Total Cost of Care

Understanding the drivers of health care costs is a critical first step in trying to reduce or control health care spending. Along with monitoring quality, IHA is committed to increasing accountability by incorporating cost trends into performance measurement.   

The development of total cost of care (TCC) measurement was key to transitioning IHA’s P4P program from focusing solely on quality to a value-based approach that measures both quality and cost. Since 2011, IHA’s Value Based BP4P program has calculated and risk adjusted the TCC for individual physician organizations, based on actual payments for each HMO/POS enrollee’s care, including professional, pharmacy, hospital and ancillary services, and consumer cost-sharing. 

In March 2016, IHA partnered with the California Office of the Patient Advocate to publish the largest  statewide multi-payer public report card to provide side-by-side assessments of physician organization performance on all three key aspects of value—clinical quality, patient experience, and costs.

Fact Sheet: Total Cost of Care

Public Report Card: Medical Group Report Card for Commercial HMO Plan Members

Health Affairs Blog: Value Milestone - Public Reporting by Physician Organizations of Costs Alongside Quality

Video: IHA's Jill Yegian Discusses TCC and the OPA Report Cards