Reporting Medical Group and Physician Performance Patient Experience & Clinical Results June 2006 Ted von Glahn Director of Consumer Engagement Pacific Business Group on Health

2 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

California Office of Patient Advocate 3 Distinguish best/worse performers (20 Top Performing CA Medical Groups)

4 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

5 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

6 Greater Performance Variation w/ Medical Groups (Source: IHA and HEDIS 2005) HMOs Cervical Cancer Screening Medical Groups Cervical Cancer Screening ~ 90 th Percentile85%80% ~ 25 th Percentile80%62%

7 Greater Performance Variation w/ Medical Groups (Source: IHA and HEDIS 2005) HMOs Cholesterol Control (LDL <130) Medical Groups Cholesterol Control (LDL <130) ~ 90 th Percentile79%73% ~ 25 th Percentile68%53%

8 Greater Performance Variation w/ Medical Groups (Source: PAS Patient Survey; CAHPS Member Survey 2005) HMOs Doctor/Care Access Medical Groups Doctor/Care Access ~ 90 th Percentile7867 ~ 25 th Percentile7356

Pacific Business Group on Health 9 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)

10 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?

11 Reporting: Methods Development  Construct roll-up/summary indicator  Medical group reliability 91%  Establish performance cutpoint to delineate grades  99 th percentile to set ‘excellent’ grade  Handle uncertainty through misclassification error adjustment  Half to one point buffer yields <5% error rate

12 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

13 Summarize Performance: Roll-up of Clinical and Patient Experience Results

14 Patient Experience: Performance Cutpoints  Judging excellence (99 th PCT) in delineating grades  Distinguishing real performance differences

15 Patient Experience: Minimizing Medical Group Misclassification Error

16 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