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IHA News
February 24, 2016
IHA's newsletter is issued quarterly and provides key updates on IHA programs, initiatives, and publications. 
Message from the "Chief Collaboration Officer"
Heading into the heart of 2016, it feels a bit like going back to the future on payment reform. Federal payment reform efforts have given us a batch of new acronyms to master, including MACRA, MIP, and APM, but the core direction is really about integrating care delivery and advancing value-based payment efforts. Sound familiar? The rest of the nation is catching up to what California pioneered 20 years ago and continues to perfect through programs like IHA's work with "Choosing Wisely" adoption, Value Based P4P and Medicare Advantage Stars. I know we can't call it capitation anymore, but frankly that's what "population health payment" boils down to, and we are all supposed to get there by 2018. Fortunately, California physician organizations, health plans, hospitals and health systems, and other stakeholders have much to offer the rest of the nation when it comes to integrated care models, even as we continue to work through challenges on the ground. 

One major challenge, which has persisted for decades, is getting full and accurate encounter data without driving everyone to early retirement. Read about some early "wins" for all of us as we work through what it takes to do end-to-end standards. Also, read about IHA's efforts to leverage our success in the commercial Value Based P4P program to highlight the inaugural OPA reporting of Medicare Advantage Stars results at the physician organization level. And explore what is truly new: IHA's new look and feel, which you can experience for yourself on our new website. Last but not least, we welcome Barry Arbuckle, CEO of MemorialCare Health System, as our board chair for the next two years. We are blessed with strong and committed leadership throughout our Executive Committee and the board overall.

Sincerely,
Jeffrey Rideout, MD
 
IHA Launches New Look with Redesigned Website
New Logo Represents IHA Core Competencies
IHA launched a new logo and redesigned website in January. The new logo symbolizes IHA's core competencies: our expertise in health care performance measurement, data aggregation, analytics, reporting and alternative payment models, and our role as a trusted and neutral convener of diverse stakeholders across health care sectors committed to high-value, integrated care that improves quality and affordability for patients across California and the nation. Along with the fresh look, iha.org has improved functionality to make it easier for users to find IHA information and resources.

Encounter Data Initiative
Project Team Reaches Agreement on Form 837
As announced in November, IHA is working to put in place an industry-wide, end-to-end process standard for encounter data submissions. The project includes three main components: standardization of the "outbound" 837 form from physician organizations (POs) to health plans; standardization of the edit reports from plans/clearinghouses back to POs; and standardization of threshold, eligibility and alternate submission models. Since its launch, the project work group has agreed on a single interpretation of the 837 form; specifically 13 data elements that are subject to different interpretation across the various contracting parties. IHA is working with DMHC, DHCS, CMS and Covered California to ensure endorsement and alignment with the agreed interpretations; and with CAPG and CAHP to ensure endorsement and commitment for implementation with their member organizations. Next steps include collecting all data associated with the different edit reports coming from plans and POs, and producing an edit report process grid to serve as the basis for discussions on standardizing the edit reports. The project team consists of seven health plans (Aetna, Anthem, Blue Shield, Cigna, HealthNet, UnitedHealthcare, Kaiser Permanente) and seven POs (Brown & Toland, Dignity Health, HealthCare Partners, Hill Physicians, Monarch, Sharp Rees-Stealy, Sutter).

Decreasing Unnecessary Care in Partnership with Choosing Wisely�
Interventions are Underway at Partner Organizations
Avoiding wasteful or unnecessary medical tests, treatments and procedures is critical to improving the patient experience and creating value in the U.S. health care system. With support from the Robert Wood Johnson Foundation and ABIM Foundation's Choosing Wisely� campaign, IHA has partnered with Sharp Rees-Stealy Medical Group (San Diego County), Sutter Health (Sacramento/Central Valley/San Francisco Bay areas), the California chapter of the American College of Physicians, the Center for Healthcare Decisions, and Blue Shield of California to reduce overuse of antibiotics for adult bronchitis, diagnostic testing for low back pain, pre-operative stress testing, imaging for uncomplicated headache and repetitive complete blood count (CBC) and chemistry testing. 
 
Interventions are underway at both Sharp Rees-Stealy and Sutter Health. Sutter Health's approach centers on providing individuals actionable feedback in a group setting that is helpful and respectful. Sharp Rees-Stealy has a multi-pronged approach that includes clinical decision support, clinician education and comparative performance data, peer-to-peer consultation for clinicians, and patient education.The Center for Healthcare Decisions is near completion of the Doing What Works project, which captures the perspectives of the public on the best ways to reduce overuse. Results will be presented at an upcoming webinar.
 
IHA has compiled information about the project and related resources on our website, including a video interview by Daniel Wolfson of the ABIM Foundation's Choosing Wisely initiative with Jill Yegian, PhD about the IHA-led project.
 
Medicare Advantage 5-Star Reporting of Physician Organizations
Public Report Cards Coming in March 2016
Since 2008, the Centers for Medicare and Medicaid Services has publicly reported the performance of Medicare Advantage (MA) health plans on a variety of clinical quality, member experience and customer service measures through a 5-star rating system. Building on the MA star rating system for health plans, IHA uses a subset of 13 clinical measures to award star ratings at the medical group level in California. Along with providing beneficiaries with actionable information, measuring performance at the medical group level allows IHA to combine data from participating MA health plans to identify performance variations that can help plans and medical groups target quality improvement efforts. 
 
IHA released a summary of MY 2014 PO results in late 2015. Specific medical group ratings for Medicare Advantage will be publicly reported in partnership with the Office of the Patient Advocate (OPA) in March 2016. The medical group report card will include clinical measures ranging from breast and colorectal cancer screenings to eye exams and blood sugar control for patients with diabetes to managing osteoporosis in women with a previous fracture to appropriate medication management. 
 
IHA also congratulates all PO Medicare Stars Quality Award winners that earned Medicare Star ratings of 5 or 4.5 and the Medicare Stars Quality Improvement Award winners, who improved by at least 1 star rating over last year.
 
IHA Board Officer Succession
At its February meeting, the IHA Board of Directors formally approved the slate of officers for 2016-2017. The new officers are:
  • Chair - Barry Arbuckle, PhD, President & CEO, MemorialCare Health System (pictured)
  • Chair-Elect - Martha Smith, Chief Program Officer, Health Net
  • Past-Chair - David Joyner, Chief Executive Officer, Hill Physicians Medical Group
  • Treasurer - Tammy Wilcox, Senior Vice President of Managed Care, Dignity Health
  • Secretary - Barbara Wachsman, Senior Executive, Employee Health Benefits, Disney Worldwide
Staff Spotlight
Ginamarie Gianandrea, Value Based P4P Program Coordinator
Ginamarie Gianandrea supports Value Based P4P program communications and operations, with a focus on managing the clinical quality measure set. She is also responsible for meeting and event coordination for several IHA committees and the annual IHA Stakeholders Meeting. Ginamarie earned her B.A. with honors in Women and Gender Studies with minors in Critical Race Studies and Conflict Resolution from San Francisco State University. When she's not at the office working to get our stakeholders the critical information they need to succeed, Ginamarie enjoys delicious vegetarian cooking, volunteering with local non-profits benefiting women and girls, and training for her first marathon in July.
 
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