Regional Variation and Diabetes/Heart Disease Management in California Pay for Performance

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Regional Variation and Diabetes/Heart Disease
Management in California Pay for Performance

• Tom Williams
• Executive Director
• Integrated Healthcare Association
• CQI The Right Care Initiative

September 29, 2008
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IHA Sponsored California Pay for Performance
(P4P) Program

• Health Plans
• Aetna
• Blue Cross
• Blue Shield
• Western Health Advantage
• Medical Group and IPAs
• 230 groups
• 35,000 physicians

• CIGNA
• Health Net of CA
• Kaiser
• United

12 million HMO commercial enrollees
Kaiser participates in the public reporting only
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Measurement Domain Weighting
Appropriate use measures to be introduced in
2009 with incentive based upon gain sharing.
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California Pay for Performance Performance
Results 2003-07

• Clinical continued modest improvement on most
  measures
• 5.1 to 12.4 percentage point increases since
  inception of measure
• Patient experience scores reflect modest over
  year improvement leveling in 2007
• IT-Enabled Systemness IT measures have shown
  significant improvement with almost one-third of
  physician groups demonstrating robust care
  management processes

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California Pay for Performance Clinical
Performance Variation
Based upon a composite clinical measure score.
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California Pay for PerformanceA Tale of Two
Regions

• Inland Empire Bay Area
• PCPs/100K Pop. 53 116
• Pop. Medi-Cal 17 12
• Hispanic 43 21
• Per Capita Income 21,733
  39,048

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California Pay for PerformanceA Tale of Two
Regions
Clinical Performance
P4P Performance Score
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Are Quality Variations Correlated with Physician
Reimbursement Disparities?

• The data and subjective experience suggest
• Physicians in geographies with low
  socioeconomics receive disproportionately lower
  reimbursement across their practice, resulting in
  diminished physician and organizational capacity,
  reducing both access and quality of healthcare,
  even in a uniformly, well-insured population.

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Coordinated Diabetes CareMeasurement Domain

• Diabetes Clinical Measures
• HbA1c screening, poor control gt9, good control lt7
• LDL screening, control lt100
• Nephropathy Monitoring
• Diabetes Population Management Activities
• Diabetes Registry (including blood pressure)
• Actionable Reports on Diabetes care
• Individual Physician Reporting on Diabetes
  measures
• Diabetes Care Management

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Clinical Diabetes Measures Average Rates and
Count of Physician Organizations
(1) Typically health plan data are incomplete
for the lab results measures and PO rates are the
most frequently used rates. (2) Lower
rates are better for this measure
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Appendix
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Paying for Performance Improvement
Excerpt from CMS Hospital Value-Based Purchasing
Listening Session 2, April 12, 2007
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California Pay for Performance

• For more information
• www.iha.org
• [phone]
• Pay for Performance has been supported by major
  grants from the California Health Care Foundation