Policymakers, providers, and consumers use healthcare measures to incentivize effective care, and to evaluate provider performance with regard to cost, quality, and other domains. Acumen has extensive experience developing, reporting, and evaluating health care performance measures, with a particular focus on cost measures. Our group currently develops and reports episode-based cost measures for clinicians, hospitals, and post-acute care providers.
Episode-based cost measures assess the costs of care for the initial treatment of a given condition or procedure, as well as typical follow-up care and complications. Episodes create a framework to meaningfully benchmark providers’ resource use by comparing the costs of treating similar patients, using statistical techniques to account for differences in patients’ previous health profiles and demographic characteristics.
Episode-based cost measures are used in conjunction with other types of performance measures to recognize providers that provide high quality care at a lower cost. Acumen’s measure development work includes defining clinical logic for episode construction, performing analyses of Medicare claims data, and soliciting input from a wide range of stakeholders. Our group also leverages its expertise in risk adjustment and advanced statistical modeling techniques.
MACRA Episode Groups and Cost Measures (2016 – Present): Prepared for Centers for Medicare & Medicaid Services, Center for Clinical Standards and Quality
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 established the Quality Payment Program, which rewards clinicians for high quality and high value care through either Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). Under MIPS, Medicare payment for eligible clinicians will be adjusted based on the clinician’s performance with respect to quality, improvement activities, advancing care information, and cost. Acumen works with CCSQ to develop episode-based cost measures for use in the MIPS cost domain; these measures could begin affecting payment as soon as the 2019 performance year (with payment rendered in 2021).
To develop episode-based cost measures for MACRA, Acumen considers the following
- How should episodes of care be constructed to meaningfully assess the efficiency of a clinician’s treatment for a given condition/procedure?
- Which claims are most relevant in determining clinician accountability in an episode of care?
- How should measures take into account factors that are outside of clinicians’ control (pre-existing conditions, socio-economic characteristics, etc.)?
Answering these questions involves contributions from on-staff and external clinicians, solicitation of extensive stakeholder and public outreach, and qualitative and quantitative research, including extensive analyses of Medicare claims data. To date, Acumen’s work on MACRA has included hosting multiple stakeholder input meetings, production of a draft list of episode groups and codes, and implementation of field testing of newly developed measures.