California physicians achieved across-the-board gains last year in 14 clinical performance measures used by the Integrated Healthcare Association to assess their quality of care. Significant improvements were also seen in all three measures promoting physician-group use of information technology. Six measures used to gauge patient satisfaction logged smaller gains.
The IHA measures track performance for more than 35,000 physicians representing 225 medical groups who care for more than 6.2 million HMO patients. The measures will be used by the seven health plans participating in the IHA's pay-for-performance program to calculate bonuses paid to physician groups. Last year marked the first time bonuses were awarded, and the total amount of the payouts was estimated at more than $40 million, said IHA Program Development Manager Dolores Yanagihara.
"Patient-wise and physician-wise, it's the largest (pay-for-performance program) in the country," said California Medical Association past President Ronald Bangasser, M.D.
Based in Walnut Creek, Calif., IHA is a statewide healthcare leadership group consisting of health plans, physician groups, healthcare systems, employers, consumer groups and other stakeholders. The plans participating in the program are: Aetna, Blue Cross of California, Blue Shield of California, Cigna, Health Net, PacifiCare and Western Health Advantage. Program data is collected by the National Committee for Quality Assurance.
"I think what was most notable -- and encouraging -- is that we saw improvements in all measures - notable and encouraging," said IHA Executive Director Tom Williams. "We believe the program itself has caught the attention of physicians, not just its financial incentives, but the breadth of the program as well."
Williams noted that there was a correlation between the medical groups with the highest IT scores and those with the highest clinical scores. Yanagihara said that she thought the most significant finding was the improvement in IT scores -- including a 71% jump in the integration of clinical data sets and a 69% gain in the use of decision-support.
Yanagihara said that an 8.2% increase in cervical cancer screening scores was also significant. "We thought we were maxing it before," she said. The IHA reported that this equals 117,000 more women getting tested.
Williams said physician feedback has been favorable "though it's not 100%." He said there has been some pushback from the addition this year of a performance measure for chlamydia screening, which he said was encouraged by the California Department of Managed Health Care in a response to a state public health problem.
Williams said a technical committee develops measures, which then are approved by a steering committee after receiving public comment and stakeholder recommendations.
One member of the steering committee is Steve McDermott, chief executive officer of the San Ramon, Calif.-based Hill Physicians Medical Group, an independent network of 2,600 physicians with 395,000 patients.
"We're pleased with the results, particularly because the program is in its infancy and we believe the results will be more dramatic as the program matures," McDermott said. "Pay-for-performance is standard in American industry, it's just the medical industry that's just catching up."
Information technology is "essential" in making healthcare pay-for-performance work, McDermott said, because of the data warehousing and data-mining functions it offers. These include "disease registries" that allow physicians to identify and track all the diabetics in their practice.
Although computers are generally viewed as the tools of younger physicians, McDermott said they are being accepted by older doctors and are being used to extend their careers.
"My own primary-care physician is an older, solo physician who was thinking of retiring because he couldn't keep up," McDermott said. "Now he's a lighter, happier guy. He enjoys going to work, and is not looking to retire anytime soon."
McDermott predicted that in the years to come the performance measures used in the IHA program will lead to a healthier population and a less costly healthcare system -- even though that is not necessarily what the program is designed to do.
"Pay-for-performance is not designed to lower healthcare costs; it's designed to improve the overall performance of what we're paying for," McDermott said. He added, however, that money will factor into the program's long-term success.
Hill Physicians received $5.7 million in IHA-related health plan bonuses last year, and McDermott said health plans will eventually need to expand the bonus pool beyond the original $40 million they paid out last year.
Bangasser, who chairs the program's technical committee and serves on the IHA board, said some physicians have complained that the bonuses weren't as large as they were hoping for. "But we haven't heard anyone say they didn't think the program was worthwhile and they weren't going to participate anymore," he said.