California Medical Group Report Card Now Includes Cost as Well as Quality Information

OAKLAND, Calif., March 09, 2016 -- Marking a milestone for health care transparency, consumers and purchasers can now compare side-by-side cost and quality ratings for more than 150 medical groups caring for about 9 million commercially insured Californians.  

The result of a partnership between the nonprofit Integrated Healthcare Association (IHA) and the California Office of the Patient Advocate (OPA), the Medical Group Report Card is the largest statewide multi-payer public report card to provide side-by-side comparisons of both quality and cost measures at the medical group level—where care is delivered.

“The public reporting of total cost of care, alongside clinical quality and patient experience, at the physician organization level in California marks a milestone for health care transparency and shifting the focus from volume to value in health care,” said IHA President and CEO Jeffrey Rideout, M.D. 

“Agreeing on a common way of measuring total cost of care and gaining buy-in to report the results publicly was no easy task—it took a lot of hard work and collaboration from California physicians and health plans to make it happen,” Rideout said.

The report card uses a 4-star rating system to compare each medical group’s performance on providing recommended clinical care, patient experience, and average annual payments for care from both health plans and patients—also known as total cost of care.

Participating medical groups care for about 9 million Californians enrolled in commercial health maintenance organization (HMO) and point of service (POS) products offered by 10 health plans. The cost ratings are based on risk-adjusted annual payments to medical groups for each HMO/POS enrollee’s care, including amounts for professional, pharmacy, hospital and ancillary services and consumer cost sharing.

“Making side-by-side quality and cost information for medical groups available on such a large scale will help consumers make more informed choices and encourage providers to compete on cost and quality,” said OPA Director Elizabeth Abbott. “Research shows that higher costs do not necessarily mean higher quality care, and the report card shows that many medical groups provide high-quality care at a lower average cost than other groups.”

The cost data in the Medical Group Report Card—labeled as “Rating of Average Payment by Patients & Health Plan for Care”—were collected through IHA’s Value Based Pay for Performance program, one of the nation’s largest advanced alternative payment models designed to reward physician organizations that provide high-quality, affordable, patient-centered care.  

Across California, there is significant variation in the total cost of care—about $1,600 per patient per year—ranging from less than $3,158 on average per patient for 4-star medical groups in the least costly 10 percent to more than $4,744 for 1-star medical groups in the costliest 10 percent. The magnitude of variation indicates significant savings are possible if higher-quality, higher-cost medical groups can achieve performance levels comparable to higher-quality, lower-cost medical groups.

“Encouraging physicians to be accountable for both quality and costs is a critical step in getting better health care value,” Rideout said. “Through commitment to insurance products relying on integrated care delivery where physicians are responsible for the quality and cost of patient care, California plans and providers are at the forefront of advancing the triple aim of better care, better health and smarter spending.

Medicare Advantage 5-Star Rating System for California Physician Groups

In related news, OPA and IHA today also unveiled a new quality report card, the Medical Group Medicare Report Card, for medical groups caring for seniors and people with disabilities enrolled in Medicare Advantage health plans.

Since 2008, the Centers for Medicare and Medicaid Services has publicly reported the performance of Medicare Advantage health plans on a variety of clinical quality, member experience and customer service measures through a 5-star rating system. IHA uses a subset of 13 clinical measures to award star ratings at the medical group level in California.

The report card includes such clinical measures as those for breast and colorectal cancer screenings, eye exams and blood sugar control for patients with diabetes, managing osteoporosis in women with a previous fracture, and appropriate medication management. Collecting these measures at the medical group level allows IHA to combine data from participating health plans to identify performance variations that can help plans and medical groups target quality improvement efforts.

In previous years, IHA posted these star ratings on its website. To increase awareness and access to the ratings, IHA partnered with OPA to produce a public report card on OPA’s website at www.opa.ca.gov.

Based in Oakland, Calif., the nonprofit Integrated Healthcare Association (IHA) convenes diverse stakeholders—including physicians, hospitals and health systems, purchasers, and health plans—committed to high-value, integrated care that improves quality and affordability for patients across California and the nation.

Contacts:
Alwyn Cassil, Integrated Healthcare Association, (202) 271-9260, [email protected]
Ruben Mejia, Office of the Patient Advocate, (916) 445-3110, [email protected]