Choose a topic or population that is important to payers. For example, you may want to pick the highest cost patients as a starting population to measure and analyze. A starting topic also might be one of six priority areas for Value Based Pay for Performance in California: prevention, cardiovascular, diabetes, maternity, musculoskeletal, and respiratory conditions. Or, there are indicators for asthma, behavioral healthcare, cancer screening, chlamydia screening, diabetes care, heart care, and maternity care that are publicly reported in California, by health plan and medical group.
Aligning with payer priorities may also open doors to payers sharing data with you to advance their priorities. For example, payers may be able to analyze claims, emergency department, inpatient utilization, and pharmacy data to help you identify and target the highest cost patients.
Or, payers may be calculating avoidable emergency department utilization among patients with chronic conditions. These data can anchor your measurement approach (discussed in Step 3). Getting data from payers can be challenging—don’t let that deter you. Start now to build mutually beneficial relationships with key contacts at health plans.
In this video, Dr. Boutwell talks about selecting a topic or population to measure by identifying payer incentives, such as avoidable emergency department use or avoidable readmissions.