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Frequently asked questions about the Partnership
for Peak Healthcare Performance (PPHP)
| 1. What
is the Partnership for Peak Healthcare Performance (PPHP)? |
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PPHP is a multi-stakeholder
initiative to measure, report and improve care for chronic
conditions, starting with a focus on diabetes care. The
PPHP was formed by the Dallas-Fort
Worth Business Group on Health (DFWBGH) in July 2007,
and is a collaborative of physicians, employers, health
plans, consumer groups and pharmaceuticals working collectively
to improve the care delivered to diabetes patients in
DFW. |
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A key component of the PPHP
mission is measuring and reporting quality of care provided
to commercially insured health plan members. PPHP aggregates
data across five major health plans, including Aetna,
Blue Cross Blue Shield of Texas, CIGNA, Humana and UnitedHealthcare.
These consolidated results are reported to physicians
to provide a broader, more statistically significant view
of the care their diabetes patients are receiving. The
first set of diabetes care results were shared with physicians
in May 2009, using calendar year 2007 commercial claims
data. Thereafter, reports will be mailed in December for
the prior calendar year (i.e. December 2009 reports reflect
2008 data). |
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Physicians have been integral
participants on the PPHP's multi-stakeholder Leadership
Team and working committees since the project's inception.
Members represent physicians, medical groups, employers,
health plans, pharmaceuticals and consumers. A Physician
Advisory Council ensures that all committees benefit from
physician input on issues related to physicians. |
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More information about PPHP
can be found at www.dfwbgh.org/partnership. |
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| 2. Which
physicians receive DFW Diabetes Care Reports? |
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Reports are mailed to individual
physicians who contracted with one or more of five participating
health plans (including PPO and POS product lines) during
the measurement year. |
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Using commercial claims
data, PPHP measures and provides results to physicians
practicing in the specialties of endocrinology, family
practice, general practice, and internal medicine, and
who have 20 or more commercially insured diabetes patients
through the participating health plans. These physicians
receive personalized DFW Diabetes Care Reports annually
showing the collected data for diabetes care quality measures
for certain of their commercially insured patients. |
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| 3. What
patient data were included in the results? |
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The eligible patient population
includes commercially insured adult patients (age 18 to
75 as of December 31 of the measurement year) with PPO
and POS coverage (excludes HMO), who were continuously
enrolled in one health plan with no more than one gap
of up to 45 days within the measurement year, and who
were diagnosed with or received treatment for diabetes
in the measurement year or the year prior. |
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| 4. How
did the project assign (or attribute) patients to me? |
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The patient attribution
method was decided by the PPHP Data Collection & Aggregation
Committee and approved by the PPHP Leadership Team. |
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Patients are assigned to
the physician with whom they had the most visits within
the measurement year. In the event of a "tie," the patient
was attributed to the physician with whom s/he had the
most recent office visit. The patient care specialties
included were endocrinology, family practice, general
practice and internal medicine. |
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Click on Methodology
to learn more. |
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| 5. What
clinical quality measures are reported? |
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PPHP measures performance
using clinical quality measures that are evidence-based,
and nationally standardized and endorsed. The measures
address diabetes care management. The measures were selected
by the PPHP Performance Metrics/Public Reporting Committee
and reviewed by the PPHP Leadership Team and PPHP Physician
Advisory Council. |
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The four measures used are
calculated using calendar year commercial claims data
for the measurement year. All measures have to be capable
of being calculated using the administrative claims data
available from the five participating health plans. |
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The four measures are listed
below. |
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A1c Test |
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LDL Test |
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Nephropathy Test or
Treatment |
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Retinal exam |
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PPHP uses measure specifications
from the National Committee for Quality Assurance (NCQA)
Healthcare Effectiveness Data and Information Set (HEDIS)
(www.ncqa.org). |
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Two outcomes measures also
are calculated and reported even though the data are incomplete
and cannot be considered reliable. The ability of claims
systems to link lab values to patients and their prescribing
physicians is limited at this time, however average A1c
