Comparing cost and quality between Primary Care Providers

Flagship Program: Intelligent decision support to improve value and efficiency

Project Description

There is significant variation in the practice patterns of Primary Care Providers (PCPs) in the US (across the nation, states, regions and local communities). This variation results in significant differences in cost and quality of care between different PCPs (both individual practitioners and groups). Due to data set limitations and limits in the patient panel size for any one payer it can be difficult to develop benchmarks for cost and quality indicators that allow comparisons to be made between individuals and groups in a defined geographic area or payer network. These limitations make it difficult for payers to prioritise care of their patients to PCPs who optimise cost and quality. This project will use claims data to develop benchmarks and an analytical model that allows comparisons of the practice patterns within PCPs to be made.

Project Objectives

This project aims to analyse and develop benchmarks for basic characteristics of PCP practice patterns. These benchmarks would allow payers to evaluate cost effectiveness and quality among providers in their network and compare this to local, regional and national benchmarks. Basic measures would include referral rates, patterns of treatment, cost of care, utilisation rates and quality measures among other indicators. An analytical model will be developed for running comparisons of individual or group PCP practices against the benchmarks.

Industry Participant

Donna Price, Vice President

Research Participant

The University of Sydney
Junlin Lin (Masters student)
Dr Hanieh Poostchi Mohammadabad (Academic mentor)
Dr Audrey P Wang (Supervisor)

Project Value: