Using Measurement Data to Improve Quality

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Using Measurement Data to Improve Quality

• Michael J. Belman, M.D., M.P.H.
• Staff Vice PresidentMedical Director of Quality
  ManagementBlue Cross of CaliforniaWoodland
  Hills, CA

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Belman
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Blue Cross of California (BCC) and its Approach
to Quality

• 7 million members PPO, HMO, and Medicaid
• HMO 10 years of performance measurement
• 2002 multiple measures financial incentive
• 2003 PPO physician quality incentive
• Goal emphasize business case for quality

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About the Consumer Assessment Survey (CAS)

• Measures satisfaction w/physician medical group
• Derived from AHRQ-sponsored CAHPS survey
• Random sample selected from each medical group
• Results presented in 4 domains
• getting needed care
• getting care quickly
• physician communication
• overall rating

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BCC Combines Tools to Measure and Promote
Quality

• HMO report card combines
• Clinical quality
• Member satisfaction perceptions of care (CAS)
• Administrative service
• Added points for internal group incentive program
• Generic prescription performance
• Significant financial incentive tied to
  performance
• Profiles performance of about 160 medical
  groups/IPAs in California
• Report card on BCC web site

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BCC and Pay 4 Performance Program has Major Impact

• Business case for quality
• Open Access Programs improve member satisfaction
• Groups work to improve HEDIS performance
• IT investment to improve medical and patient
  management
• Synergy with Integrated Healthcare Association
  (IHA) Pay 4 Performance (P4P)
• Coalition of 6 major HMO plans in California
• P4P funded through RWJ grant

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Keys to Positive Physician Reaction

• Measures important to physicians member
• Clinical measures are well recognized based on
  HEDIS specifications
• CAS survey seen as reliable objective
• Administrative service measures tied to
  contractual requirements
• Physician leadership input before implementation

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BCCs CAS Results

• Bluecrossca.comgtfind a doctor or
  hospitalgtprovider performance profile
• Healthscope.orggtmedical groups
• Site of the Pacific Business Group on Health

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