and LDL values are calculated for those values that can
be captured. |
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Click on Methodology
for more detail. |
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| 6. What
data sources are used to develop these reports? |
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PPHP uses administrative
claims data from the five participating health plans to
generate the quality care measures for patients continuously
enrolled during the measurement year. |
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The data are drawn from
ambulatory visits, lab and other screening services, and
pharmacy claims. The data do not include Medicare, Medicaid,
indemnity or HMO patients, or PPO/POS patients from non-participating
plans. |
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There are data gaps in claims
data due to incomplete claims records, coding errors,
and errors in data handling processes, among other issues. |
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Missing physician identifiers
on the claims records would exclude some patient events
from being attributed to any physician. One of more of
your patients may have had a visit with you, but if the
claim was missing your physician identifier, it could
not be linked to you for attribution. |
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As one step in improving
the data, we are sending DFW Diabetes Care Reports to
physicians and inviting them to comment on their results. |
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| 7. Which
health plans participated in the data aggregation? |
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Five major health plans
in the DFW area participate in the data collection and
aggregation. These are: Aetna, Blue Cross Blue Shield
of Texas, CIGNA, Humana, and UnitedHealthcare. |
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| 8. How
are these data obtained and how is patient confidentiality
protected? |
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The five health plans voluntarily
collect and summarize patient data at the physician level
using a standardized data schema. These data are submitted
to Austin Provider Solutions, Inc (a third party data
management company contracted by DFWBGH) which aggregates
the data across plans and reports results. All data are
handled in strict compliance with HIPAA regulations. In
order to protect patient confidentiality, no individual
patient-identified data are collected. |
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| 9. How
was the DFW Diabetes Care Report created? |
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PPHP's Performance Metrics/Public
Reporting and Data Collection & Aggregation Committees
prepared the content and format of the DFW Diabetes Care
Reports. Subsequently the report underwent numerous rounds
of review and refinement involving input and feedback
from the PPHP Physician Advisory Council and the PPHP
Leadership Team. Members of these groups include the chief
executives of several large physician organizations in
DFW. Physician members of our working committees also
received sample reports containing their own performance
results for review and comment before the report formats
were finalized. |
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| 10. How
have the data been validated? |
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The data collection and
aggregation methodology was first conducted with calendar
year 2006 commercial claims data. The results were reviewed
and tested by PPHP staff, the PPHP Data Collection &
Aggregation Committee and the health plan medical directors
to look for and correct inconsistencies in the collection
and aggregation process. Additionally, the regional results
were compared to national benchmark data. Once satisfied
with the methodology, the PPHP collected and aggregated
calendar year 2007 data. |
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Click on Methodology
for more information. |
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| 11. How
reliable are the physician results? |
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Reliability tends to increase
as a physician's patient sample size increases. With the
guidance of the PPHP Physician Advisory Council and the
PPHP Data Collection & Aggregation Committee, we chose
a minimum patient sample size of 20 for reporting results
to physicians. Only those physicians within the designated
practice specialties who had 20 or more diabetes patients
attributed to them receive the DFW Diabetes Care Report. |
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Note that the calculated
average A1c and LDL lab values are not considered reliable
because for many physicians the number of records to which
lab values can be linked falls below 20 patients. The
number of patients whose lab values are available and
included in the average is indicated in parentheses on
the report. |
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| 12. What
benchmark is used to compare my results? |
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After reviewing a number
of possible benchmarks, the PPHP determined (with concurrence
from the PPHP Physician Advisory Council) that the most
meaningful benchmark for a physician is the PPHP project-specific
average results among all the DFW area physicians who
were measured. The DFW Diabetes Care Report includes a
benchmark comparison for each measure showing the all-DFW
average. |
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There are few external benchmarks,
as measurement at the individual physician level is relatively
new. PPHP all-DFW average results are compared to the
Commercial HEDIS audit means for PPOs (NCQA) and Commerical
HEDIS 90th percentile for PPOs (NCQA) to gauge the reasonableness
of observed performance rates at the population level.
