Program Governance and Process

IHA P4P Program Governance

P4P program oversight is provided by the IHA Board of Directors, with program management and governance from the P4P Steering, Executive, and Technical Committees, and a technical team including experts from the Pacific Business Group on Health (PBGH), the National Committee for Quality Assurance (NCQA)and IHA staff. A team of researchers from the RAND Corporation and U.C. Berkeley conducted an evaluation of the program from 2003 - 2007 which received widespread attention.  A summary of the IHA P4P program governance structure is shown below:




Roles and Responsibilities

IHA Board of Directors	Provides organizational governance and oversight
P4P Steering Committee	Determines strategy and sets policy
P4P Executive Committee	Provides overall program direction
P4P Technical Quality Committee	Develops clinical, patient experience, and systemness measures
P4P Technical Efficiency Committee	Develops efficiency measures
P4P Payment Committee	Recommends payment method
IHA Staff	Facilitates governance and project management
NCQA (IHA subcontractors)	Data collection, aggregation, and technical support
Thomson Reuters	Efficiency measurement

Process

Results are reported the year following each Measurement Year (MY). The first California P4P results were released in 2004 using data collected in 2003 (MY 2003). The IHA P4P measure deployment process is shown below.

The initial IHA P4P measurement set had three categories: 1) clinical quality, 2) patient experience, and 3) health information technology (HIT) adoption. The HIT domain was expanded to IT-Enabled Systemness in 2007, Coordinated Diabetes Care was added in 2008, and Appropriate Resource Use was added in 2009, for a total of five categories. In addition, several existing measures have been used to create a new domain for senior patient populations over age 65 (Medicare). This domain is for public reporting purposes only, and does not impact a physician organization's payments. 

The weighting of these domains remains dynamic from year to year as measures within each domain are refined, added, or deleted. The IHA P4P common measure set is designed to include measures that are evidence-based and relevant to California consumers. The number of measures has dramatically increased over the years, and the measurement set has become more sophisticated. Measurement evolution is described in the Measurement Set Development table in Related Resources (to the right).