IHA’s newsletter is issued quarterly and provides key updates on IHA programs, initiatives, and publications.
Message from the ‘Chief Collaboration Officer’
Even with so much continuing uncertainty at the federal level, health care and health care improvement remain largely local. This is good news for collaborative regional efforts that are working to drive performance improvement and greater cost and quality transparency. And, an interesting side effect of collaboration is that it seems to be self-reinforcing–when organizations and individuals work together, it encourages others to do the same and fosters a willingness to explore other issues ripe for collaboration. Both are happening in California and within the IHA community as several initiatives simultaneously gain traction, including efforts to standardize commercial accountable care organization (ACO) performance measurement and build a statewide provider directory.
In the same vein, earlier this week I met with Kate Goodrich MD, Chief Medical Officer at the Centers for Medicare & Medicaid Services (CMS) and her staff, to discuss how California is making performance measurement more aligned and less burdensome for practitioners, specifically through our VBP4P programs, including commercial HMO, ACO, and Medicare Advantage. This was not a random invitation-it came through our friends at the Network for Regional Healthcare Improvement Organization, specifically Elizabeth Mitchell, who co-chairs the Physician-Focused Payment Model Technical Advisory Committee, or PTAC, with Jeff Bailet, M.D., of Blue Shield of California. In Congressional testimony last month, Dr. Bailet publicly endorsed the IHA-Pacific Business Group on Health (PBGH) ACO measurement initiative. Also, the PBGH California Quality Collaborative attended the CMS meeting to discuss the very successful California physician Practice Transformation Network that partners with…you guessed it, IHA.
In this newsletter, read more about: 1) the ACO measurement initiative; 2) the IHA-led statewide effort to develop a comprehensive provider directory; 3) the upcoming Pay for Performance Summit and CAPG annual conference; 4) Medicare Stars recognition of physician organizations; 5) efforts to promote safe, affordable health care; and 6) meet Jennifer Wong, IHA project manager.
-Jeff Rideout, M.D.
ACO Measurement Initiative Reaching Critical Mass
As leading California health care purchasers, plans, and providers continue to commit to standardized performance measurement and benchmarking for commercial ACOs, the IHA-PBGH partnership is gaining critical mass toward a public announcement next week–so stay tuned. The goal of the IHA-PBGH partnership is to develop and implement a standard quality and cost performance measure set for commercial ACOs that meets the needs of participating purchasers, health plans, and providers while advancing national efforts for coordinated, meaningful performance measurement that promotes high-quality, affordable, patient-centered care–or high-value care. The effort builds on IHA’s other successful performance measurement and benchmarking programs for California physician organizations participating in commercial HMO and Medicare Advantage health plan provider networks. More information about the Commercial ACO Measurement & Benchmarking Initiative is available online.
Update: Statewide Provider Directory
Since IHA’s selection in August to host a comprehensive statewide provider directory spanning commercial, Medicare, and Medi-Cal health plans, IHA has focused on building capacity to govern the provider directory utility, oversee the technical build of the directory, and support regulatory compliance for directory participants as well as outreach and education.
The effort is the direct result of the state’s Department of Managed Health Care’s approval of the Blue Shield of California-Care 1st merger agreement, which included a provision to create a statewide “utility” to build and host a provider directory to strengthen the health care delivery system through increased transparency of health plan provider networks.
The first of its kind in the state, the provider directory will offer a one-stop shop for providers and plans to update their data, leading to both a simpler process and more accurate provider data to give health plan enrollees a better customer experience. Accomplishments to date include:
- Expanding IHA’s Executive Committee to include additional stakeholders, including Blue Shield, Health Net, and Covered California.
- Forming a Utility Management Committee to provide guidance and recommendations on policy, technology, business development, and outreach and education.
- Hiring additional staff to lead utility development and operations.
- Completing 30-plus in-depth interviews with health plans, provider organizations, and purchasers to inform development of the technology partner request for proposal that will be launched in early 2018.
- Meeting with state and federal regulators to understand compliance requirements for commercial, Medicare, and Medi-Cal health plans and providers that will be incorporated into the utility and product design.
