Healthcare Hot Spotting: Wide Variation in Quality and Resource Use in California
Reinforcing that all health care is local, a new analysis from the nonprofit, nonpartisan Integrated Healthcare Association (IHA) shows wide variation—down to the ZIP code level—in health care quality and resource use across California. For example, there is more than a 40-percentage-point gap in the colorectal cancer screening rate between the highest performing California county (Solano, 76.4%) and the lowest performing county (Modoc, 33.5%), the analysis found. And similar geographic gaps exist for other quality measures, including breast cancer screening and blood sugar control for people with diabetes.
“Identifying where to target performance improvement is a critical step toward achieving the triple aim of better care, better health and lower costs,” said IHA President and CEO Jeff Rideout, M.D., M.A. “While the analysis uses only descriptive statistics, such sizeable geographic gaps in health care quality mean there are major opportunities to improve care for hundreds of thousands of California residents.”
The analysis is based on a new online tool—HEDIS by Geography—that organizes 2013 HEDIS (Healthcare Effectiveness Data and Information Set) results for 11 health plans covering about 19 million Californians by geographic area to gain a clearer picture of population health across the state.
Created by IHA with support from the California HealthCare Foundation, the online tool allows users to examine performance on six clinical quality measures—such as breast and colorectal cancer screening rates—and three resource use measures—such as hospital readmissions—by geography or health plan product line, including commercial health maintenance organization (HMO) and preferred provider organization (PPO), Medicare Advantage, and managed Medi-Cal.
Along with wide variation in quality and resource use across geographic areas, the IHA analysis found that health plan products that rely primarily on integrated care delivery networks, such as HMOs and Medicare Advantage, generally have higher quality scores without using more resources. For example, of the population included in HEDIS by Geography, about 85 percent of the Commercial HMO women ages 50-74 met clinical guidelines for breast cancer screening and received a mammogram, compared to about 70 percent of similar Commercial PPO patients. If PPOs had performed at the same level as HMOs, an estimated 55,356 more California women would have received mammograms in 2013.
The Integrated Healthcare Association (IHA) is a nonprofit multi-stakeholder leadership group that promotes healthcare quality improvement, accountability and affordability for the benefit of all Californians. IHA has over a decade of experience leading regional and statewide performance measurement and incentive programs and serving as an incubator for pilot programs and demonstration projects. As a regional healthcare improvement collaborative, IHA convenes diverse, cross-sector organizations to collaborate on challenging healthcare issues. Please visit: www.IHA.org.