California Medical Groups Honored for High-Quality Care of Medicare Advantage Patients
OAKLAND, CALIF.—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 12 clinical quality measures to collect performance data and assign star ratings to 181 physician organizations across the state based on how well they provided recommended care in 2016 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, and managing osteoporosis in women with a previous fracture. Collecting these measures at the physician organization level allows IHA to combine data from five participating health plans to identify performance variations that can help plans and medical groups target quality improvement efforts.
“California physicians are leaders in making health care more transparent through their voluntary participation in Medicare Advantage star quality ratings,” said IHA President and CEO Jeffrey Rideout, M.D. “We applaud their hard work and commitment to improving the quality of care for Medicare beneficiaries.”
As of September 2017, Medicare enrollment in California totaled almost 6 million people, with about 2.6 million enrolled in Medicare Advantage and 3.4 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.
Cumulatively, almost half (46%) of participating California POs achieved overall quality ratings of 4 stars or higher. Ten physician organizations achieved an overall 5-star rating, while 39 earned an overall rating of 4.5 stars. Additionally, IHA recognized 26 physician organizations that improved their overall star rating from 2015 to 2016. A list of physician organizations achieving top star ratings and a fact sheet with more information on the IHA Medicare Advantage 5-Star Rating System for California Physician Organizations are available online.