More Information:
Lauren K. Lempert
(510) 507-1947
CONTINUED QUALITY IMPROVEMENT IN CALIFORNIA HEALTH CARE
ANNOUNCED BY INTEGRATED HEALTHCARE ASSOCIATION
OAKLAND, Calif. – July 13, 2006 – California’s
physician groups continued to show improvement last year on important measures
of preventive care and chronic care management, along with increased use of
information technology to support patient management and care, according to the
Integrated Healthcare Association (IHA).
Compared to 2004, physician groups participating in IHA’s
Pay for Performance (P4P) program in 2005 reported that they screened about
60,000 more women for cervical cancer, tested nearly 12,000 more individuals for
diabetes, and administered approximately 30,000 more childhood immunizations for
their patients enrolled in HMO plans.
“Pay for performance is improving the quality of care in
California. Physicians need
evidence-based targets against which they can evaluate their performance and
that can be used by physician groups and health plans to make continuous
improvement,” said Bart Asner, M.D., CEO of Monarch HealthCare and an IHA
board member.
Program results, which are collected and reported by the
National Committee for Quality Assurance (NCQA), indicate that these physician
groups effectively managed more patients with high cholesterol and diabetes,
screened more women for breast cancer and Chlamydia, and continued to track
improved clinical performance in other areas. The clinical quality measures are adapted from NCQA’s Health
Plan Employer Data and Information Set (HEDIS®), the most widely
used set of performance measures in health care.
“California is leading the way by showing that changing
how we pay for health care can lead to quality improvements,” said Peter V.
Lee, J.D., CEO, Pacific Business Group on Health.
“This initiative is demonstrating that bringing a value proposition
that considers the quality of care provided can benefit not only consumers, but
also physicians, medical groups and purchasers of health care.”
In addition to the across-the-board improvements on the
evidence-based clinical measures, physician groups participating in the program
increased their use of IT for such activities as prescribing, monitoring lab
results, preventive and chronic care reminders, and electronic messaging.
The percentage of physician groups achieving the maximum score for IT use
increased by 11% in 2005. Prior
year results showed that physician groups that received full credit on IT
measures had average clinical scores that were significantly higher than those
that showed little or no evidence of IT adoption.
California’s P4P program is the nation’s largest,
involving approximately 35,000 physicians in 211 physician organizations that
care for over 6 million individuals enrolled in seven major health plans (Aetna,
Blue Shield, Blue Cross, CIGNA, Health Net, PacifiCare, and Western Health
Advantage). Physicians are rewarded
financially by the plans based on their physician group’s performance in
relation to clinical quality and patient satisfaction measures, and for
investment in information technology (IT).
According to Tom Williams, IHA’s Executive Director, IHA
is planning to include efficiency data in future P4P performance measures.
“We are encouraged by the continued progress and
commitment of these physician groups to improve not only their patients’
health, but also the quality of their healthcare experiences.
We are looking forward to incorporating efficiency into the calculus to
achieve even better results in the future,” said James K. Wang, M.D., V.P. and
Regional Medical Executive at CIGNA HealthCare of California, Inc.
“After three years of measuring results, we continue to
find that physicians and their patients benefit from P4P’s quality
measurement, financial incentives and public reporting,” said Williams.
“California health plans and physician groups are setting an example for the
rest of the nation as they cooperate to measure and improve health care
performance and invest in clinical information technology.”
The 2005 measurement year results will be used by health
plans to calculate incentive payments for distribution to physician groups later
this year. Health plans have
already distributed over $90 million in payments to physician organizations as a
result of meeting P4P quality measures during 2003 and 2004.
Each health plan develops its own formula to determine payments.
Payment of incentives for the 2005 measurement year results has begun and
should be completed by the end of September.
For the first time, the 2005 P4P results will include
clinical measurement scores for Kaiser Permanente’s physician groups serving
both Northern and Southern California for the purpose of public reporting.
Scores for all participating physician groups reflecting 2005 results
will be posted on the California Office of Patient Advocate Web site, www.opa.ca.gov,
by mid-September.
(Results for the
clinical, patient satisfaction, and IT measures are available at http://www.iha.org/p4pyr3/P4P%20Results%202005.pdf)
About IHA and Pay
for Performance
IHA
is a statewide leadership group of California health plans, physician groups,
and healthcare systems, plus academic, consumer, purchaser, and pharmaceutical
representatives that promotes quality improvement, accountability, and
affordability for all California consumers through innovation and collaboration.
An organizing principle behind P4P
is the uniform evaluation of physician groups’ performance across multiple
health plans and a common set of quality measures.