|
Medi-Cal Performance Measurement and Payment Pilot Issue Brief
IHA is excited to release a new issue brief, Piloting Performance Measurement of Physician Organizations in Medi-Cal Managed Care: Findings and Implications. In response to interest from health plans and supported by a grant from the Blue Shield of California Foundation, the Integrated Healthcare Association conducted a pilot project to collect standardized Medi-Cal quality of care results in four southern California counties at the physician organization (PO) level. The pilot showed that performance measurement of POs in Medi-Cal managed care is feasible and that Medi-Cal managed care health plans are interested in measuring and reporting closer to where care is delivered. This issue brief describes the pilot in detail and shares our findings and implications for future work in this area.
|
|
Covered California Snapshot
During Covered California's first open enrollment period, over one million Californians obtained health insurance, the vast majority of whom were eligible for premium assistance. The second open enrollment period, ending mid-February, brings new product offerings to additional enrollees. IHA staff developed a detailed Snapshot of 2015 Offerings and Early Enrollment for the IHA Board, which summarizes information about product offerings, performance measurement and network adequacy of the plans in 2015.
(Back to Top)
|
California's 1115 "Bridge to Reform" Waiver, a five-year demonstration of health care reform initiatives, is set to expire in October 2015. The State has the opportunity to build upon the momentum and successes achieved over the past five years with a waiver renewal. IHA was asked to provide technical assistance to the California Department of Health Care Services (DHCS) on the development of the next round of the State's 1115 waiver application to CMS. Specifically, IHA was asked to provide assistance to the Expert Stakeholder Workgroup on plan-provider incentives. The primary objectives of this focus area relate to reducing the total cost of care and trend and improving overall health outcomes. As a consultant, IHA is able to contribute the expertise we have built over the last decade to help inform the State's decision about the specific plan-provider initiatives included in the 1115 waiver application. Information on the 1115 waiver renewal process, including materials related to all the workgroups, is publicly available at http://www.dhcs.ca.gov/provgovpart/Pages/1115-Waiver-Renewal.aspx .
(Back to Top)
|
|
IHA Excellence in Healthcare Awards
IHA unveiled a new "Excellence in Healthcare" award in November that recognizes exceptional physician organizations (POs) with strong quality and cost performance. Based on Measurement Year 2013 Value Based P4P results, there were 11 POs that met the awards criteria. We would like to congratulate the following POs that are already delivering on the goal of improved healthcare value, and we look forward to learning from their successes.
- Affinity Medical Group
- Arch Health Partners
- Encompass Medical Group
- Hill Physicians Medical Group, Bay Region
- Hill Physicians Medical Group, Solano Region
- Mercy Medical Group/Dignity Health Medical Foundation
- Meritage Medical Network
- Physicians Medical Group of Santa Cruz
- PIH Health Physicians - Group Division
- St. Joseph Heritage Medical Group
- UC Davis Medical Group
Kaiser Permanente did not participate in reporting this first year, but efforts are underway so that it will be part of the Excellence in Healthcare Awards for Measurement Year 2014.
|
|
Medicare Stars Awards and Public Reporting
IHA also recognized the Medicare Stars Top Physician Organizations in November. Awards were presented to eight POs who received 5 Stars on the Overall Star Rating. Overall Star ratings are calculated using benchmarks and weighting established by CMS. In addition, forty-one POs earned 4.5 Stars. Medicare Stars Most Improved Physician Organizations were awarded at the meeting as well. Nine POs whose Overall Star rating improved by at least 1/2 star were recognized. Lists of all of the Measurement Year 2013 Award Winners are available on the IHA website. The physician group public report card for Medicare Advantage Measurement Year 2013 is also now available.
|
|
IHA's 10th National Pay for Performance Summit: March 2-4, 2015 in San Francisco
The National P4P Summit Breakout Sessions were announced in December. Join us in San Francisco this March to hear from leading experts on the topics of:
- Choosing Wisely: Unleashing Professionalism
- A Delivery System's Experience with a Very Large P4P Compensation Model
- Patient Engagement in Accountable Care Organizations
- Engaging Multiple Stakeholders in the Implementation of a Maternity Bundled Payment
- Advancing Primary Care Delivery: Practical, Proven, and Scalable Approaches
- Population Health Management: Creating a Clinically Integrated Network
- Paying for Quality: How to Promote Optimal Use of Appropriate Therapies
- Can We Truly Measure Healthcare Efficiency? Efforts in Linking Cost and Quality
- From Fee-for-Service to Fee-for-Value: BCBS of Michigan's Value Partnership Programs
- What Behavioral Economics Tells Us about P4P Design: Lessons from Some Medicaid Health Plans
- A Measure of the Quality and Value of Standardized Genomic Testing in an Integrated Health System: A Review From BayCare Health System
IHA Board and Affiliate members, and affiliates of our conference co-sponsors (AcademyHealth, AHRQ, CAHP, CAPG, CHCF, CPCA, CPR, CHQPR, HCI3, The Leapfrog Group, NCQA, NRHI, PBGH, and PQA) are eligible for registration discounts. Please contact Jen Kellar at jkellar@iha.org or 510-208-1742 for details and a discount code. Complete information is available at http://www.pfpsummit.com/.
(Back to Top)
|
|
New Coded DOFR ExplorerTM Search Tool
IHA will offer a new DOFR Explorer search tool for organizations to easily look up the codes organized by service and sub-service categories, consistent with our Coded DOFR Release 5.0 to be released in early March. The IHA Coded DOFR has been vetted by a multi-stakeholder workgroup that includes health plans, physician organizations and hospitals. It provides a framework for payers and providers to use when allocating financial responsibility for services in commercial HMO, POS and Medicare Advantage contracts. Having an industry-standard and codified DOFR alleviates claims misdirection by providing granular clarity at the code level. The online search tool will be available for a $99 annual license fee per user. The traditional downloadable DOFR Excel file is also available for purchase.
|
Changes in IHA Leadership
 As announced previously, long-time IHA CEO Tom Williams stepped down at the beginning of the year to take on an executive position at Stanford Health Care leading accountable care development, partnerships and operations. He was recognized at the January IHA Board Meeting with a resolution honoring his decade of leadership. IHA Senior Vice President of Programs and Policy Jill Yegian, PhD, has stepped into the role of Interim CEO and continues to provide leadership on IHA policy, research and programs. Pictured: Williams (right) with IHA Board Chair David Joyner (left), COO of Hill Physicians Medical Group. Tom can be reached at twilliams@stanfordhealthcare.org. (Back to Top) |
|
Staff Spotlight
Cayman Nava, Web Engineer/Developer
Cayman Nava manages the web platforms for the California Value Based Pay for Performance Program and other IHA projects. He is responsible for designing and building out the web infrastructure for IHA projects as well as automating reporting and analyses. Cayman earned a Bachelor of Science in Computer Science from the University of Texas at Dallas. He enjoys travelling and is an avid cryptocurrency enthusiast.
(Back to Top)
|
