Health Plans Make Quality Gains
The 2003 Report on Quality published by the California Cooperative Healthcare Reporting Initiative (CCHRI) provides new evidence that HMOs and medical groups in California are responding to public quality reports by improving performance. Since 2001, the plans’ average rate for controlling high blood pressure has increased 6.3 percent to 61.3 percent; similar improvements have occurred in asthma and diabetes care. Over the last three years, an additional 72,000 HMO members with diabetes showed improved levels of cholesterol control, preventing almost 300 deaths or subsequent heart attacks.

Read the CCHRI news release or get a full copy of the report from the link above to learn more about how California health plans and medical groups are improving quality of care. CCHRI is a collaboration of health plans, providers and purchasers, managed by PBGH.

Breakthrough Plan Competencies Assessed
As part of its ongoing Breakthrough Strategy, PBGH defined a set of Breakthrough Plan Competencies and conducted an inventory of best practices among leading California and national plans. A new report benchmarks ten health plans - PPOs, HMOs, and consumer-driven options - in the areas of health promotion, risk reduction/lifestyle behavior change, consumer health decision support, disease management, provider performance measurement, and consumer and provider engagement. The Breakthrough Plan Competencies were identified as having high impact on quality and trend moderation and defined in consultation with national clinical experts and health plans' medical leadership.

As expected, no single plan met all of the best-practice features. Most met some of the criteria in health decision support and disease management, but more effective consumer engagement in health promotion and risk reduction is a key opportunity. Consistently across all competency areas, plans fell short in quantifying net cost savings and premium impact and in offering incentives for participants.

PBGH and its members are meeting with plans to present study results, provide feedback and identify opportunities for improvement. Purchasers are using the report to inform benefit design and collaborate with plans to optimize consumer support and engagement. In addition, purchasers are incorporating competency expectations into RFPs, contract discussions and performance guarantees with plans. PBGH also is promoting the inclusion of these competencies in national standards for measuring plan value (e.g., NCQA's accreditation standards and guidelines). For more information, see the Executive Summary.

PBGH Evaluates and Promotes Better Health Plan Tools for Consumers
The leading health plans of California and the nation have made significant investments in developing enrollee Web sites to include health and provider search information and "self-service" functionality. While several plans have added evidence-based medicine and treatment option support tools, PBGH's Web tools evaluation indicates that many of these Web sites continue to focus on transactional features such as claims status and member ID card replacement. Read the Health Plan Web Site Core Requirements for a description of basic and best-in-class features that health plans can put in place to support consumer choice.

With much health content static in nature, significant opportunities lie in making the information more interactive, personalized to a member's health needs and tailored to an individual's plan design. Examples include augmenting physician directories with quality and efficiency metrics or supplementing formulary lists with generic drug substitution options and information on drug efficacy. While health plans have made strides in adding hospital quality information to their Web sites, integrating such data with benefit design and out-of-pocket costs can help members understand potential cost savings and trade-offs in their decision-making.

Public Reporting Spurs Care Improvements by Medical Groups
Medical groups that have participated over three years in a publicly reported survey of patient experience at the medical-group level have improved significantly in the quality of their care. That's the major finding of the third annual California Consumer Assessment Survey (CAS), a survey that asks HMO patients to rate the care they receive from doctors and other health care providers in their medical group.

The 50 medical groups that have participated in the consumer survey from its beginning three years ago have averaged 5-percentage point increases in patient access to care from a personal physician and in getting preventive health exams from the physician as soon as wanted. These findings demonstrate how performance measurement and public reporting can stimulate quality improvement efforts. The number of participating medical groups grew to 124 in 2003.

The results from the consumer survey will play a key role in California's Pay for Performance initiative next year, with CAS scores serving as one of the quality indicators on which health plans base bonuses to contracting medical groups. CAS results have been posted on the Web site of the California Office of the Patient Advocate HMO Report Card. They're also available on the PBGH HealthScope Web site, as well as through the Report on Quality of the California Cooperative Healthcare Reporting Initiative (CCHRI), which is on the new CCHRI Web site.

Medical Group Report Highlights Technology Gaps; Pay for Performance Likely to Accelerate Progress
A new study reveals that while many medical groups are making IT investments to support clinical care, it is likely that the California Pay for Performance initiative of the Integrated Healthcare Association will accelerate needed improvements in care delivery.

The Physician Organization Information Technology Capability study was sponsored by the Provider Group Oversight Improvement Project (P-GO) of the Pacific Business Group on Health, the National Committee for Quality Assurance and the California HealthCare Foundation. The report indicates that 80 percent of medical groups can monitor patient care with electronic data and can qualify for a portion of the quality bonus payments from health plans. However, fewer than half are able to make clinical information available electronically to most physicians.

The substantial room for improvement in this area underscores why purchasers, health plans and medical groups participating in Pay for Performance seek financial rewards to encourage all medical groups to invest in the technologies needed to reengineer care delivery. The IHA Pay for Performance Steering Committee recently doubled the portion of the bonus to be awarded for IT investment and added outcomes measures to the clinical data set.

California Hospitals Step Up to Leapfrog Reporting, Achieve Improved Heart Care
A record number of California hospitals are participating in the national Leapfrog survey on patient safety practices. Nearly two-thirds of California's 323 urban acute care hospitals completed the voluntary online survey that measures three cutting-edge practices to reduce preventable mistakes in hospitals. Read the Leapfrog California news release to learn more. The results are available online at www.leapfroggroup.org.

In addition, new data suggests that hospitals that participate in voluntary reporting perform better in delivering cardiac care. On average, hospitals that participate in California's voluntary program to report mortality associated with coronary artery bypass graft (CABG) surgery have a lower rate of mortality (2.7 percent) than do those that refuse to participate (3.3 percent), according to a new report on surgeries performed in 1999.

The California Report on Coronary Artery Bypass Graft Surgery, sponsored by PBGH and the State of California, compares risk-adjusted outcomes following heart bypass surgery at 70 hospitals. CABG reports are a concrete example of growing community expectations for public accountability for hospital quality, and in coming years will be a part of a mandatory, state-run program that will report outcomes at the surgeon-level. For more information, read the CABG news release and the Summary Report.

PBGH Spotlight is published by Pacific Business Group on Health 221 Main Street Suite 1500 San Francisco, CA 94105 phone: 415.281.8660 email: info@pbgh.org www.pbgh.org © 2000-9 PBGH