Reporting Medical Group and Physician Performance Patient Experience & Clinical Results

Reporting Medical Group and Physician PerformancePatient 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

Distinguish best/worse performers(20 Top Performing CA Medical Groups) 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

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 Reporting Performance – California Medical Groups (2006)

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)

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) 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 • 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

Patient Experience Summary Indicator Summary indicator constructed of 4 survey composites has medical group reliability 91% • Patient-Doctor Interactions • Coordinated Patient care • Patient Access • Helpful Office Staff Indicator represents “objective” patient-reported care and service experiences

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

Patient Experience: Minimizing Medical Group Misclassification Error

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

Reporting Medical Group and Physician Performance Patient Experience & Clinical Results