MMA Viewpoint
A Question of Value
Determining value. This small, yet critical, issue is the focus of what is likely to be one of the most important-but-controversial provisions of Minnesota’s 2008 health care reform act—provider peer grouping. We all attach value to things in our lives—housing, transportation, food, clothing, and recreation. Doing so usually is a fairly straightforward process. Determining the value of health care, however, is far more complex and personal.
What an individual considers valuable is a reflection of his or her belief system; however, it is impossible to determine value without basic information about cost and quality. The provider peer grouping mandated in the health care reform act is an attempt to make information about health care cost and quality more available to patients, employers, purchasers, and other providers. Although Minnesota leads most other states in the reporting of quality data as well as in actual performance, the available amount of valid, reliable, standardized, and comparable information is still insufficient.
The MMA supports making more information available but is concerned that the information be accurate and meaningful. As a community, we need to work to balance the pressing need for information with the responsibility to be fair and accurate. The stakes are high if we waiver from this commitment—relationships between physicians and patients could be disrupted, professional reputations damaged, access to care reduced, and financial viability threatened.
Starting this summer, an advisory group that includes four MMA representatives will hold public meetings to develop recommendations for creating a combined measure of providers’ risk-adjusted costs and quality of care. The methodology needs to reflect both cost and quality. Among the specific issues the group must consider are which providers (including which physician specialists) should be included in the analysis, what data sources should be used (claims data, medical records, patient satisfaction surveys), how cost and quality data should be attributed to clinics or practices, how to measure cost (per service, per episode, per capita), how to adjust for unique or outlier cases, how risk adjustment should be incorporated, who should be considered a “peer” for purposes of comparison, and how costs should be adjusted to reflect variations in contracted payment rates.
The law requires the methodology to be finalized no later than January 1, 2010. By June 1, physicians and other providers will have an opportunity to review the underlying data and, if necessary, appeal their accuracy. By September 1, 2010, the results will be made public.
The MMA will work to ensure that the methodology yields transparent, valid, reliable, and useful information. We will also continue to work to ensure that it is patient-centered. The law requires that by January 1, 2011, government and private health plans use the information to create incentives for individuals to choose high-quality, low-cost providers. In that way, the state is defining value for Minnesota patients. Although important, quantitative measures, should not be the sole measure of value—as they cannot capture all dimensions of a patient’s experience or preferences. A formulaic approach for determining value is inconsistent with other elements of the health care reform act that are much more patient-centered.
Physicians must support making useful and reliable information on health care costs and quality available to the public. But we also must work to safeguard our patients’ autonomy and ensure that they always have the final say about what’s of value to them.