PBGH Advances Physician Quality and Efficiency Measurement
PBGH is engaged in major initiatives to improve individual physician quality and efficiency.  Accurate and meaningful metrics can advance system change by supporting provider performance rewards and focusing improvement efforts.  Performance transparency is critical to individual physician behavior change and reducing variation in health care services.  The Physician Performance Project seeks to:

• Engage the physician community to use comparative performance information for quality improvement;

• Encourage benefit designs that incent consumers to make informed health care choices;

• Encourage health plan contracting and payment systems to include incentives that reward high quality and efficient physicians;
• Make performance information publicly available for consumer choice.

In a 2003 pilot, commercial and Medicare claims data were used to compare the relative efficiency with which individual physicians delivered care.  In the three physician specialties studied (Internal Medicine, Family/General Practice and Cardiology), estimated savings potential based on changes in physician practice or consumer choice of physician ranged from 1.5% to 4.8% of costs (which is similar to the range of 2-5% estimated by leading researchers and actuaries for the Consumer/Purchaser Disclosure Group).  PBGH will expand this project in 2004 to include several medical group pilots and efficiency analyses of additional specialties.  Read more.

PBGH and 12 Medical Groups Collaborate on Physician-Level Measurement

PBGH led a groundbreaking study in 2003 that surveyed 30,000 patients on their experience with individual doctors.  Until now, most standard surveys have focused on health plan and medical group-level measurement.  This survey captured patient experience with 400 doctors belonging to six medical groups.  The results are significant because they establish that:

• Performance can be meaningfully distinguished among physicians at 30-40 patients per doctor;
• Survey results collected on the Web are comparable to mail survey results;
• Select survey questions from standard satisfaction questionnaires at the medical group and health plan levels can be reliably used at the physician level;
• Medical groups recognize the survey results report as an effective quality improvement tool.

Twelve medical groups, representing a broad cross-section of California provider organizations, are participating in the 2004 survey.  This phase of the project will include approximately 1200 doctors and nearly 100,000 patients.  Findings of this survey will be used by medical groups for quality improvement and may qualify them for bonus money through California's IHA Pay for Performance program, which will adopt physician measurement as a group-level reward in 2006.  In years to come, PBGH sees this information as an important addition to assist consumers in choosing doctors.  Stay tuned for further work in this area.  Read more.

PBGH's Health Plan Chooser Earns High Marks from Employers

Large employers that are using the PBGH Health Plan Chooser are getting very satisfied feedback from employees.  At a time when it is more important than ever for employees to understand their benefit decisions, employers have a means of communicating key features of their plans:

• Annual premium cost;
• Estimated OOP cost based on individual's self-rated likelihood of using services;
• Quality information about the health plan, using clinical outcomes and patient experience data based on standard metrics;
• Doctor affiliation linked to plan and plan type (PPO, POS, HMO, and CDHP);
• Plan rules and features including selection of a PCP, referrals, availability of disease management and nurse advice services.

The PBGH Health Plan Chooser tool allows users to rank health plans by "fit" based on self-selected attributes and self-reported projections of medical service usage.  By understanding how employees make plan-selection decisions, employers are able to better meet plan choice and communication needs. Employee feedback affirms that these five attributes are central to plan choice.  In one employer's population, over half of user survey respondents elected to make a change in their current plan. As a service to its members, PBGH also recently completed an evaluation of plan chooser tools sponsored by private vendors. 

Purchasers Recognize Importance of Pay for Performance

PBGH continues to support the business case for quality through the Pay for Performance (P4P) statewide collaborative, managed by Integrated Healthcare Association (IHA).   P4P rewards physician organizations based on common metrics in clinical quality, patient experience, and IT investment through public reporting and health plan bonus payments.   Six plans will make bonus payments in 2004: Aetna, Blue Cross, Blue Shield, CIGNA, Health Net and PacifiCare (Western Health Advantage joins in 2005). 

The 2005 measure set  includes:

• Three new clinical measures: Chlamydia screening, appropriate antibiotic use, and depression treatment;
• Incremental adoption of "outcomes measures" with a composite score based 50% on testing rates and 50% on actual levels for Hemoglobin A1c and low-density cholesterol levels;
• Increased weighting of the portion of the bonus for groups' information technology adoption.

The California IHA Pay for Performance initiative is garnering national attention; it was described in recent articles in Wall Street Journal and the Journal of the American Medical Association. PBGH members helped launch the program in its infancy, developed the statewide measurement system with NCQA, and continues to encourage health plans (through contractual performance standards) to participate fully in this unique program to align incentives to improve care.  Proposed 2006 measures will recognize efforts undertaken by provider organizations to evaluate and reward the performance of individual physicians.  A comparison of plan programs, along with other program information is posted on the IHA Website.

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