Patient assignment and quality performance: a misaligned system | JoVE Visualize

Area of Science:

Health Services Research
Health Outcomes Research
Health Policy

Background:

Accurate patient assignment to primary care physicians (PCPs) is crucial for effective healthcare delivery and quality measurement.
Understanding the congruence between assigned and established patients is essential for evaluating healthcare system performance.
The shift towards value-based payments necessitates precise identification of physician-patient relationships.

Purpose of the Study:

To evaluate the alignment between patient assignments and established patient-physician relationships within a large healthcare system.
To determine the association between patient assignment congruence and Healthcare Effectiveness Data and Information Set (HEDIS) quality performance.
To identify the extent of true-positive, false-positive, true-negative, and false-negative classifications in patient assignment.

Main Methods:

Retrospective cross-sectional analysis of Medicaid enrollees from January 2020 to February 2022 in Phoenix, Arizona.
Inclusion of 100,030 Medicaid patients assigned to or receiving primary care services from a PCP within a fully integrated healthcare delivery system.
Utilized precision and recall measures to assess congruence and analyzed HEDIS quality metrics as outcome measures.

Main Results:

Only 15% of patients were congruently established and assigned to the same PCP (true-positive).
Overall precision was 21% and recall was 37%, indicating significant incongruence in patient assignments.
Established patients demonstrated significantly higher HEDIS quality performance for 5 out of 6 metrics compared to non-established patients.

Conclusions:

A substantial majority of assigned patients did not receive care from their designated PCP, impacting care continuity.
Established patient-physician relationships are associated with superior HEDIS quality performance.
The findings underscore the need for improved methodologies to accurately identify physician-patient relationships, especially in the context of value-based care models.