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 four types of attribution methodologies that assign individual patients to patient populations for reporting purposes. All reporting dashboards leverage these methodologies, where available, 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: Persons may be attributed to more than one organization if they have had encounters rendered at more than one site during the lookback period.	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: Participants may choose to establish multiple active custom attribution files to differentiate specific patient populations of interest for reporting purposes. For more information on how participants can create custom attribution files, view the section on Participant-Supplied Custom Attribution.	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: Not all patients included in MaineCare’s AC custom attribution file may be considered active, eligible members per MaineCare’s daily eligibility file; however, the attribution file nonetheless serves as a source of truth of MaineCare members for reporting purposes. Organizations reported in MaineCare’s AC custom attribution file are defined by their HIE-specific organization identifier. Patients (i.e., MaineCare members) are only attributed to one AC member organization at a time. Analytic participants who are included in MaineCare’s AC custom attribution file will receive access to their organization’s attributed MaineCare patient population.	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 (per MaineCare)
Geographic-Based Attribution	Patient-to-zip code, patient-to-county, and patient-to-public health district attribution is available in HARP Population Health at the aggregate level. This type of patient attribution is determined using a patient’s most recent, non-null home address zip code. Note: Maine’s Public Health Districts are defined as follows: York: York County Cumberland: Cumberland County Western: Androscoggin, Franklin, and Oxford Countries Midcoast: Waldo, Lincoln, Knox, and Sagadahoc Counties Central: Somerset and Kennebec Counties Penquis: Penobscot and Piscataquis Counties Downeast: Washington and Hancock Counties Aroostook: Aroostook County The Tribal Health District is not included in HARP Reporting at this time.d in HARP Reporting at this time.	A patient’s most recent, non-null home address, as received from an HIE-participating organization, is Bar Harbor, ME. This patient will be included at the aggregate level in HARP Population Health for zip code 04609, Hancock County, and the Down East (District 7) Public Health District.	Daily

Additional Notes:

In addition to MaineCare’s daily member eligibility file, the office separately supplies a twice annual 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 Member” filter option (for more information, see the MaineCare Eligibility Criteria 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	The provider (e.g., MD, DO, NP, PA, etc.) to which the patient is attributed. 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 (Primary Care Provider)
Site	The location(s) and/or department(s) to which the patient is attributed.	Maine Medical Partners - South Portland - Pediatrics
Facility	The healthcare facility(ies) to which the patient is attributed.	Maine Medical Partners
Group	The medical group or broader healthcare institution(s) to which the patient is attributed.	MaineHealth
Program	A value-based program, such as an Accountable Care Organization, in which distinct healthcare groups and/or facilities are participating.	MaineHealth ACO
Zip Code	A 5-digit sip code representing a geographic region as defined by the US Postal Service	04609
County	A geographic sub-division of a state that includes many zip codes.	Hancock County
Public Health District	A geographic sub-division of a state that may include one or more counties, as determined by the CDC. In Maine, these are defined as: York: York County Cumberland: Cumberland County Western: Androscoggin, Franklin, and Oxford Counties Midcoast: Waldo, Lincoln, Knox, and Sagadahoc Counties Central: Somerset and Kennebec Counties Penquis: Penobscot and Piscataquis Counties Downeast: Washington and Hancock Counties Aroostook: Aroostook County Note: The Tribal Health District is not included in HARP Population Health reporting at this time.	Downeast Public Health District

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 and the design of the HARP module in which they are working. 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.