In general, DFW physician results compare favorably with
these national benchmarks. |
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| 13. How
can I respond to this report or obtain additional information? |
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Physicians can provide feedback
on the DFW Diabetes Care Evaluation by going to www.dfwbgh.org/pphp
and following the Physician
Report Feedback Form link. |
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Additional information including
the project overview, methodology, and other details can
be accessed at www.dfwbgh.org/partnership. |
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| 14. I
believe I treat more patients than appear in my report.
How do you account for the missing data? |
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PPHP measurements only include
commercial PPO and POS patients insured through the five
participating health plans (Aetna, Blue Cross Blue Shield
of Texas, CIGNA, Humana and UnitedHealthcare). This excludes
commercial HMO and indemnity, and Medicare/Medicaid patients.
(Note that the calendar year 2007 date reported in May
2009 also included Aetna's indemnity patients.) |
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The eligible patient population
includes commercially insured adult patients (age 18 to
75 as of December 31 of the measurement year) with PPO
and POS coverage (excludes HMO), who were continuously
enrolled in one health plan with no more than one gap
of up to 45 days within the measurement year, and who
were diagnosed with or received treatment for diabetes
in the measurement year or the year prior. |
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To qualify, a patient must
have had an ambulatory physician office visit during a
specific time period. Some number of patients may be excluded
because they did not have an ambulatory office visit during
this period. |
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Missing or incorrect information
on the claims records may have excluded some patients. |
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Although some patients may
have received treatment from more than one physician,
for the purposes of this study each patient is assigned
to only one physician - the physician s/he visited most
often during the measurement year. |
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See Methodology
for more information. |
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| 15. How
will these results be used? |
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The Diabetes Care Reports
are designed to inform physicians about the PPHP quality
work, share their results on quality of patient care compared
to their regional peers, solicit their feedback on the
report, and begin the process of quality improvement.
The first reports showing 2007 baseline data were mailed
to about 1,300 physicians in May 2009. Thereafter, the
PPHP will produce reports annually in December. |
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Regional summary reports
and physician-identified results are reported to the PPHP
for analysis and use in identifying opportunities for
targeted care improvement efforts. |
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PPHP will not publicly report
these results from the Diabetes Care Reports. Based on
physician feedback on these reports, the PPHP committees,
along with input from the PPHP Physician Advisory Council,
will evaluate and refine the data collection and aggregation
process. |
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The market place is moving
toward transparency of quality data. The CMS has already
begun reporting hospital quality statistics based on Medicare
data. The PPHP anticipates publicly reporting physician-specific
quality measures at some point in the future, but probably
not before 2011. In the interim the PPHP will implement
a number of programs targeted to the various stakeholder
groups to help improve diabetes care management, including: |
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Patient and consumer
education programs to help improve health care decision
making and compliance with physician instructions; |
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Employer and health
plan forums promoting value-based benefits design; |
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Physician practice
support tools and forums to share best practices. |
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| 16. What
are upcoming steps of this initiative in 2009? |
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Test and adapt metrics and
methods to achieve reliable results. |
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Implement programs targeted
to the various stakeholders to help improve diabetes care
management, including: |
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Patient and consumer
education programs to help improve health care decision
making and compliance with physician instructions; |
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Employer and health
plan forums promoting value-based benefits design; |
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Physician practice
support tools and forums to share best practices. |
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| 17. Who
do I contact if I have further questions or if I did not
receive a DFW Diabetes Care Reports? |
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For additional information,
please explore the other materials available on the
www.dfwbgh.org/partnership website. |
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If you have 20 or more commercially
insured diabetes patients through the five participating
health plans, but did not receive a report, you may click
on Request missing or duplicate
report to request a report. |
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If you have unanswered questions,
please contact us. |
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| 18. I
am interested in participating in future PPHP measurement
and reporting work? How can I get involved? |
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PPHP welcomes your participation.
Please let us know by contacting
us. |
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| Portions of the PPHP
website and materials related to the Diabetes Care Reports were
modeled after those of the California Physician Performance
Initiative of the Pacific Business Group on Health with their
permission. |
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