IHA Overview and Principal Projects
Who is IHA?
The Integrated Healthcare Association (IHA) is a nonprofit multi-stakeholder leadership group that promotes health care quality improvement, accountability and affordability in California. IHA convenes and collaborates with diverse healthcare stakeholders on a variety of critical health care issues, administers regional and statewide programs, and serves as an incubator for pilot programs and demonstration projects.
Principal projects include the California Pay for Performance (P4P) program, measurement and reward of efficiency in health care, value-based purchasing of medical devices, health care affordability, bundled episode of care payments, administrative simplification, Accountable Care Organization (ACO) models, and prevention programs directed at obesity.
Established as a statewide association in late 1994, IHA is governed by a 38-member board of directors with equal representation from health plans, physician groups, and hospital and health systems. Our mission is to create breakthrough improvements in health care services for Californians through collaboration among key stakeholders. Accomplishing this mission involves a focus on education, policy influence, project development and program administration. IHA's strength is its ability to bring together leaders from all key sectors of health care in California to promote innovation through both individual and collaborative efforts.
Pay for Performance
The California P4P program began in 2003 and is a story of consensus building and engagement. The program enables physician organizations to earn health plan incentive payments based upon performance against a set of 85 quality and efficiency measures. Results are publicly reported and top performers are recognized in a yearly awards ceremony. IHA is responsible for collecting data, deploying a common measure set, and reporting results on behalf of eight health plans for approximately 200 physician groups representing 35,000 physicians caring for almost 10 million members. It is the largest non-governmental physician incentive program in the U.S. Bonus payments to physician groups by participating health plans cumulatively total over $400 million since 2003.
P4P has successfully raised awareness and acceptance for the use of objective measures in health care quality performance, increased accountability of health plans and physician groups, and helped identify variations in clinical care results related to socioeconomic status. IHA is currently developing a value-based purchasing model using performance-based contracting to incorporate cost and quality measures to produce a total cost of care measure.
Bundled Episode of Care Payments
IHA is implementing a demonstration project funded by the Agency for Healthcare Research and Quality to test the feasibility of bundling payments to hospitals, surgeons, consulting physicians and ancillary providers for selected inpatient surgical procedures. The demonstration is expected to enable improved patient care quality and efficiency, and facilitate shared savings among health plans, providers, employers, and patients.
The demonstration will include a rigorous evaluation of the impact of bundled episode payment on both clinical quality and healthcare costs in comparison to current payment mechanisms. These evaluations will be carried out independently by the RAND Corporation and by researchers associated with the University of California at San Francisco and Berkeley.
Value Based Purchasing
IHA launched a value-based purchasing initiative for New Medical Technologies project in 2008 to improve data transparency and payment methods for high-value medical devices, including orthopedic and cardiac implants, in the California health care system. This project brought together prominent hospital systems across the state to develop purchasing benchmarks and to participate in the exchange of best practices through collaborative roundtable events.
Accountable Care Organizations
California's unique 30?year experience with physician organizations that coordinate care for defined patient populations offers valuable lessons ? both positive and negative ? for health care leaders who are now creating accountable care organizations (ACOs) as described under federal health reform legislation. In 2010, IHA published a white paper which described California's health care system as a robust laboratory for understanding ACOs and answering crucial questions about their potential to promote higher quality and more efficient health care delivery in the U.S. The lessons shared in the paper were derived from a careful examination of questions surrounding five key features of the California ACO experience: organizational structure, payment methods, relations with health insurance plans, maintenance of consumer choice, and public policy and regulation. IHA is publishing a second white paper entitled Provider Coordination and Patient Choice: Applying ACO Principles to the Commercial PPO Population.
In partnership with a number of healthcare stakeholders, IHA has developed a standardized Division of Financial Responsibility (DOFR) template for use in contracts involving capitation between health plans, physician organizations, and hospitals. The DOFR provides a framework for these organizations when allocating financial responsibilities for services and includes a standard set of 104 health care service categories and 10,000 associated billing and revenue codes. It gives plans and providers a uniform starting point for capitated payment negotiations and assignment of risk. The standard set of service categories and associated codes help organizations define lines of responsibility, reduce payment ambiguities, minimize administrative burdens associated with managing multiple risk relationships, and lower costs associated with misdirected claims ("claims ping-pong") that also lead to consumer frustration with their care experience.
IHA has thirteen employees and is based in Oakland, California. IHA has considerable organizational experience and expertise in performance measurement, public reporting, data aggregation, use of multi-payer information, payment reform models, and value-based purchasing. IHA actively convenes regional and national conferences to provide a forum for collaboration, shared learnings, and innovation.