By Ivy Xiwen Deng

Signed into law in March of 2010, the Affordable Care Act directed the release of Medicare data to the private and public sectors for performance measurement.

Until today, we haven’t had a trusted or transparent measure of costs or outcomes for the healthcare delivery system at the physician level. Most of today’s existing methodologies leverage either proprietary datasets or proprietary algorithms, or both, to measure cost and outcomes. Moreover, their output is fraught with low reliability and frequent misclassification.

In Atul Gawande’s 2009 article, The Cost Conundrum, he compares the variation in care delivery in McAllen, Texas, relative to El Paso, Texas. The two regions are similar in ethnicity breakdown, size of the population, and statistics on population health indicators, whereas the costs of care vary greatly from different practice patterns. Throughout the comparison, Atul Gawande called for greater transparency around clinical variation and an understanding of how providers could reduce it.

Toward that mission, CareJourney has developed a universal provider rating system – the CareJourney Index – built on “innovator” access to the fully identifiable Medicare Fee-For-Service claims dataset. CareJourney deems the cost of care a logical starting point for provider evaluation, as costs are best addressed with claims data, which is standardized and available nationally for multiple years at the patient-level.

The CareJourney Index has four fundamental pillars.

  1. The CareJourney Index is built on longitudinal patient analysis using an open, validated episode grouping logic. CareJourney has access to over ten years of Medicare Fee-for-Service (FFS) data, which contain over 10 billion claims of 80 million beneficiaries. The longitudinal dataset presents us with the complete insight of the full patient journey, which allows for expanding the scope of responsibility for providers from procedures they render to the episodes they manage.
  2. The CareJourney Index uses risk adjustment measures to remove patient complexity and demographics that are outside of the physician’s control. As provider ratings at physician group or health system level often obscure significant variations among individual physicians, CareJourney normalizes patient complexity on over a hundred variables, such as age, gender, comorbidities, and socioeconomic status. Hence, the CareJourney Index can provide an evaluation of physician performance based on factors that under their control.
  3. Providers are benchmarked within their Core-based-statistical-areas (CBSAs) to account for geographic variations. Depending on practice patterns and provider diversity, the cost of care can differ significantly by region. The CareJourney Index ranks providers within each CBSA and specialty separately based on average observed/expected (O/E) across episodes.
  4. The CareJourney Index offers episodic details that help providers to focus effort on high-cost areas. By breaking down the score of individual doctors, the CareJourney Index allows stakeholders to identify the provider’s observed cost for a specific episode type against the expected cost based on a risk-adjusted benchmark. The CareJourney Index aims to provide physician performance rating in a granular and transparent manner, and present healthcare professionals guidance on room for improvement.

CareJourney is excited to update and improve the algorithm as we receive new data and member feedback, and new, collaborative methods for bundling, risk adjustment, and attribution are developed. Future iterations will also suggest relevant care models the provider can institute to improve outcomes or costs for the patient panel or targeted patient segments.

If you are a member and would like to contribute to refining our algorithms through a collaborative process, please contact your Member Services representative.

Want to learn more about the CareJourney Index? You can access the presentation deck and recording by filling the form on the right!

CareJourney Index Webinar Recap