On Jan. 1, 2003, California health plans began receiving the first of millions of patient claims sent throughout the year from patients treated by thousands of physicians with managed-care contracts.
Twelve months later, at midnight on New Year's Eve, the claim stream for 2003 stopped.
Under a $50 million bonus-payment plan instituted for the first time this year by a consortium of six California managed-care plans, that data from the plans, plus any that the physicians could conjure up from their own practices, was submitted to the consortium's analysis company.
But the groups wouldn't get their data back until August 2004, some 19 months after the first claims were processed.
That's way too long, said Doug Allen, M.D., chief medical officer for the Greater Newport Physicians, an independent practice association of 145 primary-care physicians and 300 specialists in Newport Beach, Calif.
Allen is the physician champion of an innovative plan by the California Association of Physician Groups to speed up access to their own and other groups' comparative clinical data. To that end, the association has created the vast CAPG Clinical Data Repository, a data warehouse in which 11 major California IPAs and physician groups have agreed to participate and share information from 1.5 million patients.
"One of the goals of the warehouse is to do quarterly reports," said Allen, who serves as chairman of the CAPG's benchmarking committee, which is developing the repository.
Data analysis isn't foreign to any of the participating groups, Allen said. Most operate their own data repositories or, if they don't, they're contracting the work to outside vendors as they develop their own in-house capabilities, Allen said.
"You almost had to, to prepare for pay-for-performance," Allen said.
Greater Newport Physicians, for example, has run its own repository for three years, he said. The information pulled from the database feeds the group's disease-management programs and patient-action lists against Health Plan Employer Data and Information Set, or HEDIS, benchmarks, driving "phenomenal quality improvement," Allen said.
If the groups themselves have databases, why create this massive repository and do comparative benchmarking with other groups?
"It would help to know if you had high utilization of some test or procedure, if it was just some physicians in your area, or if this was statewide and was going up," Allen said. "Is the volume of face-to-face cardiology visits going up?"
Another reason for a multigroup warehouse is improved efficiency, Allen said. Having a central repository will give all the participating physicians access to sophisticated claims-matching programming that should improve claims-matching rates to 95%, he said.
In addition to claims data, the repository will receive lab results and pharmacy records
The development cost of the repository is $4 million, with the physicians looking to cooperating health plans and foundations for the initial funding. Beginning in 2006, participating groups are to contribute $20,000 each for operating costs.
The goal is to have the database operational by Jan. 1, 2005, and have the first reports by next summer.
"I think we've almost concluded enough funding to get started, so that might be imminent," Allen said.