Value Based Pay for Performance Results Show Physician Groups Improved Care for Tens of Thousands of Californians in 2015
More than 33,000 additional Californians had their high-blood pressure under control, about 2,500 more boys received recommended HPV vaccines, and about 20,000 more diabetics received needed care for kidney disease in 2015 compared to 2014, according to results from the Integrated Healthcare Association’s Value Based Pay for Performance (VBP4P) program.
One of the largest alternative payment models in the country, IHA’s VBP4P program merges quality, total cost of care and patient experience measures into a single performance measurement and incentive program across health plans to reward physician organizations that provide high-quality, affordable, patient-centered care. The statewide VBP4P program, which includes 10 health plans and more than 200 physician organizations caring for 9 million Californians enrolled in commercial health maintenance organization (HMO) and point of service (POS) products, has four key components: a common set of performance measures and benchmarks; health plan incentive payments; public reporting of results, and public recognition awards.
Standardized measures allow consumers to compare the performance of participating physician organizations. IHA partners with the California Office of the Patient Advocate (OPA) to publicly report VBP4P results annually at the individual physician-organization level. The OPA 2016-2017 Medical Group Commercial Report Card also was released today and allows users to compare physician organization performance within a county, showing overall performance as well as scores on individual clinical quality, patient experience and total cost of care measures.
Overall, the performance of the physician organizations participating in measurement year (MY) 2015 improved on 10 of 24 clinical quality measures, held steady on 13 measures and declined on one measure. More detailed overall VBP4P results are available online, along with a fact sheet.
“We continue to see steady performance improvement on many clinical quality measures, including improved rates of childhood immunization, cervical cancer screening, and blood pressure control for hypertensive patients with and without diabetes,” said IHA President and CEO Jeffrey Rideout, M.D.
People cared for by VBP4P-participating physician organizations and health plans represent more than 95 percent of the commercial enrollment in California HMO/POS products, which typically outperform commercial preferred provider organization (PPO) products in California on both clinical quality and cost measures, according to the California Regional Health Care Cost & Quality Atlas.
“A leading explanation for the higher performance among HMO products is their reliance on integrated care delivery networks that include physician organizations with more sophisticated care management infrastructure, such as IT and data systems, and more established care coordination procedures,” Rideout said.
Other key findings from MY 2015 Valued Based P4P results include:
- Clinical Quality Performance Gains from 2008 to 2015. Over time, steady incremental performance gains on clinical quality measures add up: For example, since 2008, the rate of colorectal cancer screening has increased 15.5 percentage points, reaching 60.9 percent of all recommended adults in 2015, which translates to about 280,000 more people getting appropriate screening in 2015 compared to 2008. Similarly, the rate of people with diabetes whose blood sugar is in control increased 13.2 percentage points between 2008 and 2015, reaching 55.7 percent, or nearly 58,000 more diabetics in 2015 with their blood sugar under control.
- Total Cost of Care (TCC). Since 2011, a TCC measure, based on actual payments for each HMO/POS enrollee’s care, including professional, pharmacy, hospital and ancillary services, and consumer cost sharing, has been calculated and risk adjusted for each physician organization. Average TCC increased to $3,912 per enrollee annually in MY 2015, up from $3,794 in MY 2014, or about a 3 percent increase. To be eligible for health plan incentive payments, physician organizations must first meet thresholds for both quality and cost performance. About three-quarters (73%) of participating physician organizations met both thresholds in 2015, down from 84 percent in 2014—the drop was solely attributable to fewer physician organizations meeting the cost requirement.
- Patient Experience. Patient experience rating results improved in 2015, with overall ratings of care increasing by 1.6 percentage points to 69.2 percent of patients in MY 2015 reporting the highest possible score for their care. Along with overall care, the patient experience measures include ratings of doctor-patient interaction, timely care and service, care coordination, and office staff.
Each year, IHA recognizes physician organizations that perform in the top 50 percent in all three major VBP4P measurement areas: clinical quality, patient experience and total cost of care. Only 34 physician organizations statewide attained Excellence in Healthcare Award performance standards for 2016, based on VBP4P results for MY 2015. For the first time, the OPA Medical Group Report Card recognizes the winners with a special designation.
If all participating physician groups performed at the same level as the Excellence in Healthcare Award winners:
- More than 41,000 additional California patients with diabetes would have their blood sugar controlled, helping to lower their risk of adverse health outcomes.
- More than 290,000 additional California patients would rate their overall care quality a 9 or a 10, with 10 the highest score.
- Health care savings would be about $3.9 billion a year—or about $440 (11%) less spending per enrollee annually.
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.