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For more information contact:
Integrated Healthcare Association |
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Karen Hunt |
Oakland and Walnut
Creek, CA -- The Integrated
Healthcare Association (IHA), a statewide leadership group active in health
policy and managed care issues, has been awarded two grants totaling $1,232,735
from the California HealthCare Foundation (CHCF) to conduct pilot programs
demonstrating how financial and non-financial incentives can help health care
providers improve quality.
The IHA pilot programs
are part of a national initiative called Rewarding Results, which is
administered by the National Health Care Purchasing Institute. The $4.9 million
grant program, made possible by The Robert Wood Johnson Foundation and CHCF,
with additional support from the Commonwealth Fund, will test ways to implement
recommendations the Institute of Medicine made in its report Crossing the
Quality Chasm. In addition, the federal Agency for Healthcare Research and
Quality has awarded $1.5 million to Boston University researchers to conduct a
comprehensive national evaluation of all six Rewarding Results projects.
“This effort
represents a critical step toward creating a quality-driven health care system
based on measuring, disclosing, and rewarding results,” said Mark D. Smith,
M.D., M.B.A., president and CEO of the California HealthCare Foundation.
“Working closely with their provider communities and using
nationally-recognized measures of quality, these projects will develop and test
a variety of incentives.”
The first pilot is
IHA’s Pay for Performance, a groundbreaking initiative announced in January to
change the way six of the largest HMOs in California evaluate and reward their
contracted physician groups. Under the grant, a common set of performance
measures will be developed for physician groups based on six areas of clinical
performance (weighted at 50 percent), patient satisfaction (40 percent), and
information technology investment (10 percent). The major non-financial
incentive will be a widely disseminated public scorecard in 2004 showing actual
physician group performance.
Financial incentives
will be paid by the six participating health plans directly to their contracted
medical groups based on these performance measures, but consistent with health
plan-specific bonus programs, according to IHA Executive Director Beau Carter.
Participating plans are Aetna, Blue Cross of California, Blue Shield of
California, CIGNA HealthCare of California, Health Net, and PacifiCare, which
together serve some eight million California commercial HMO enrollees.
“Pay for Performance
delivers a long-awaited business case for medical group performance,” said
Steve McDermott, president and CEO of Hill Physicians Medical Group and
2000-2001 chair of the IHA Board of Directors during the development of Pay for
Performance. “If the health plans can sustain significant levels of financial
incentives, we should see major improvement in health care quality and patient
satisfaction in the next three to five years, and a long-term improvement in
overall public health.”
In addition to the
grant, the initiative partners will contribute more than $4 million to support
the pilot project over the next three years, over and above the incentive
payments to medical groups. “Pay for Performance is the latest and by far the
most significant, collaborative California effort among purchasers, health
plans, and providers,” said Thomas Davies, Healthcare Manager for Verizon,
Western United States and chair of the Pay for Performance Steering Committee.
“In addition to the obvious benefits to physician groups, it will give
purchasers better value for their premium dollar, health plans a stronger set of
physician group partners, and consumers a timely, public guide to quality
providers.”
Under
the second pilot project, IHA will work in partnership with the eight Local
Initiative health plans that serve low-income families and children enrolled in
the State’s Medi-Cal (Medicaid) and Healthy Families programs to develop
financial and non-financial incentives for providers who serve the one million
children enrolled in the plans. The rewards will target well-baby visits,
well-adolescent visits, identification and management of childhood obesity, and
timely submission of electronic data.
The partner plans are
the Alameda Alliance for Health, Contra Costa Health Plan, Inland Empire Health
Plan, Kern Health Plan, L.A. Care Health Plan, Health Plan of San Joaquin, San
Francisco Health Plan, and Santa Clara Family Health Plan.
“As public health
plans, we are colleagues, not competitors, but until now we have not had the
ability to participate in a structured quality improvement initiative. We are
eager to get started, totally committed to learning from each other, and excited
about the prospects for significant success,” said Leona Butler, CEO of Santa
Clara Family Health Plan and IHA board member.
In addition to the
grant, IHA has committed $189,886 of its own funds to support the initiative.
“This grant not only provides the opportunity to collaborate on incentives to
improve the quality of care for low income children and adolescents, but also
enables us to break new ground in designing a performance measure and incentive
program dealing with childhood obesity,” said Helen DuPlessis, M.D., M.P.H.,
chief medical officer of L.A. Care Health Plan and IHA Board member.
Rewarding Results
grantees were recommended by an advisory panel of leading health care experts
representing health care professionals, employers, and researchers in a
nationwide competition, which attracted 57 applications.
Organizations involved in the Rewarding Results
initiative:
The Integrated Healthcare Association is a
California leadership group of health plans, physician groups, and health care
systems, plus academic, purchaser, consumer, and pharmaceutical industry
representatives, committed to policy development, public dialogue, and special
projects associated with the continuing evolution of managed health care. For
more information, visit www.iha.org.
The California
HealthCare Foundation, based in Oakland, is an independent philanthropy
committed to improving California’s health care delivery and financing
systems. CHCF’s work focuses on informing health policy decisions, advancing
efficient business practices, improving the quality and efficiency of care
delivery, and promoting informed health care and coverage decisions. For more
information, visit www.chcf.org.
National
Health Care Purchasing Institute, sponsored by The Robert Wood Johnson Foundation,
helps Fortune 500 companies, Medicare, and other health care purchasers learn
and share ways to improve quality. NHCPI’s efforts focus on rewarding
high-quality care and empowering consumers and purchasers through public
disclosure of physician and hospital performance. For more information about
NHCPI and its Rewarding Results program, visit www.nhcpi.net.
The Institute is part of AcademyHealth, a leading nonprofit, nonpartisan health
policy and research organization in Washington, DC (www.academyhealth.org).
The
Robert Wood Johnson Foundation, based in Princeton, NJ, is the nation's largest
philanthropy devoted exclusively to health and health care. It concentrates its
grantmaking in four goal areas: to assure that all Americans have access to
basic health care at reasonable cost; to improve care and support for people
with chronic health conditions; to promote healthy communities and lifestyles;
and to reduce the personal, social and economic harm caused by substance abuse
-- tobacco, alcohol, and illicit drugs. Visit www.rwjf.org.
NHCPI’s
partner, Agency for Healthcare
Research and Quality,
is the lead U.S. Department of Health and Human Services agency charged with
supporting research designed to improve the quality of health care, reduce its
cost, improve patient safety, address medical errors, and broaden access to
essential health services. AHRQ sponsors and conducts research that provides
evidence-based information on health care outcomes, quality, and its cost, use
and access. For more information, visit www.ahrq.org.
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