Volume Technical Subgroup
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Volume Technical Subgroup Provides Input to Payment Models Workgroup. Their focus includes:
1. Formal Policy on Out-of-State and Deregulation Volume Adjustments: The subgroup is working towards establishing a formal policy that will allow for routine adjustments that enhance transparency and predictability in the system.
The HSCRC adjusts global budgets to account for anticipated changes in demographics/volume patterns and observed shifts in the market. These adjustments are implemented through the following volume policies:
- Demographic Adjustment: Annual age-adjusted population funding for in-state use rate growth.
- Marketshift: Semi-annual adjustments for regulated market shifts (zero-sum).
- Complexity and Innovation: Prospective funding to Academic Medical Centers for growth in unique quaternary services.
- CDS-A: Funding for changes in volume for select drugs (only volume variable methodology).
- Out-of-State (NEW!): Annual adjustments for material changes to out-of-state volumes.
- Deregulation (NEW!): As needed reductions for observed shifts to unregulated settings.
The workgroup's evaluation of methodologies for adjustments related to out-of-state and deregulated volumes includes considerations such as:
- Data sources and granularity of analysis.
- Materiality thresholds.
- Time periods for assessment and potential one-time adjustments.
- Implementation schedule.
- Interaction with other policies (e.g., EQIP, total volume policies).
2. Comprehensive Volume Scorecard: The workgroup will advise on the development of a comprehensive volume scorecard that accounts for all volume policies. The current scorecard assesses only Marketshift and Demographic Adjustment funding for growth in in-state volumes (excluding PAU, high-cost drugs, innovation, and chronic cases). The future scorecard will incorporate adjustments for out-of-state volumes, deregulation, and PAU, as well as adjustments related to Efficiency policies, but will not include CDS-A and Complexity and Innovation, as those policies are standalone.
Subgroup Meeting Schedule:
