California Medical Groups Honored for High-Quality Care of Medicare Advantage Patients
Almost a third of medical groups statewide achieved top honors for providing high-quality care to Medicare Advantage patients, according to the Integrated Healthcare Association (IHA), a statewide nonprofit group committed to high-value, integrated care that improves quality and affordability for patients across California and the nation.
Building on the Medicare Advantage star rating system for health plans, IHA uses a subset of 13 clinical quality measures to collect performance data and assign star ratings to 186 physician organizations across the state based on how well they provided recommended care in 2015 to more than 2 million California seniors and people with disabilities enrolled in Medicare Advantage HMOs.
The clinical quality measures include breast and colorectal cancer screenings, all-cause hospital readmissions, eye exams and blood sugar control for patients with diabetes, managing osteoporosis in women with a previous fracture, and appropriate medication management. Collecting these measures at the physician organization level allows IHA to combine data from the six participating health plans to identify performance variations that can help plans and medical groups target quality improvement efforts.
For example, if all participating physician organizations had attained 5-star performance ratings for 2015:
- More than 37,000 more people would have received colorectal cancer screenings.
- More than 4,000 hospital readmissions would have been prevented.
- More than 20,000 people with diabetes would have received a recommended eye exam.
- Almost 10,000 people with diabetes would have had their blood sugar levels controlled, lowering their risk of serious complications like heart disease and kidney failure.
“Through Medicare Advantage Stars quality measurement, we recognize physician organizations that are committed to providing integrated care that helps make sure their patients get important recommended care. Significantly, these results are not ‘graded on a curve,’” said IHA President and CEO Jeffrey Rideout, M.D. “We also believe California is the only state in the country providing overall Medicare Advantage star quality ratings at the physician organization level, and we applaud all participating physicians for leading the way in making health care quality more transparent.”
Along with recognizing high-performing physician organizations, IHA partners with the California Office of the Patient Advocate (OPA) to use the medical group star ratings to report publicly on the quality of care for people enrolled in Medicare Advantage plans. The 2016-17 edition of the OPA Medical Group Medicare Report Card was released today. The OPA report card includes an overall star rating for each medical group and allows users to look at participating groups’ performance on specific clinical measures, so a patient with diabetes, for example, could see which medical groups score well on clinical quality measures related to diabetes.
As of late 2016, Medicare enrollment in California totaled more than 5.8 million people, with about 2.5 million enrolled in Medicare Advantage and 3.5 million enrolled in original Medicare, according to the federal Centers for Medicare & Medicaid Services. In recent years, more and more Californians are opting for Medicare Advantage, which allows beneficiaries to enroll in private managed care plans, increasing the importance of publicly reported quality ratings for medical groups caring for Medicare Advantage patients.
“With more than 2 million Californians currently enrolled in Medicare Advantage plans, it is important that they can find the facts they need in order to make informed health care decisions,” said OPA Director Elizabeth Abbott. “Our online Report Card provides accurate and unbiased information and makes it quick and easy for consumers to compare medical groups side-by-side.”
Cumulatively, 59 percent of participating California POs achieved overall quality ratings of 4 stars or higher. Six physician organizations achieved an overall 5-star rating for 2016-17, while 52 earned an overall rating of 4.5 stars. Additionally, IHA recognized 21 physician organizations that improved their overall star rating from 2014 to 2015. A fact sheet with more information on the IHA Medicare Advantage 5-Star Rating System for California Physician Organizations is available online.
Based in Oakland, Calif., the nonprofit Integrated Healthcare Association (IHA) convenes diverse stakeholders—including physicians, hospitals and health systems, purchasers and health plans—committed to high-value, integrated care that improves quality and affordability for patients across California and the nation.