Reporting Medical Group and
Physician Performance
Patient Experience & Clinical Results
June 2006
Ted von Glahn
Director of Consumer Engagement
Pacific Business Group on Health
Performance Accountability in
California Market -- The Promise
 Foster improvements in care and service
 Incentive payments: HMOs pay medical groups
 Public accountability: State and private purchasers
 Dampen premium cost trend
 Purchaser: high-value provider networks savings
 Consumer: meaningful ‘product’ choices
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Distinguish best/worse performers
(20 Top Performing CA Medical Groups)
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California Office of Patient Advocate
Pay for Performance Spurs Statewide
Reporting
Patient survey reporting
 Group-level samples for 180 medical groups
 Doctor samples for 3,100+ MDs (27 medical groups)
• Common survey & integrated sampling process for
group, site and clinicians
Clinical reporting
 Reportable results for ~ 180 medical groups
 Data source: mix of group self-report and HMO data
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Reporting Performance – California
Medical Groups (2006)
Patient Survey Measures
Patient-Doctor Interactions
Patient Access
Coordinated Patient Care
Helpful Office Staff
Health Promotion
Global Rating of Doctor &
Care
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Clinical Measures
Asthma Medications (3)
Cancer Screening (2)
Chlamydia Screening
Immunizations
Heart Care (2)
Diabetes Care (2)
Child Infections
Greater Performance Variation w/ Medical
Groups (Source: IHA and HEDIS 2005)
HMOs
Medical Groups
Cervical Cancer Cervical Cancer
Screening
Screening
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~ 90th Percentile
85%
80%
~ 25th Percentile
80%
62%
Greater Performance Variation w/ Medical
Groups (Source: IHA and HEDIS 2005)
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HMOs
Medical Groups
~ 90th Percentile
Cholesterol
Control
(LDL <130)
79%
Cholesterol
Control
(LDL <130)
73%
~ 25th Percentile
68%
53%
Greater Performance Variation w/ Medical
Groups (Source: PAS Patient Survey; CAHPS Member Survey 2005)
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HMOs
Medical Groups
Doctor/Care
Access
Doctor/Care
Access
~ 90th Percentile
78
67
~ 25th Percentile
73
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Chronic Care Health: Dovetail Plan
and Medical Group Efforts
Range of CA HMO Performance (2005)
 56%-77% patients’ high blood pressure controlled
 65%-77% patients getting asthma medications
 60%-72% patients’ cholesterol controlled (diabetes)
Medical Group Patient Survey Results (2006)
 42% chronically ill patients report providers gave them written list of
things to do to manage health condition
 61% chronically ill patients report providers ask whether hard to do
things you need to do each day (home/work)
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Pacific Business Group on Health
The Promise – Is it Working?
Modest Positive Signals
 Increasing number of participating medical groups
 Overall, small gains in performance results
Questions
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Clinical indicator gains -- better reporting or better care?
Compression of patient survey results at group level
Document evidence of effective improvement tactics
Are lowest performers improving?
Is within-group variation decreasing?
Reporting: Methods Development
 Construct roll-up/summary indicator
 Medical group reliability 91%
 Establish performance cutpoint to delineate
grades
 99th percentile to set ‘excellent’ grade
 Handle uncertainty through misclassification
error adjustment
 Half to one point buffer yields <5% error rate
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Patient Experience Summary Indicator
Summary indicator constructed of 4 survey
composites has medical group reliability 91%
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Patient-Doctor Interactions
Coordinated Patient care
Patient Access
Helpful Office Staff
Indicator represents “objective” patient-reported
care and service experiences
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Summarize Performance: Roll-up of Clinical
and Patient Experience Results
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Patient Experience: Performance Cutpoints
 Judging excellence (99th PCT) in delineating grades
 Distinguishing real performance differences
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Patient Experience: Minimizing Medical
Group Misclassification Error
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Challenges – Physician Performance
Accountability
 Construct physician-level clinical quality index
 medical group clinical measurement not a promising path
 Construct physician-level resource efficiency index to
craft an affordable health plan product
 Reduced premium product will foster demand for public reporting of
physician performance
 Need compelling cost savings and quality assurance to
offset employee backlash from adopting high-value
network products that constrain employee’ doctor choice
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