How are medical groups identified as high-performing? The effect of different approaches to classification of performance

Sangeeta C Ahluwalia,Ann Haas,Cheryl L Damberg,Paul G Shekelle

doi:10.1186/s12913-019-4293-9

Sangeeta C Ahluwalia, Ann Haas + Show 2 more

Open Access

https://doi.org/10.1186/s12913-019-4293-9

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Abstract

BackgroundPayers and policy makers across the international healthcare market are increasingly using publicly available summary measures to designate providers as “high-performing”, but no consistently-applied approach exists to identifying high performers. This paper uses publicly available data to examine how different classification approaches influence which providers are designated as “high-performers”.MethodsWe conducted a quantitative analysis of cross-sectional publicly-available performance data in the U.S. We used 2014 Minnesota Community Measurement data from 58 medical groups to classify performance across 4 domains: quality (two process measures of cancer screening and 2 composite measures of chronic disease management), total cost of care, access (a composite CAHPS measure), and patient experience (3 CAHPS measures). We classified medical groups based on performance using either relative thresholds or absolute values of performance on all included measures.ResultsUsing relative thresholds, none of the 58 medical groups achieved performance in the top 25% or 35% in all 4 performance domains. A relative threshold of 40% was needed before one group was classified as high-performing in all 4 domains. Using absolute threshold values, two medical groups were classified as high-performing across all 4 domains. In both approaches, designating “high performance” using fewer domains led to more groups designated as high-performers, though there was little to moderate concordance across identified “high-performing” groups.ConclusionsClassification of medical groups as high performing is sensitive to the domains of performance included, the classification approach, and choice of threshold. With increasing focus on achieving high performance in healthcare delivery, the absence of a consistently-applied approach to identify high performers impedes efforts to reliably compare, select and reward high-performing providers.

Highlights

Payers and policy makers across the international healthcare market are increasingly using publicly available summary measures to designate providers as “high-performing”, but no consistently-applied approach exists to identifying high performers
As consumers are being encouraged and even financially incentivized to obtain all or most of their care within a single health system or a medical group, it is reasonable for consumers to expect that the system or medical group they choose should be high performing across multiple dimensions of performance
Measures Drawing upon the Institute of Medicine’s (IOM) conceptual framework for a twenty-first century health system that is safe, effective, patient-centered, timely, efficient, and equitable [19], we examined medical group performance across 4 of the 6 IOM performance domains, that were identified in our prior review [16]: quality, total cost of care, access, and patient experience

Summary

Introduction

Payers and policy makers across the international healthcare market are increasingly using publicly available summary measures to designate providers as “high-performing”, but no consistently-applied approach exists to identifying high performers. Wide variation exists in how payers and researchers designate “high-performing” providers, applying different performance domains (e.g., quality, cost, access, patient experience) and types of measures (e.g., individual vs composite measures) within those domains, and using varying thresholds. While the merits of each of these approaches can be argued and improved upon, consumers, payers, and policy makers are typically limited to the domains and measures included in existing publicly available data for assessing provider performance and selecting or rewarding the “high-performers”. It is important to understand – through the data currently available to stakeholders – the extent to which different applications of the definition and measurement of performance impact if and how groups are identified as high-performing

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