Every measure has detailed specifications about what will be measured and how. These specifications are used by health plans and health care providers to guide their own measurement activities. The Community Checkup primarily uses technical specifications from government agencies such as the Centers for Medicare & Medicaid Services and the Agency for Health Care Research and Quality as well nationally-recognized private nonprofits such as the National Committee for Quality Assurance and the Pharmacy Quality Alliance. The Alliance has also developed our own measures specifications on a much more limited basis.
Provider Attribution Methodology
To report performance results at the clinic level, Milliman assigns patient-level measure results to those providers deemed most appropriate for each type of measure. This varies based upon the type of care each measure reflects.
The Alliance worked with expert committees and medical groups within the region to develop and test several different attribution methods. PCP (primary care provider) attribution is applied to prevention-related measures based on the concept that the PCP is primarily responsible for a patient's preventive care management. The Team method is applied to measures related to specific health conditions, based on the belief that patients benefit most when their entire medical team works together to ensure that they receive appropriate care.
After results have been attributed to providers, the Alliance leverages its clinic roster (that is regularly reviewed and updated by medical groups) to assign and summarize these results at clinic and medical group levels.
How we calculate our scores
Summary rates are calculated and scores are then assigned to the results based upon how each rate compares to the state rate. If a clinic’s rate is significantly lower than the state rate—if the computed confidence interval around that clinic’s rate is entirely below the state rate—the score is worse. If a clinic’s rate is significantly higher than the state rate—if the computed confidence interval around that clinic’s rate is entirely above the state rate—then the score is better. If the confidence interval of the clinic’s rate overlaps the state’s confidence interval, then the score is average.
Working with stakeholders
The Alliance works with our committees and other stakeholders to test and develop our reporting and analysis methodologies. We also frequently field requests from stakeholders asking to explore new types of measurement.
The Alliance works closely with the Washington State Health Care Authority (HCA) and the governor-appointed Performance Measures Coordinating Committee (PMCC) to publish results for the Washington State Common Measure Set for Health Care Quality and Cost.