Reporting Medical Group and Physician Performance Performance Accountability in
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Performance Accountability in California Market -- The Promise Reporting Medical Group and Physician Performance Foster improvements in care and service Incentive payments: HMOs pay medical groups Public accountability: State and private purchasers Patient Experience & Clinical Results Dampen premium cost trend Purchaser: high-value provider networks savings Consumer: meaningful ‘product’ choices June 2006 Ted von Glahn Director of Consumer Engagement Pacific Business Group on Health 2 Pay for Performance Spurs Statewide Reporting Distinguish best/worse performers (20 Top Performing CA Medical Groups) 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 3 California Office of Patient Advocate 4 Greater Performance Variation w/ Medical Groups (Source: IHA and HEDIS 2005) 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 Clinical Measures Asthma Medications (3) Cancer Screening (2) Chlamydia Screening Immunizations Heart Care (2) Diabetes Care (2) Child Infections 5 Pacific Business Group on Health HMOs ~ 90th Percentile ~ 25th Percentile Medical Groups Cervical Cancer Cervical Cancer Screening Screening 85% 80% 80% 62% 6 1 Greater Performance Variation w/ Medical Groups (Source: IHA and HEDIS 2005) Greater Performance Variation w/ Medical Groups (Source: PAS Patient Survey; CAHPS Member Survey 2005) HMOs Medical Groups HMOs Medical Groups Cholesterol Control (LDL <130) 73% ~ 90th Percentile Doctor/Care Access 78 Doctor/Care Access 67 ~ 90th Percentile Cholesterol Control (LDL <130) 79% ~ 25th Percentile 73 56 ~ 25th Percentile 68% 53% 7 8 Chronic Care Health: Dovetail Plan and Medical Group Efforts The Promise – Is it Working? Modest Positive Signals Increasing number of participating medical groups Overall, small gains in performance results 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) Questions 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) 9 Pacific Business Group on Health 10 Reporting: Methods Development Patient Experience Summary Indicator Construct roll-up/summary indicator Summary indicator constructed of 4 survey composites has medical group reliability 91% Medical group reliability 91% Establish performance cutpoint to delineate grades 99th percentile to set ‘excellent’ grade Handle uncertainty through misclassification error adjustment Pacific Business Group on Health Patient-Doctor Interactions Coordinated Patient care Patient Access Helpful Office Staff Indicator represents “objective” patient-reported care and service experiences Half to one point buffer yields <5% error rate 11 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? 12 2 Summarize Performance: Roll-up of Clinical and Patient Experience Results Patient Experience: Performance Cutpoints Judging excellence (99th PCT) in delineating grades Distinguishing real performance differences 13 14 Patient Experience: Minimizing Medical Group Misclassification Error Challenges – Physician Performance Accountability 9 Construct physician-level clinical quality index medical group clinical measurement not a promising path 9 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 9 Need compelling cost savings and quality assurance to offset employee backlash from adopting high-value network products that constrain employee’ doctor choice 15 Pacific Business Group on Health 16 3