2018 Value-Based Payment and Pay for Performance Summit, Feb. 28-March 2
The 13th annual Value-Based Payment and Pay for Performance Summit in San Francisco, Feb. 28-March 2, will feature a plenary session on updated findings form IHA’s California Regional Health Care Cost & Quality Atlas, along with mini-summits on the IHA statewide provider directory and ACO performance measurement initiatives. Co-chaired by CAPG President and CEO Don Crane, J.D., and IHA’s Jeff Rideout, the summit includes keynote speakers such as CMS Chief Medical Officer Kate Goodrich, M.D.; former CMS Administrator and FDA Commissioner Mark McClellan, M.D., Ph.D.; and Barbara L. McAneny, M.D., F.A.S.C.O., M.A.C.P., president-elect of the American Medical Association. For more information and to register, visit the conference website.
CAPG Annual Conference Set for April 19-21
The CAPG Annual Conference 2018, April 19-21, in San Diego is designed for all who are committed to capitated and alternative payment models in health care delivery. You’ll hear from renowned experts about the current politico-economic landscape, gain practical information to help you thrive in all payer arrangements, and make valuable networking connections. Featured sessions will include Dr. Robert Pearl, former CEO, The Permanente Medical Group; Dr. John Kitzhaber, former governor of Oregon; Dr. Elisabeth Rosenthal, editor-in-chief, Kaiser Health News; and a panel, Healthcare 2018: Analyzing the Rollercoaster. Learn more and register on the conference website.
Medicare Stars Recognition
Almost a third of physician organizations (POs) statewide achieved top honors for providing high-quality care to Medicare Advantage (MA) patients through IHA’s Medicare 5-Star recognition program. Building on the MA star rating system for health plans, IHA uses a subset of 12 clinical quality measures to collect performance data and assign star ratings to 181 POs across the state based on how well they provided recommended care in 2016 to more than 2 million California seniors and people with disabilities enrolled in Medicare Advantage HMOs.
The clinical quality measures include breast and colorectal cancer screenings, all-cause hospital readmissions, eye exams and blood sugar control for patients with diabetes, and managing osteoporosis in women with a previous fracture. Collecting these measures at the physician organization level allows IHA to combine data from five participating health plans to identify performance variations that can help plans and medical groups target quality improvement efforts.
Cumulatively, almost half (46%) of participating California POs achieved overall quality ratings of 4 stars or higher. Ten physician organizations achieved an overall 5-star rating, while 39 earned an overall rating of 4.5 stars. Additionally, IHA recognized 26 physician organizations that improved their overall star rating from 2015 to 2016. A list of physician organizations achieving top star ratings and a fact sheet with more information on the IHA Medicare Advantage 5-Star Rating System for California Physician Organizations are available online.
Resources to Reduce Overuse: Smart Care California and Choosing Wisely
Smart Care California, a public-private partnership convened by IHA with funding from the California Health Care Foundation, promotes safe and affordable health care in California by focusing on reducing the overuse of C-sections for low-risk, first-time births; opioids; and inappropriate treatment for low back pain. Smart Care California has compiled and curated resources that enable multiple stakeholders-patients, families and caregivers; providers; and payers and purchasers-to take action in these three focus areas. New resources include tools created and endorsed by the multi-stakeholder Smart Care California workgroup including:
- Aligning Birth Payment to Reduce Unnecessary C-Section: A Menu of Options.
- Curbing the Opioid Epidemic: Checklist for Health Plans and Purchasers, updated November 2017
- Reducing Opioid-Related Morbidity and Mortality: Payer and Provider Strategies
Smart Care California first began as the statewide workgroup on reducing overuse and looked to the national Choosing Wisely campaign for recommendations of test, treatments, and procedures that were being overused. Smart Care California features many Choosing Wisely patient-facing materials in its resources lists. For more resources to reduce C-sections for low-risk, first-time births; opioids; and inappropriate treatment for low back pain, visit Smart Care California . If your organization is working to reduce overuse of other conditions, find more information and resources about Choosing Wisely here.
As a project manager, Jennifer leads IHA’s initiatives to reduce overuse of low-value care: Smart Care California and the Choosing Wisely® Campaign. She also is supporting the Value Based P4P program’s expansion into Medi-Cal. Before joining IHA, Jennifer spent over 4 years at the Center for Excellence in Primary Care at the University of California San Francisco, where she supported primary care quality improvement efforts at safety net clinics in San Francisco. Jennifer earned a B.A. in integrative biology and an M.P.H. with a concentration in health policy and management from UC Berkeley. In addition to her devotion to fixing health care, Jennifer enjoys crafting and is a connoisseur of gourmet gummy bears.