We are a statewide leadership group of California health plans, physician groups, and health care systems, plus academic, consumer, purchaser, and pharmaceutical representatives. IHA is committed to policy development, special projects, and public dialogue on health care policy and the evolution of managed care. IHA is funded through member dues and grants.
This statewide collaboration is designed to create the business case for quality at the physician group level. The goal is to reward physician groups for performance in clinical care and patient experience by providing a clear set of health plan expectations, use of common metrics, and public reporting.
Six participating health
plans (representing more than 8 million enrollees) have agreed to participate:
Aetna, Blue Cross of California, Blue Shield of California, CIGNA HealthCare of
California, Health Net and PacifiCare. Each
plan will use the results on the common performance measures while still
designing its own physician group bonus program.
The initiative applies only to commercial enrollees and does not include Medicare. IHA is managing a separate program of rewards for providers serving Medi-Cal and Healthy Families children in conjunction with the eight Local Initiative managed care plans.
IHA estimates that up to $100 million or more could be paid out to physician groups in the first year based on the performance results. A single scorecard that incorporates patient satisfaction and clinical measures will be developed for each physician group and will be made public. Longer term we expect to expand the measures and increase the funding.
Over the past two years, health plan and physician group medical directors, researchers, and other industry experts worked collaboratively to develop a common set of measures. The goal was to select a limited, core set of measures that fairly reflect what physicians groups do for their commercial HMO patients. The measures themselves needed to be valid, understandable, and economical to collect.
Draft measures were sent to all California delegated physician groups for review and comment in July 2002. They were also presented to physician groups for discussion at an open IHA meeting held on October 16, 2002. The final measurement set has now been approved.
The performance measures selected represent a balance of three key areas: clinical quality, patient satisfaction and investment in information technology.
· Clinical
measures account for 50% of the total physician group score. They
measure performance in the management of three chronic conditions: asthma,
diabetes, and coronary artery disease. They also include three preventive health
measures: childhood immunizations, breast cancer screening, and cervical cancer
screening.
·
Patient
satisfaction
performance
accounts for 40% of the total score. Overall
performance is based on individual patient satisfaction in four areas, equally
weighted: communication with the doctor, specialty care received, timely care
and service, and an overall rating of care.
· IT investment accounts for the final 10% of the score. This measure evaluates a physician group’s investment in information technology (IT) to support clinical quality through the ability to integrate data at the group level or to provide physicians with data to support clinical decision-making at the point of care.
Health plans may still collect
data on additional measures, but the common core set will clearly focus
physician group attention.
Health plans will be the primary source of the audited, administrative data. Physician groups may also send audited clinical data. The statewide vendor managing the Consumer Assessment Survey (CAS) process will provide the patient satisfaction data. Physician groups will supply the information on meeting the IT measures. No patient medical charts will be pulled.
Measurement under P4P begins in calendar year 2003. The first health plan payments will be made in mid-2004 based on 2003 performance results.
What’s Next? Scoring and Scorecard
Each year the performance results will be presented in a consolidated scorecard that will be made public and widely disseminated. The first of these will be available in 2004. Each physician group will be compared to one another as well as to statewide averages. Other scorecard principles approved by the Steering Committee include: making it consumer-friendly, no raw scores will be used, adequate encounter data will be required, all groups will be reported, the third-party vendor will use scientifically valid methodology and non-English versions will be available.
Key scorecard decisions still to be made: specific thresholds for data (per month/per year) and the consequences of inadequate data, thresholds for scoring, iconography and funding. The goal in determining the encounter data threshold is to assure that all groups can participate while making sure there is sufficient data to be credible.
IHA and the Office of Patient Advocate (OPA) will develop a joint work program for the scorecard utilizing the technical expertise of the IHA P4P initiative and OPA consumer expertise and outreach capability. OPA will serve as a liaison member of the Steering and Technical Committees, as CMS currently does.
Developing the actual scoring methodology and the visual design of the public scorecard are the next big steps for P4P. An independent firm will be selected through a competitive process to receive the audited data and generate scores for the performance scorecard. The RFP for the data aggregator vendor will be released in February and a vendor selected in June. A separate vendor will be chosen to design the scorecard.
ASSISTANCE FOR PARTICIPANTS
Several activities are planned to help P4P participants in preparation for the first year:
A field - test on the IT measure will be held in April. Health plans and physician group participants can apply to participate to test and improve their performance in data reporting. Funding has been secured, so there is no cost to participants. (please see the letter in this packet for how to apply)
Clinical workshops will be held in March and April to provide technical assistance to physician groups for three of the diseases included in the performance measurement set.
An all-stakeholder conference will be held in September.
In recognition of this unprecedented collaboration among California stakeholders, and its potential as a model, IHA received a grant under the national Rewarding Results program to help support the P4P process and evaluation. IHA’s funding comes from the California HealthCare Foundation. A team from RAND and UC Berkeley will evaluate the initiative.
Want more information?
This new P4P e-letter will be published bi-monthly. To subscribe please visit
www.P4Pinfo.org.
The web site will include updated P4P information
at www.iha.org.