 11 publications

Provider Performance Measures In Private And Public Programs: Achieving Meaningful Alignment With Flexibility To Innovate

Provider Performance Measures In Private And Public Programs: Achieving Meaningful Alignment With Flexibility To Innovate

Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative

Productivity growth of skilled nursing facilities in the treatment of post-acute-care-intensive conditions

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