August 9, 2004 – Walnut Creek
Contact: Leslie Rose
(415) 332-0362
leslierose@sbcglobal.net
FOR IMMEDIATE RELEASE
Represents 1.5
million Quality of Care Opportunities with 45,000 Doctors
Integrated HealthCare
Association today provided 215 California medical groups with information on
their performance and that of their peer groups in the areas of: clinical
quality, patient experience and investment in technology to support patient
care. The data are part of the statewide Pay for Performance (P4P) initiative
that not only evaluates medical group performance to help promote improvement,
but also rewards the top performing groups with financial incentives. The
information released today will be made available to consumers in an easy to use
format this fall.
The IHA P4P program is the
country’s largest physician incentive program based on quality of care with
participation by six California health plans (Aetna, Blue Cross, Blue Shield,
Cigna, HealthNet and PacifiCare) with nearly 7 million commercial enrollees and
45,000 doctors. The program promotes a common set of measures that evaluate
clinical quality of care for preventive services - such as breast cancer
screening - plus treatment of chronic conditions such as diabetes and asthma.
Patient experience is evaluated by asking patients who saw their doctors during
the year for their views on factors such communication with their doctor and
access to specialists. Finally,
medical groups were rated on their investment and adoption of new information
technology (IT) to support patient care. These include building patient
registries for those with chronic illnesses and using physician or patient
reminder systems at the point of care.
“This
program marks a remarkable collaboration with the provider community and
represents years of work by major stakeholders,” observed Bruce Bodaken,
President and CEO of Blue Shield of California. “Through IHA, California
health plans have come together with the medical groups to evaluate performance
on a common measurement set that is relevant to all consumers. It is already
making a difference.”
Today, California medical
groups will receive data that shows their individual performance over all their
patients in all the health plans they contract with and that participate in P4P.
They will also receive a summary of the performance of the other groups – the
number of the groups reporting for each measurement area; the average score for
those areas and the range of scores for groups. The information is collected
from health plans and medical groups and all data have been audited. 215 groups
were evaluated on clinical performance; 133 on patient experience and 100 groups
were rated on investment in IT, based on eligibility criteria.
The data collected and
evaluated for these eligible medical groups represent more than 1.5 million “quality of care opportunities” –
that is, the number of people in 2003 who should have received specific
preventive and chronic care (as determined by generally accepted practice
guidelines) and whether they did.
The
National Committee for Quality Assurance (NCQA), a non-profit dedicated to
improving health care quality, collected and analyzed data from the 215
participating groups. “The scope of this effort and the number of health
plans, medical groups, doctors and patients that the P4P effort will affect is
truly significant,” said NCQA President Margaret O’Kane. “It’s more than
a pilot project – it’s a shift in the way California’s health care sector
does business and it will mean that millions of Californians get better care.
This is a model for the rest of the nation.”
“Publicly
reporting P4P information this fall represents the first time comprehensive
clinical information on medical groups will be available to California
consumers,” according to IHA Executive director Tom Williams. In October,
health plans will make bonus payments to qualified medical groups based on their
performance in 2003. Each participating health plan determines its own
methodology for determining bonus payments to medical groups using the common
P4P measurement set. In some cases, they may also use additional criteria in
determining payment. Total bonuses are expected to be in the $50 million to $100
million range for the first year.
“For
years we’ve had competing and conflicting requirements and rating systems,”
according to Steve McDermott, CEO of Hill Physicians Medical Group. “P4P gives
us common comparative information to evaluate and reward the best care and
service. It’s great for doctors and their patients.”
The
IHA P4P program is part of the national RWJ Rewarding Results program. Funding
for the IHA initiative is provided by the California Health Care Foundation (CHCF).
IHA
(www.iha.org) is a statewide
collaborative leadership group of California health plans, physician groups, and
health care systems, plus academic, consumer, purchaser, pharmaceutical and new
technology representatives. IHA promotes quality improvement, accountability,
and affordability for the benefit of all California consumers through special
projects, policy innovation and education.