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Pay for Performance and Regional Variation: Do the Rich Get Rich and the Poor Stay Poor?

Pay for Performance and Regional Variation: Do the Rich Get Rich and the Poor Stay Poor?. Michael J. Belman, MD, MPH Tracy I. Wang, MPH Clinical Quality and Innovations Blue Cross of California National Pay for Performance Summit February 28, 2008. Introduction.

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Pay for Performance and Regional Variation: Do the Rich Get Rich and the Poor Stay Poor?

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  1. Pay for Performance and Regional Variation: Do the Rich Get Rich and the Poor Stay Poor? Michael J. Belman, MD, MPH Tracy I. Wang, MPH Clinical Quality and Innovations Blue Cross of California National Pay for Performance Summit February 28, 2008

  2. Introduction • Integrated Healthcare Association (IHA) 5th year of statewide measurement • Over 200 groups and IPAs in the program • Incentives from 7 California health plans • Clinical quality measures and Patient Assessment Survey • Total Blue Cross bonus payment for measurement year (MY) 2006 was $69 million

  3. Regional InequalityClinical Quality North vs. South CA

  4. Regional InequalityPatient Satisfaction North vs. South CA

  5. Blue Cross of CA HMO MembershipTotal = 1.4 Million SACRAMENTO (2%) 1% 5% 12% 12% 4% 40% % = Percent of Blue Cross HMO members in each region 18% 7%

  6. Clinical Quality by Region

  7. Patient Satisfaction by Region

  8. Regional Performance MetricsClinical Quality Overall Ranking

  9. Regional Performance MetricsPatient Satisfaction Ranking

  10. Regional Performance MetricsTreatment for Children with URI

  11. Regional Performance MetricsBreast Cancer Screening

  12. Kaiser Groups MY 2006 Clinical Results by Region Health Disparities and California P4P: Clinical Performance Variation Source: Slide courtesy of IHA – Data from www.opa.ca.gov

  13. IT Implementation Has Impact onClinical Quality Scores

  14. IT Implementation Has No Impact on Patient Satisfaction Scores

  15. Blue Cross Bonus Awards by RegionMY 2004 to MY 2006

  16. Bonus Awards by RegionDisparity Between Bonus vs. Membership

  17. Did the Rich Stay Rich?

  18. Did the Poor Stay Poor?

  19. Health Disparities and California P4P:Market Statistics (2005 Data) Source: 2006 HealthLeaders-InterStudy Market Overview

  20. Health Disparities and California P4P:A Tale of Two Regions

  21. Inland Empire Performance MetricsInland Demographics • Lower PCP and specialist numbers in Inland Empire compared to California and the nation • Lower number of college graduates and higher number with high school education or below • Ethnic breakdown amongst insured in San Bernardino County shows • Higher percent African American and Latino • Lower percent Asian and White • Lower percent insured in Inland Empire compared to California

  22. Regional Plus Ethnic Disparities

  23. Number of Members Impacted by Disparity Differ Across Regions

  24. Health Plan Distribution by Medical Group Performance * Blue Cross of California * * * 65% 58% Source: Danielsen, B. and Damberg, C. (2007) Analysis of the Relative Contributions of Health Plans and Provider Organizations to the 2007 PAS scores.

  25. BCBS – MA, RI Anthem (WellPoint) – CT, NH, ME, RI HealthNet – CT Cigna – NH Aetna - CT California HealthNet Blue Shield Blue Cross Aetna US News and World Report (2007) HMO Ranking National Plans 186-216 National Plans in Top 35 Healthplan performance determined by regional factors (provider network, ethnicity, SES)

  26. Conclusions • Persistent and consistent regional variation in performance • Low performing regions in general do not improve relative performance • Inland Empire has lowest score but Los Angeles County has largest population with low scores • Membership has not declined in poor performing groups • Regional disparities may adversely impact healthplan HEDIS • Current Incentive formula perpetuates disparity in bonus award if thresholds or rank used to determine bonus • Breakthrough improvement may require investment in personnel and infrastructure

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