Practice Pattern Variation Analysis (PPVA)

What We Did:

MHQP brought together providers and payers from across Massachusetts to collectively identify, evaluate and take action on variations in practice patterns related to how specialty providers treat patients for similar conditions. Practice pattern variation analysis (PPVA) is an approach to understand unexplained and sometimes unwarranted provider variation in care that may negatively impact quality and cost.

MHQP worked with Focused Medical Analytics (FMA) to generate the first test cycle of its multi-payer analysis using three years of statewide data from the Massachusetts All Payer Claims Database. With these data, we identified overall costs for 25 of the most resource intense specialties in Massachusetts, including details about key cost drivers (e.g., surgical, imaging, pharmacy costs), specific procedures and services that contributed to the costs.

Through an iterative process involving physicians from over 14 specialties, the PPVA program then produced a detailed analysis of individual physician use of specific procedures and services, which identified variation in utilization volume among providers and potential for cost savings. MHQP, FMA and the physicians engaged in the first cycle of this powerful analysis selected three initial high priority procedures to focus on in Fall 2014.

MHQP and FMA completed a first round of statewide Practice Pattern Variation Analysis for 40 conditions to identify drivers of variation and low-value, high cost care.  Guided by review of our initial analysis in 2014, the PPVA program focused on three treatments/conditions—back joint degeneration/back surgery, ischemic heart disease/catheterization, and ultrasound beyond the first trimester—in an effort to establish best practices for care and to reduce variations in care.

Who Was Involved:

This was a collaborative project funded by Massachusetts health plans and involving physicians from over 14 specialty practices across the state. MHQP convened a multi-specialty PPVA stakeholder group of physicians and health plan leaders and facilitated a collaborative process for input and participation from these and other stakeholders. This group provided ongoing guidance and promoted the engagement of the broader healthcare community in the work.

Why This Work Matters:

Many areas of clinical care use widely accepted standards for practice or use developing community standards for care based on emerging evidence. However, significant variations from these standards and across practices still occur, despite the impact on health outcomes and expenses. The goal of this project was to deepen clinicians’ and other stakeholders’ understanding of unexplained practice variation to enable the Massachusetts medical community to work together to determine actions and interventions that result in appropriate, quality care for patients while addressing costs and resource use.

Studies on variation in physician practice show that unexplained variation in medical and surgical practices cause over- and under-utilization of services, higher resource use and costs, and lower quality associated with unnecessary or inappropriate care. An Institute of Medicine study of Medicare services suggests that over 30 percent of the variance in costs of patient care could be attributed to unexplained or possibly unwarranted variation in the use of specific health care services, such as prescribing, surgical procedures, and imaging orders. Through practice pattern variation analysis (PPVA), we can identify significant differences in how individual physicians treat similar conditions, seek understanding of the causes of the variation, determine whether the variation is clinically warranted, and consider how consistently implemented community standards would impact quality and cost. Clinician involvement is key – since behavioral change is more likely when those most impacted are involved in the process of investigating potential changes.

MHQP believes there is great power and potential benefit in continued evaluation of opportunities to reduce unwarranted variation in clinical practice.  We would welcome opportunities to deploy our expertise and methodologies further.

Related Resources:

• The output from this work is summarized in this PPVA Project Briefing.
• Read Spotlight: Practice Pattern Variation Analysis – Focus on the Use of Ultrasounds