The Importance of Member Attribution in Value-Based Contracting

Blog Series: The Value of Value-Based Care v1.03 -

Stephanie Graham, Vice President of Payer Innovation, Apervita
Stephanie Graham, Vice President of Payer Innovation, Apervita
Value-based provider payment models offer organizations a powerful tool to reward provider efforts to improve healthcare quality and reduce cost. Population approaches to value-based payment are an important component of these strategies and measure success by how well a provider organization manages care for a population of individuals for a defined period of time. An important element of these models is aligning individuals with a provider contracting entity; a method commonly referred to as provider attribution. This blog offers insights into attribution for value-based contracting, including choosing and implementing an approach that is right for you.

Types of Attribution Approaches

Most population value-based contract models align an individual to a provider entity through their relationship with a primary care provider (PCP) affiliated to that provider entity. This approach requires the attribution of a patient to a PCP for a period of time describing the contract period. Attribution can be based on a member’s own selection of a physician as their PCP; for example, a member choosing a PCP under an HMO benefit plan design. Alternatively, attribution can be based on the observed past relationship between a patient and provider – including their claims experience. It’s important to note that population based value contracts can employ both administrative and activity-based attribution. An example is using administrative attribution for that part of a population enrolled in an HMO product and activity-based attribution for the remainder. In value-based contracts, attribution results are used to hold a physician and a contracting entity accountable for the care, including the cost and quality, of the patients attributed to them.

Approaches to activity-based attribution adopted by healthcare organizations can vary. Federal and state governments have defined common methodologies to support value-based contract models designed for Medicare and Medicaid populations.1 There is less uniformity with commercial payers; methods vary across these organizations, including the elements employed and how they are modified for a contract design. These differences may derive from variations in existing networks and provider relationships, the structure and objectives of the value-based contract or even local market norms.

Goals of Attribution

The best attribution method is often based on your goals for a value-based contract, which will drive the selection of a general approach and inform the elements within that approach. Healthcare organizations can have many goals when selecting methods of attribution:

  • Patient and provider relationships, including a patient’s selection of a PCP
  • Stability of the relationship throughout the contract period
  • Relevant care and service activity
  • Comprehensiveness of the patients attributed to physicians
  • Consistency of methods across your organization’s programs

Common Elements of Attribution

There are several important elements to be considered when designing an activity-based approach to attribution:

  • Patient population
  • Qualified providers
  • Level of a provider organization
  • Relevant scope of services
  • Time period
  • Plurality vs. recency
  • Stability

The element of stability relates to the general strategy used by an organization, including prospective versus retrospective assignment:

  • Prospective assignment relies on past experience to establish attribution at the start of a contract period. That assignment is preserved for the entire contract period.
  • Retrospective assignment assigns final attribution at the end of the contract period using experience gathered during the actual contract period.
  • Hybrid assignment assigns attribution at the start of the contract period and adjusts that assignment during the period to reflect emerging experience. Final attribution is based on the retrospective approach.

There are pros and cons to using prospective versus retrospective attribution. The most important trade-off is a provider group understanding at the start of the period the members for which they are accountable under a contract versus a more dynamic approach that may best reflect the primary care role observed during that period.

 

202012-1-PCP-Diagram-v2

The elements of the attribution method will determine which patients are attributed to which PCPs for the specified period of time.

Selecting the Right Method

Apervita offers its own attribution methods in our Value Optimization solutions. Each of our standard methods are based on industry norms and observed best practices. These methods are configurable for each customer, allowing for variation of the common attribution components. We advise the most appropriate method and decisions for each component, depending on your organization’s attribution goals. Alternatively, Apervita can apply the customer’s preferred approach or that approach described in your contracts.

Want to Learn More?

Contact us to discuss your value-based contracting objectives and appropriate solutions for your attribution needs.


1 Qualifying Alternative Payment Model Participants (QPs) Methodology Fact Sheet

 

Stephanie Graham, Vice President, Payer Innovation, Apervita

Stephanie has deep experience in value-based payment models, healthcare policy, contract negotiations, and healthcare analytics with roles like Director of Network Contracting at BCBSMA and Health Systems Contracting at CVS Health. As Director of Network Contracting at BCBSMA, Stephanie developed the strategy, tactics, and tools for the Provider Contracting team across various hospital, physician, and health system-based contract models. As Vice President of Payer Innovation at Apervita, she serves as a thought leader to inform strategy, working collaboratively with Product to inform the product strategy, roadmap, and design, assisting Customer Operations during product implementations, and supporting Business Development in the sales process. Fun fact: She is a twin.

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