Health Plan and Medical Group Quality Reports Now Available
California Cooperative Healthcare Reporting Initiative (CCHRI), a statewide measurement and reporting collaborative managed by PBGH, has released its 9th annual report comparing performance across California health plans and medical groups.  The results will be used by:

• Purchasers in selecting plan offerings and setting contribution strategy;

• Consumers in making important choices among health plans and medical groups (many employers make the results available through customized health plan chooser tools); and

• Health plans and medical groups to implement quality improvement programs and performance rewards.

The improvement in HEDIS clinical scores since 1999 represents 120,000 diabetics with better levels of cholesterol control, avoiding almost 500 deaths or subsequent heart attacks.   Additionally, patient experience ratings have steadily improved among medical groups participating in the survey since 2002. 

This year, the Integrated Healthcare Association Pay-for-Performance initiative used results to reward medical groups for clinical performance and patient experience, with additional incentives for information technology adoption.   Results are publicly available on PBGH's HealthScope consumer website and on California's Office of Patient Advocate (OPA) website (PBGH was recently awarded a two-year contract by the OPA to support publication of this annual statewide health plan and medical group performance report card).

The National Committee for Quality Assurance (NCQA) recently released its annual State of Health Care Quality report.  Findings suggest that "quality gaps" result in excellent care received by some, but poor care received by others.  The report emphasizes that nearly 66.5 million avoidable sick days and more than $1.8 billion in excess medical costs can be traced to the health care system's routine failure to provide needed care.  At the same time, the report notes, health plan performance has improved in several key areas including controlling high blood pressure and cholesterol management among diabetics.  PBGH supports NCQA efforts in health care measurement and improvement at the national level.  PBGH President and CEO, Peter Lee, participates on the NCQA Board of Directors.   Read more.     

PBGH and Leapfrog Update Hospital Patient Safety Information for Californians
2004 survey results are now available at www.leapfroggroup.org, where hospitals' self-reported progress in adoption of proven patient safety measures are tracked.  Adding to the "original three leaps" of computer physician order entry, hospitals' experience and performance with select high-risk procedures, and ICU staffing, these new results reflect a set of more robust measures, including a "4th leap" on the National Quality Forum's (NQF) Safe Practices for Better Healthcare.  The Safe Practices set, endorsed via the NQF's multi-stakeholder consensus process (in which PBGH played a substantial role), focuses on thirty evidence-based practices with demonstrated effectiveness in reducing the likelihood of adverse patient events.  For the first time on a national scale, hospitals reported on use of Safe Practices.  The 4th Leap enables hospitals to showcase a far broader range of patient safety initiatives.  Additionally, the survey was expanded to include hospitals in rural areas. 

PBGH manages Leapfrog's roll-out for California, and this year 53% of recruited hospitals voluntarily reported their implementation of "the leaps".  Additionally, PBGH reinforces plan engagement in Leapfrog through performance guarantees.   Health plans include Leapfrog measures in provider tiering formulas and incentives and are promoting increased consumer awareness of hospitals' commitment to patient safety improvement through use of hospital chooser tools.

In ongoing effort to align incentives for quality-of-care improvements, PBGH and Leapfrog endorse performance-based compensation.   In addition to administering the "Rewarding Results" program, which supports multiple pay-for-performance pilots, Leapfrog developed an Incentive and Reward Compendium. This tool summarizes efforts of purchasers, health plans, and coalitions that reward quality and efficiency improvements, using both financial incentives and public recognition.

PBGH Partners to Foster a National Agenda to Improve Health Care Value

PBGH co-founded and works closely with The Consumer-Purchaser Disclosure Group.   This group of leading employer, consumer and labor organizations share a common goal to ensure that all Americans have access to publicly reported health care performance information by January 1, 2007.  PBGH's work with the Consumer-Purchaser Disclosure Group has led to recommendations for the federal government.  Recognizing the important leverage held by CMS (Centers for Medicare and Medicaid Services), the FEBP (the Federal Employees Benefit Program), and the DOD (Department of Defense), the Disclosure Group urges the government to adopt measurement, public reporting, consumerism, and performance-based incentives to enable consumer selection of hospitals, physicians, physician groups/delivery systems and treatments based on clinical quality, consumer experience, equity and efficiency.  Visit Consumer-Disclosure Group's new website.

The Pacific Business Group on Health engages with other California and national policymakers to create an environment that will enable true competition and reward better value in health care. Through effective partnerships with these groups, PBGH's goals of transparency and quality in health care are advanced.  PBGH brings the strategic vision of our members and the expertise of our staff to bear on a wide range of initiatives.  PBGH working partners over the past year have included:

• AARP

• California Hospital Association

• CMS QIOs (Quality Improvement Organizations)

• Consumer-Purchaser Disclosure Group

• Consumers' Union

• Department of Managed Health Care

• Leapfrog Group

• National Committee on Quality Assurance

• National Quality Forum

• Various legislative committees and commissions

.

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