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Pay for Performance and Regional Variation

Pay for Performance and Regional Variation. Michael J. Belman, MD MPH Anthem Blue Cross (California) Academy Health June 8 2008. Introduction. Integrated Healthcare Association (IHA) 5 th year of statewide measurement Over 200 groups and IPA,s in the program

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Pay for Performance and Regional Variation

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  1. Pay for Performance and Regional Variation Michael J. Belman, MD MPH Anthem Blue Cross (California) Academy Health June 8 2008

  2. Introduction • Integrated Healthcare Association (IHA) 5th year of statewide measurement • Over 200 groups and IPA,s in the program • Incentives from 7 California health plans • Clinical quality measures, Patient Satisfaction Survey, and Internal IT Resources • Anthem Blue Cross bonus payment for measurement year (MY) 2006 was $69 million, Total bonus for all CA plans > $150m

  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 Members 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 MetricsTreatment for Children with URI

  9. Regional Performance MetricsBreast Cancer Screening

  10. Regional Plus Ethnic Disparities

  11. IT Implementation Has Impact onClinical Quality Scores

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

  13. Change in performance over time

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

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

  16. 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

  17. Impact of Regional Variation on Quality Metrics including NCQA HEDIS CAHPS * 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.

  18. North East Region WellPoint/Anthem – CT, NH, ME HealthNet – CT Cigna – NH Aetna - CT California WellPoint/Anthem Blue Cross CA HealthNet – CA Cigna – CA Aetna - CA Impact of Regional Variation on US News and World Report (2007) HMO Ranking National Plans 186-216 National Plans in Top 35 Healthplan performance largely determined by regional factors (provider network, ethnicity, SES)

  19. 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 only thresholds or rank used to determine bonus • Breakthrough improvement may require investment in personnel and infrastructure

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