Patient Attribution
Overview
Attribution is the process of assigning patients to unique providers (e.g., MDs, DOs, NPs, PAs, etc.) and/or unique organizations, as well as identifying the hierarchical relationships among those providers and organizations, for reporting purposes. What results is the ability for users to receive a clear view of healthcare utilization, predicted risks, and quality outcomes for the patients they serve.
Attribution Type
To help meet various reporting use cases and programmatic requirements, HealthInfoNet has implemented three types of attribution methodologies that assign individual patients to providers and/or organizations (“attribution entity”) for reporting purposes. All reporting dashboards leverage these methodologies via the “Attribution Type” filter option, which allows users to differentiate and navigate among the methodologies in order to build and refine their analyses accordingly.
Attribution Type | Description | Example | Refresh Frequency |
|---|---|---|---|
Encounter-Based Attribution | Patient-to-organization attribution defined by HealthInfoNet based on the site where patients' Inpatient, Emergency Department, and Long-Term Care encounters were rendered in the last 365 days. Additional Notes:
| A patient had an Inpatient encounter at Maine Medical Center and was subsequently transitioned to Barron Center where they registered a Long-Term Care encounter in the last 365 days. For reporting purposes, the patient has encounter-based organizational attribution to both Maine Medical Center and Barron Center. | Daily |
Custom Attribution - Participant Supplied | Patient-to-provider and/or patient-to-organization attribution defined by the analytics participant. Additional Notes:
| A participant decides to establish two active custom attributed patient populations: (1) High Risk Patients and (2) MaineCare Primary Care Plus Patients. Whereas the High Risk Patients file includes patient-to-provider-to-organization attribution, the MaineCare Primary Care Plus Patients file only includes patient-to-organization attribution. Users can select the desired patient population for reporting purposes using the reporting dashboards' Attribution Type filter option. | Participant-Dependent |
Custom Attribution - MaineCare Accountable Communities1 | Patient-to-organization attribution defined by MaineCare based on each Accountable Community (AC) service location roster. Additional Notes:
| A MaineCare member is reported in MaineCare’s custom attribution file as being a patient of Eastport Health Center’s Machias site. For reporting purposes, the member has custom organizational attribution to Eastport Health Center - Machias. Users at MaineCare, CCPM, Eastport Health Center, and Eastport Health Center - Machias will receive access to the Eastport Health Center - Machias attributed MaineCare patient population, as they are each considered the “parent” to this “child” site. | Twice Annually |
Additional Notes:
In addition to MaineCare’s daily member eligibility file, the office separately supplies a twice annually custom attribution file. Whereas the daily member eligibility file identifies active, eligible MaineCare members as of the day of reporting and is used to inform the special “MaineCare Eligible” filter options (for more information, see the MaineCare Eligibility section), the custom attribution file identifies MaineCare members specifically belonging to an Accountable Community service location.
Attribution Level & Entity
After selecting the attribution methodology of interest to apply to reporting via the “Attribution Type” filter option, the next step is to identify the specific providers and/or organizations, per the “Attribution Entity” filter option, by which patients should be reported. To narrow the search of entities, HealthInfoNet has categorized all attribution entities within a hierarchical system that defines the child/parent relationships among them. Selecting the “Attribution Level” filter option will identify the specific levels within that hierarchy to assist in further narrowing the options in the “Attribution Entity” filter option.
Attribution Level | Description | Attribution Entity Example |
|---|---|---|
Provider | An individual provider (e.g., MDs, DOs, NPs, PAs, etc.) to which patients may be attributed for reporting purposes. Providers are uniquely identified by their National Provider Identifier (NPI) value, which must be found in the latest version of the National Plan Provider Enumeration System (NPPES) registry. | Dr. Juan Perez |
Site | A specific location and/or department belonging to a healthcare facility to which individual providers and/or patients may be attributed for reporting purposes. | Maine Medical Partners - South Portland - Pediatrics |
Facility | A healthcare facility potentially encompassing many locations and/or departments to which individual providers and/or patients may be attributed for reporting purposes. | Maine Medical Partners |
Group | A broader medical group, health system, integrated delivery network, etc. institution potentially encompassing many healthcare facilities. | MaineHealth |
Program | A value-based program, such as an Accountable Care Organization, in which distinct healthcare groups and/or facilities are participating. | MaineHealth ACO |
Interaction with User Permissions
When users select the “Attribution Level” filter option, they may not see all of the options identified above. Instead, the type and amount of levels available to each user will correspond to their specific role-based permissions per their defined Associated Organization determination. For more information on how Associated Organization, Attribution Level, and Attribution Entity relate to one another to inform reporting access and capabilities, view the section on User Permissions.