Understand member attribution and assignment

Attribution or assignment to a provider entity, practice or clinician participating in a VBP model is fundamental to the measurement of the provider’s quality and financial performance in the model. Patient attribution designates the population for whom a provider entity accepts accountability under the VBP model and forms the basis for performance measurement, reporting and payment.

For example, patient attribution methodologies are needed in population-based payment models where one provider entity or system of providers is responsible for the care for an entire population of individuals, and in some supplemental payment models where providers are paid a per-member per month payment for certain activities, like in many patient-centered medical home programs. Attribution is also salient for specialty VBP models too, such as maternity episodes of care. Even pay-for-performance (P4P) bonus programs require a level of patient/member attribution in order to assess the percentage of eligible individuals who have received the appropriate preventive and primary care services that are targeted by the P4P approach.

Lack of clarity and variation of attribution methodologies is a challenge for clinicians, provider practices and payers. The Primary Care Payment Reform Collaborative (PCPRC) in partnership with the former Oregon CPC+ Payer Group, developed principles for patient attribution to ensure more effective VBP-based investment in primary care. The intent of the principles is to foster alignment and transparency on methodology, and to ensure outcome metrics associated with VBPs accurately reflect a clinic’s patient population.

Transparency and consistency across attribution approaches can improve cost and quality benchmarking, increase understanding across the health system, build trust between practices and payers, enhance the ability of practices to focus their efforts and better engage patients, and maximize the benefits of data aggregation.

To be successful in VBP, provider entities will:

  • Understand patient assignments (across all payers), and specifically, those assignments that have not led to an established treatment relationship, and the patients seen by the provider entity that are not currently attributed or assigned to the provider entity.
  • Work closely with payers to access and maintain an accurate, up-to-date list of attributed or assigned enrollees and associated providers on a monthly basis.
  • Ask for payer support to identify attributed or assigned enrollees and to regularly access performance metrics and current status for attributed enrollees.
  • Develop and implement a plan for patient, family, and caregiver education and engagement in the changes and opportunities under VBP.

Payers tips for attributing patients to provider entities in VBP models, payers should

  • Have policies and processes to encourage patient choice of primary care clinicians.
  • Educate providers on how to access, utilize, and share data on attributed enrollees.
  • Have a process by which a provider may dispute the payer’s attribution of an individual enrollee in relation to a VBP arrangement, inform providers of its dispute process and promptly respond to and address provider complaints related to individual enrollee attribution/assignment.
  • Consider altering attribution and related primary care assignment when an enrollee is regularly seeing a different provider for primary care services than the primary care clinician to which the enrollee has been attributed and if an enrollee has not seen the attributed clinician in a defined period, such as the past twelve (12) months.
  • Have clear methods for adjusting its assignment and VBP attribution methodologies based on data analysis.
  • Seek to align their assignment and VBP attribution policies and methodologies to create more consistency across payers and less confusion for providers.