California Quality Collaborative Accelerating Improvement of the Commercial Delivery System Neil A. Solomon, MD Clinical

1. California Quality CollaborativeAccelerating Improvement of the Commercial Delivery SystemNeil A. Solomon, MDClinical Director, CQC

2. Regional Variation Clinical Performance Patient Ratings of Care MY 2006 P4P Results by Region Courtesy of IHA

3. California Quality Collaborative • Statewide collaboration of purchasers, health plans, physician groups, QIO, and their partners • Identify and accelerate adoption of innovations in ambulatory care to achieve the highest attainable value • By promoting system changes and care re-design • At the practice site • At the physician groups • For the benefit of all patients cared for by practices affiliated with delegated physician groups • With other organizational partners in California (e.g. government, public health, academic institutions) • To achieve the 6 IOM aims • Started as Diabetes CQI project (7 years), then Breakthroughs in Chronic Care Program (2 years): Progressive scope of work.

4. Strategy for Changing Practice Est. 13 million HMO and PPO Patients Lever for Change 110 Physician Groups Contract with: • What groups/IPAs can do that most doctors can’t: • Provide feedback reports from multiple payers • Invest capital for IT systems (EMR/registries) • Hire staff to redesign practice • Offer Practice incentives • Coordinate care across settings and offices 35,000 Practices Care for:

5. Run Implementation Collaboratives • Improving Patient Satisfaction Scores (PAS) • Improving Clinical Results • Improving Efficiency/Total Cost • Coordinate disease management between health plans and groups • Facilitate Regional Learning Networks • Conduct performance Improvement training for executives and executive teams

6. Improving Patient Experience 2007 • 4 groups participated in first implementation collaborative 2006-07, showed improvement across all 2008 P4P measures. Rating of all care improved 7.6%, twice state average. • Improved patient experience scores an average of 3 points in 9 months. Improved Staff Satisfaction over same time period • Documented key changes in change package published on web site www.calquality.org 2008 • Supported implementation of key changes at 8 more physician groups (estimated 1.2 million HMO/PPO enrollees) • Analyzed and submitted findings for publication 2009 • To begin implementation at additional 10 groups • Will disseminate best practices through one-day conference

7. Clinical Improvement 2006-08 • Improved 7 Diabetes and Cardiovascular process measures for practices at 13 physician groups (2 million HMO/PPO members) • HbA1c < 7 increased 28 percentage points (from 49% to 77%) over following 12 months while matched controls remained unchanged • In 2008, working with 23 more groups in Inland Empire In 2009: • Will Support implementation of best practices - reporting tools and workflows to improve clinical performance – in lower performing physician groups

8. Example: Diabetes Results in One Group Hill Physicians

9. Efficiency 2008 • Trained 6 physician groups (est. 1.2M HMO/PPO members) in methodology to engage physicians on reducing overuse • 4 focus areas: ED use, CAD testing, extremity MRIs, anti-HTN • Producing change package for managing ED use 2009 • Showcase methods to address variation and reduce overuse at one-day conference in March • Teach 8 new physician groups to address variation and overuse (integrating P4P Efficiency metrics) • Offer teleconferences on reducing ED use and improving generic prescribing

10. Regional Variation Clinical Performance Patient Ratings of Care MY 2006 P4P Results by Region Courtesy of IHA

11. Learning Networks • Inland Empire: • 31 physician groups participated over 12 month period • Participants improved more than others in the region better on P4P Patient Experience ratings (Clinical results to come..) 2007 to 2008. • Los Angeles and Orange County to start in Q4 20089

13. Steering Committee (summer 2008) Lance Lang, MD – Co-Chair Vice President, Senior Medical Director, Health Net Nancy Oswald, PhDExecutive Director, Redwood Community Health Coalition Susan Payan-Lopez California Diabetes Program Linda Sawyer, PhD, APRN , BC Chief Operating Officer, Lumetra Wells Shoemaker, MD Co-Chair Medical Director, California Association of Physician Groups Michael Van Duren, MD Medical Director Hill Physicians Ellen Badley Department of Managed Health Care State of California Mike Belman, MD, MPH Staff VP & Medical Director Quality Management, Blue Cross of California Michael-Anne Brown, MD Sr. Medical Director of Quality , Blue Shield of California Elizabeth Haughton Chief Counsel, NAMM Halsted Holman, MDProfessor of Medicine, Stanford University  David Hooper, MDChief Operating Officer, Palo Alto Medical Group David Hopkins, PhDDirector of Quality Management, Pacific Business Group on Health/CCHRI

14. 2007 Funding$1.2 Million