全球智库信息集成服务系统

• States varied in their approaches to collecting non-FFS payment data. Some states (Vermont and Rhode Island) collected high-level total non-FFS payment data from each payer, and others (Oregon, Colorado, and Massachusetts) collected disaggregated payments at the level of the provider group.
• Discussion with the expert panel revealed varied viewpoints around how to categorize different types of non-FFS payments (e.g., capitation payments, alternative payment model [APM] payments) and how to identify the full range of potential primary care payments. For some use cases, cumulative non-FFS payments from each payer might be sufficient; for others, provider- or patient-level data might be needed.
• States or other entities might have an interest in assessing use cases, such as measurement of APM payments; enabling complete spending estimates for specific health care services; and assessment of the relationship between non-FFS payments to providers and their performance on measures of cost, access, low-value care, and clinical quality for different units of analysis.
• Developing a standard approach that can be used across states will improve the comparability of estimates of total spending for primary care and non-FFS spending across states and among payers and ease the burden placed on payers who operate in multiple states because they can apply the same methods in all states to aggregate and report data. However, compiling and reporting these data could be time-consuming and burdensome for payers, as payers' current processes and systems to administer and track non-FFS payment vary widely.

Primary care spending as a percentage of total health care spending is a relatively new measure that allows end users to assess the degree to which a health system is oriented toward primary care delivery. The Milbank Memorial Fund recently supported research to develop a methodology to calculate primary care spending as a percentage of total health care spending by commercial health plans and to adapt this methodology for use in examining primary care spending in fee-for-service (FFS) Medicare. However, there is concern that calculation of primary care spending and total health care spending using FFS payment data alone underestimates both primary care spending and total health care spending by excluding non-FFS payments. Several states and other multistakeholder entities have begun to collect non-FFS spending data from insurers in their states to measure primary care spending or total health care spending and changes over time.

The authors interviewed states and other multistakeholder entities, as well as payers, about their current capture of non-FFS payment data as an initial effort to inform a clearer discussion of how to develop standardized methods to collect and report these data. Based on the interviews and discussion of findings with a technical expert panel, the researchers summarize current practice and offer preliminary recommendations about considerations to inform future efforts to develop a standardized methodology for collecting non-FFS payment data. The goal is to support more-complete measurement of primary care spending and total health care spending.

• Chapter One

  Background

• Chapter Two

  Methods

• Chapter Three

  Findings

• Chapter Four

  Conclusions