“Excellence in Healthcare” award winners are physician organizations that have been
successful at achieving strong quality results while effectively managing costs. To earn this
recognition, physician organizations must have performance that ranks in the top 50% for
clinical quality and patient experience and cost performance. Cost performance is based on
the Total Cost of Care, including adjustments to account for members’ risk and geography.
Quality Performer Award
“Quality Performer” award winners are identified as any physician organization whose
overall achievement score meets a comprehensive threshold based on the top 25% score for
each measure included in P4P—and who doesn’t have any individual measure scores in the
bottom 25%. The overall achievement score for quality is determined by calculating
achievement scores in each of the three P4P quality measurement domains, which are then
weighted according to the recommended P4P payment weightings: clinical quality 50%,
patient experience 20%, and meaningful use of health information technology 30%.
Most Improved Award
“Most Improved” award winners are determined by calculating the relative improvement for
each physician organization on the overall achievement score for this year compared to the
overall achievement score for last year. The physician organization in each of the eight P4P
regions that has the highest relative improvement score for overall quality performance—
and does not decrease performance in any quality measurement domain—is recognized as
the most improved group in that region.
Medicare Five-Star Award
“Medicare Five-Star” award winners are five-star rated physician organizations, identified by
comparing performance on individual Medicare Stars measures against national benchmarks
provided by the Centers for Medicare & Medicaid Services (CMS) which were then combined
into a weighted overall Stars rating across a set of 14 Part C (Medicare Advantage) and Part
D (Prescription Drug Plan) measures.
Medicare Stars Most Improved Award
“Medicare Stars Most Improved” award winners are determined by calculating the relative
improvement for each physician organization on the overall Medicare Stars score for this
year compared to the overall score for last year. The physician organizations that improved
by at least ½ Star overall are recognized as the most improved groups in California.
"To drive major improvements, performance-based payments must exceed 10% of total provider income. Incentives of this magnitude can only be mobilized if they originate in payer savings.”