Table 1.

Comparison of the Plurality Provider Algorithm and Diabetes Care Home method in assigning patients to a provider group for diabetes performance measurement.

	Plurality Provider Algorithm (PPA)	Diabetes Care Home (DCH) Method*
Current implementation	Medicare’s Physician Group Practice (PGP) Demonstration	Wisconsin Collaborative for Healthcare Quality (WCHQ), a voluntary statewide consortium of health care organizations engaged in a public reporting initiative
	Medicare’s Group Practice Reporting Option (GPRO) of the Physician Quality Reporting Initiative (PQRI)
	Proposed for use when extending the Medicare PGP Demonstration to Accountable Care Organizations (ACOs)3
Description of methodology	Patient is assigned to the single provider group that accounts for the greatest number of his/her E&M visits in the year. Ties are assigned to the group with more total charges.7	The provider group is responsible for a patient’s diabetes care during the measurement year if s/he had 1) ≥2 diabetes-coded E&M visits with any provider in the group regardless of specialty during the measurement year and prior year, and 2) ≥2 E&M visits (any diagnosis) to a primary care provider (PCP), or at least 1 visit to a PCP and 1 to an endocrinologist within the group over the same period, with at least 1 visit occurring during the measurement year.
Conceptual definition	The group delivering the most outpatient E&M services to a patient is solely responsible for the quality of all types of care the patient receives, including diabetes care.	A group is responsible for a patient’s diabetes care – but not necessarily other types of care – if it delivers diabetes-specific AND primary care services (or a mix of primary and endocrinology care) to the patient on more than 1 occasion.
Comments	Requires complete visit information across all provider groups used; therefore, feasible for use by health plans but not individual provider groups. Also difficult to apply to uninsured patients	Requires visit information only from the provider group in question, making it feasible for use by provider groups to self-monitor performance; allows inclusion of uninsured patients
	Assigns a patient to a single provider group, eliminating ambiguity in determining who is responsible for the patient’s care	Can result in multiple groups simultaneously considering themselves responsible for the same patient’s care, which may better reflect the patient’s reality
	Assignment is not condition-specific	Assignment is specific to measuring diabetes performance; WCHQ has developed similar methods of patient selection for measuring quality of care for other conditions and services

Abbreviations: PGP = Physician Group Practice; E&M = Evaluation and Management; PCP = Primary Care Provider; WCHQ = Wisconsin Collaborative for Healthcare Quality

^*This method is property of WCHQ and is used herein with their permission.