Data FAQ Flashcards
How does Garner come up with their metrics?
Metrics based on:
-latest medical literature (peer-reviewed journals, society guidelines)
-input from Garner’s clinical advisory board to understand evidence-based care for a given speciality
What factors go into Garner’s recommendations?
i500DAP
-in-network doctors
-500+ cost and quality metrics
-distance from member
-availability
-patient reviews
How does distant go into Garner’s rankings?
-Determine, “Reasonable distance” looks at:
1. Volume of speciality (high-volume dermatology vs. low-volume spine surgeon)
2. Type of region (urban, suburban, rural)
How heavily does Garner weight patient reviews in our rankings?
-Lit shows patient reviews have some bearing on outcomes
-Patients reporting positive experience more likely to adhere to treatment
-Included in our recommendations, but weighed less than quality metrics since reviews are subjective
How do we risk-adjust?
Garner’s method was designed to remove the impact of things outside of a physicians control
We do this in a few key ways:
-First, Garner’s metrics measure how often doctors adhere to evidence-based protocols during an episode of care
-Benefits:
-it isolates doctor performance signficantly better
-requires much less data than traditional methods
-Second is, we’re using data exclusions in our analysis
-To simply take out those complex and outlier cases and look at healthy patients apples to apples
-Finally, if a metric still has potential bias not caught from the two methodologies mentioned
-We created an internal risk adjustment methodology based on methods frequently used by CMS
-For things like: age, gender, comorbidities
How is Garner staying up with latest research and best practices?
-We re-examine metrics when new literature comes out
-Ex: Every week, we scan newly published articles in top medical journals and make updates as needed
How frequently does Garner update its data?
-On a monthly basis
Has Garner’s data and metrics been validated by an independent third-party?
-We get input from our Clinical Advisory Board
-Haven’t done a formal review yet with a third-party like Milliman
How does Garner rank doctors in areas where we don’t have as much data?
-We have enough data to rank Dr’s everywhere in country
-Our bottoms-up approach to performance measurement doesn’t require large amounts of data, like the traditional episode grouper approach, for us to feel confident in a doctor’s performance
Extra:
-Confidence varies depending on how much data we have (we account for this through our stat methods)
What if doctors have admitting privileges to multiple hospitals that vary in cost? Is Garner taking that into consideration?
-Use a utilization-weighted average for FFS
-If Dr. performs procedures at two hospitals, we’ll take the cost of those hospitals, and how often they use them
-Comes up with the average
How is Garner’s approach different from carriers? Are they doing the same thing?
Garner evaluates at physician level, whereas carriers tend to focus on the facility as a whole
-We’ve seen significant variations in care DBD, even within best know hospital systems and physician groups
-hence the importance of focusing on the individual provider
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(Claims Analysis)
-We go claim-by-claim and construct bottoms-up metrics
-The traditional method (episode groupers) is top-down: tries to estimate the avg. cost of care for a Dr’s patient
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Issue here, the Grouper approach requires:
-a lot of data
-dependent on proper risk adjustment
-gives you a black box output that’s hard for patients to understand
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-Garner analyzes all decisions made by a doctor to determine cost and quality
-Ex: care appropriateness, prescribing patterns, site-of-service, & patient outcomes
Where does Garner’s review data come from?
-We aggregate review from variety of sources
-includes carriers, aggregator websites and our own members’ experiences
Where does Garner’s claims data come from?
-We acquire claims data from a number of sources, including:
1. Third-party partnerships
2. aggregation of clearinghouses
3. All-payer claims databases
4. Insurance companies
How long does it take to get enough data on a new doctor?
-For baseline, standard approaches require 4-5 year of sample size
-Garner’s bottoms-up approach takes way less time
Typically have good view of Dr. performance:
-80% accurate at 9 months
-Full view within 18 months
-Variation based on volume of speciality
New doctor data accuracy further explained
For docs we have no data on, we start with a conservative default, assume they’re worse than the average in clinical metrics
-and will adjust as data comes in
How quickly that changes depends on metric and behavior in question
-14 days: FFS rates, SoS preferences, referral locations for imaging (those elements don’t change frequently)
-1-2 months: Basic practice patterns - use of generic drugs, ordering right patient screenings
-12-18 months: surgical complication
