A coalition of California health insurers that last year paid $55 million to physician groups for reaching quality care measures in a pay-for-performance program has added care efficiency to its assessment domains.
Since 2003, the Integrated Healthcare Association's P4P program evaluated the state's physician groups in three quality domains: Clinical care, patient satisfaction and the use of information technology. The efficiency domain's measures will be separated into episode-based group efficiency, population-based group efficiency, efficiency by clinical area and generic drug prescribing.
"IHA's new efficiency measures are a first step to realizing the Institute of Medicine's seminal recommendations to include efficiency measurement at every level of provider aggregation, and to prioritize efficiency measurements in P4P," IHA board member Arnold Milstein, MD, said at the recent National Pay for Performance Summit in Los Angeles.
Ronald Bangasser, chairman of the IHA’s ethical quality committee, said the group is ready to take on care assessment after making adjustments in 2006. The rewarded money increased by only $1 million last year, and IHA only added one new measure, he said.
"We used that year to take a deep breath and catch up with the measures we had already put into place," said Bangasser. "Now we're looking at how to do efficiency right."
Additionally, IHA will test eight new quality measures in 2008, he said.
As an intermediary between the California Medical Association and IHA, Bangasser has ensured that the program follows the CMA's pay-for-performance guidelines. CMA requires that performance measures are valid and fair, and that the reporting is transparent.
"There can be no ownership of data," said Bangasser. "We all know what's going on with everything."
The 228 medical groups involved in the initiative can appeal if they find fault in the program's assessment or data transfering. The number of physician groups that appealed decreased from six or seven in 2005 to three in 2006, Bangasser said.
"The doctors in our groups generally felt that the measures were valid, and they felt like they could be held responsible for the data," he said. "We don't have a huge number of measures yet, but the doctors have felt that it's a few good measures."