The Opportunity

Attribution is the methodology used to assign patients, and their healthcare outcomes, to organizations or providers. The identification of accountable entities is used by payers, providers and other measure users, to determine how payment is distributed and, ultimately, who is responsible for improving care delivery, patient outcomes and reducing cost.

In December 2016, NQF published a report laying out a series of principles and recommendations for attribution. A key component of that report was the Attribution Model Selection Guide (PDF). The Guide aims to offer direction on the key components of and considerations for building an attribution model. This work seeks to build NQF’s prior work to explore unresolved challenges to attribution. This project will also work to increase uptake of the Guide among measure developers and payment programs, while recommending changes to the measure endorsement and selections processes so they fairly consider attribution models as part of their work.

Objectives

Under a contract with the Centers for Medicare and Medicaid Services, NQF will publish a white paper describing key attribution challenges, and offering recommendations for a path forward to resolving those challenges. Key issues include:

• current approaches and best practices for testing attribution models;
• unintended consequences of attribution;
• the challenges that data integrity and collection pose to developing attribution models;
• approaches to attributing care in team-based care delivery models;
• challenges in attributing complex patients and those in special populations and settings;
• the evaluation of attribution models as part of the endorsement and selection processes; and,
• recommendations for improving the Attribution Selection Guide, its dissemination, and use.

NQF Process

1. Convene a multistakeholder advisory group to guide and provide input on the direction of the white paper, as well as engage NQF members and public stakeholders at key points throughout the project;
2. Review relevant evidence related to attribution and interview key informants to gather qualitative data on implementing and testing attribution models;
3. Develop a written report that summarizes the evidence review, qualitative interviews, and recommendations; and
4. Develop a blueprint for further development of the Attribution Selection Guide into a user–friendly tool.

Funding

This project is funded by the Department of Health and Human Services.

For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.

Related NQF Work

• Attribution: Principles and Approaches
• Attribution Model Selection Guide (PDF)

Contact Information

For more information, contact the project team at 202-783-1300 or attribution@qualityforum.org.