Fragmented Care Index Overview Fragmented Care Index measure

Fragmented Care Index – Overview • Fragmented Care Index measure selected by Maine SIM Steering Committee as SIM Core Measure in May 2014 • Lewin directed to Liu 2010 (Care Fragmentation and Emergency Department Use Among Complex Patients With Diabetes, Am J Managed Care 2010 16(6) 413 -420) • Intent is to measure dispersion in the management of patient care • Liu 2010 shows a 0. 1 increase in the FCI was associated with 15% more ED visits lewin. com | 0

Fragmented Care Index – Issues to Address • Definition in Liu 2010 is vague compared to most measure specifications (HEDIS, NQF, CMS, etc. ) • Distribution of FCI is bi-modal which is difficult to summarize • Maine. Care data does not readily identify clinics • FCI is mostly 0 for commercial members lewin. com | 1

Fragmented Care Index – Definition • FCI = lewin. com | 2

Fragmented Care Index – Definition • Lewin worked with Muskie and OCQI to align FCI definition with work done for Multiple Chronic Conditions Project. • The following modifications were made, – Agreed to common primary care definition and limited calculation to primary care only. – No age filter – No arbitrary cut point (e. g. > 75 th percentile); just reported median. – Results computed at servicing provider level, not necessarily clinic or practice lewin. com | 3

Recap of findings from ME SIM First Annual Evaluation Report Core Metric Fragmentation of Care Index Stage A Control Desired Outcome 0. 0% +6. 8% Decrease lewin. com | 4