Understanding Attribution in Value-Based Care
Attribution models determine which patients are assigned to your practice for quality and cost measurement. Understanding how these models work is essential for success in value-based payment arrangements.
Why This Matters
What Is Attribution?
Attribution is the method used by payers and accountable care organizations to assign patients to a specific provider or practice. It determines which patients count toward your quality scores, cost benchmarks, and shared savings calculations.
Attribution is not the same as a patient panel. A patient may consider you their primary care provider, but if the attribution model assigns them elsewhere, their outcomes will not count toward your performance metrics.
Common Attribution Models
Prospective Attribution
Patients are assigned to a provider at the beginning of a performance period based on historical claims data. This gives practices clarity on their attributed population upfront, but it may not reflect changes in patient behavior during the year.
Retrospective Attribution
Patients are assigned at the end of the performance period based on where they actually received the majority of their care. This captures real-world utilization patterns but makes it harder for practices to plan interventions during the year.
Plurality-Based Attribution
The patient is attributed to the provider who delivered the plurality of their primary care services, typically measured by evaluation and management visit claims over a 12 to 24 month lookback period.
Why Attribution Matters
Attribution directly impacts:
- Quality Scores: Only attributed patients count toward your MIPS and commercial quality measures.
- Cost Benchmarks: Your total cost of care is calculated based on attributed patients only.
- Shared Savings: Eligibility for shared savings distributions depends on attributed patient outcomes.
- Care Gap Reporting: Payer-reported care gaps are based on your attributed population.
How PHN Helps
Our managed care team helps member practices understand their attribution reports, identify gaps between expected and actual attribution, and implement strategies to ensure accurate patient assignment. We work directly with payer attribution teams on behalf of our practices.