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

Ahluwalia SC1,2, Damberg CL3, Haas A4, Shekelle PG3,5.

Author information

1: RAND Corporation, 1776 Main Street, Santa Monica, CA, 91403, USA. sahluwal@rand.org.
2: UCLA Fielding School of Public Health, Los Angeles, CA, USA. sahluwal@rand.org.
3: RAND Corporation, 1776 Main Street, Santa Monica, CA, 91403, USA.
4: RAND Corporation, Pittsburgh, PA, USA.
5: VA West Los Angeles Medical Center, Los Angeles, CA, USA.

Abstract

BACKGROUND:

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. This paper uses publicly available data to examine how different classification approaches influence which providers are designated as "high-performers".

METHODS:

We 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.

RESULTS:

Using 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.

CONCLUSIONS:

Classification 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.