Uses and Limitations of Claims-Based Performance Feedback Reports: Lessons from the Comprehensive Primary Care Initiative

Publisher: Journal for Healthcare Quality (online ahead of print, subscription required)
Aug 22, 2017
Margaret Gerteis, Deborah Peikes, Arkadipta Ghosh, Lori Timmins, Ann S. O'Malley, Michael Barna, Erin F. Taylor, Timothy J. Day, Kaylyn Swankoski, Perry W. Payne, Jr., and Randall Brown

Background. Performance feedback is central to data-driven models of quality improvement, but the use of claims-based data for feedback has received little attention.

Purpose. To examine the challenges, uses, and limitations of quarterly Medicare claims-based performance feedback reports generated for practices participating in the Comprehensive Primary Care (CPC) initiative from 2012 to 2015.

Methods. Mixed methods study of nearly 500 CPC practices in seven regions, combining pilot testing; systematic monitoring; surveys; in-depth interviews; user feedback; and input from data feedback team.

Results. Designing reports required addressing issues about timing, data completeness and reliability, variations in patient risk across practices, and use of benchmarks and metrics understandable to users. Practices' ability to use reports constructively depended on their experience, analytic resources, expectations, and perceptions about the role of primary care in improving reported outcomes.

Conclusions. Generating claims-based feedback reports that support practices' quality improvement efforts requires a significant investment of analytic expertise, time, resources, continuous improvement, and technical assistance.

Implications. Claims-based performance feedback can provide insight into patterns of patients' care across provider settings and opportunities for improvement, but practices need data from other sources to manage patients in real time or assess the short-term effects of specific changes in care delivery.