Integrated Healthcare Association Honors Top Performing and Most Improved California Physician Organizations

<0> Integrated Healthcare AssociationCindy R. Ernst, 510-208‐1743 </0>

The Integrated Healthcare Association (IHA) today announced at the 2012 Annual Pay for Performance Stakeholders Meeting California’s top performing and most improved physician organizations. Out of nearly 200 physician organizations, the 47 top performers achieved the highest overall benchmark for quality in 2011 based on the IHA statewide Pay for Performance (P4P) program measures. In addition to celebrating the top performers, IHA honored the physician organizations that demonstrated the most quality improvement from 2010 to 2011.

Awards are based on performance in three P4P quality measurement domains: meaningful use of health IT, patient experience, and clinical measures that include priority conditions such as cardiovascular, diabetes, musculoskeletal, respiratory, and prevention.

The California P4P program enables physician organizations to earn health plan incentive payments based upon performance against a set of quality and efficiency measures. The program overall has demonstrated steady incremental improvements over the past ten years, and the efforts of some individual physician organizations to measure and improve physician performance has resulted in rapid gains from most improved status to that of a top performer. One notable example of this is Encompass Family Physicians Medical Group, who has shown consistent improvement over the past few years, and is now an IHA top performer. Encompass serves the East San Diego County Communities of La Mesa, El Cajon, Spring Valley, Rancho San Diego, Lemon Grove, and San Diego’s Mid City region.

The four physician organizations that achieved both top performing and most improved recognition for 2011 are: Arch Health Partners, St. Joseph Heritage Medical Group, and two Kaiser Permanente groups, in the Diablo/Antioch and Fontana/Ontario Service Areas.

Top performing physician organizations in 2011 were identified by an overall composite score, based on their P4P domain scores, and compared against a comprehensive benchmark calculated from the top 25 percent scores statewide for each P4P quality measure. Forty-seven organizations met the top performers’ criteria for 2011:

Physician organizations whose composite scores have improved the most over the previous year are recognized with the Ronald P. Bangasser, MD, Memorial Award for Quality Improvement. The most improved award winners for this year are:

Starting in 2013, a new Value Based Pay for Performance (P4P) design that aims to incorporate healthcare costs and appropriate resource use with quality will be implemented in the California P4P physician incentive program. Value Based P4P is a key step in holding organizations responsible for both the quality and cost of care delivered to their members, and is aligned with the national movement towards Accountable Care Organizations.

In addition to being used for determining awards, the 2011 P4P results are used by seven health plans – Aetna, Anthem Blue Cross, Blue Shield of California, Cigna HealthCare of California, Health Net of California, UnitedHealthcare, and Western Health Advantage – to calculate incentive payments for distribution to physician organizations in 2012. Since 2004, health plans have paid over $410 million in incentive payments to physician organizations for outstanding quality and service. Each health plan develops its own formula to determine payments, taking into consideration recommendations from the IHA P4P Governance Committee. Payouts for 2011 performance are distributed during the fall of 2012, and are expected to bring the total to nearly $450 million.

IHA is a statewide leadership group that promotes quality improvement, accountability, and affordability of healthcare in California. The IHA P4P program is the largest non-governmental physician incentive program in the U.S. and includes eight health plans (including Kaiser Permanente for reporting only) and nearly 200 medical organizations representing approximately 35,000 physicians providing care for about 10 million members. Other IHA programs include: value-based purchasing of medical devices, bundled episode of care payments, the measurement and reward of healthcare efficiency, healthcare affordability, administrative simplification, and accountable care organizations. For more information, please visit: .

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