Models for Pay for Performance

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Models for Pay for Performance The Role of
Public Reporting Sandra Perez,
Director California Office of the Patient
Advocate California Association of Health
Plans ? Palm Desert, California ? October
20, 2009
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TODAY

• OPA Overview
• OPA Report Card
• Medical Group Report Card
• OPA Promotion of Report Cards
• Results
• Lessons Learned

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STATUTORY MANDATESOffice of the Patient Advocate

• Consumer Education

• Health Care Quality Report Card

• Advice and Assistance to HMO Enrollees

• Recommendations to DMHC

• Collaboration with Other Organizations

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OPA DMHC INTERFACEConsumer Assistance
Administration
OPA
DMHC
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DESIRED OUTCOMEOffice of the Patient Advocate

• Consumers who are engaged and empowered (through
  information and education) to
• proactively participate in their own health care
• act as their own advocates to access and use
  quality health care from their health plans.

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STATUTORY MANDATEHealth Care Quality Report Card
Health Safety Code 1368.02 (c)(3)(B) (B)
Compiling an annual publication, to be made
available on the departments Internet Web site,
of a quality of care report card including but
not limited to health care service plans.
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HEALTH CARE QUALITY REPORT CARDOffice of the
Patient Advocate

• OBJECTIVES
• To provide the public with useful, usable
  information on the quality of California health
  care.
• To create transparency, greater accountability,
  and incentive for improvement at all levels of
  the health care system.
• To engage consumers to become effective,
  efficient purchasers of health care.

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CONTENT (DATA SOURCES)2008 Health Care Quality
Report Card

• Californias 9 largest HMOs -- 95 of all
  commercial enrollees (HEDIS and CAHPS)
• 200 medical groups 85 of all commercial
  enrollees (HEDIS and PAS)
• Linguistic access information for 25 commercial
  and/or Medi-Cal plans (OPA Survey)

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OPA QUALITY PORTAL LINKS2008 Health Care Quality
Report Card

• Product Line Report Cards
• HMOs, PPOs, Medi-Cal, Healthy Families,
  Medicare, CalPERS
• Provider Type Report Cards
• Medical Groups, Hospitals, Long Term Care
  Facilities
• Language Services

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• Medical Group
• Report Card

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CLINICAL QUALIITY DATA (HEDIS)2008 Medical Group
Report Card

• Individual Clinical Measures (Bar Charts) - 14
• Asthma Cholesterol Control
  - Heart
• Breast Cancer Cholesterol
  Testing - Diabetes
• Cervical Cancer Cholesterol
  Control - Diabetes
• Colorectal Cancer Blood
  Sugar Testing - Diabetes
• Child Immunization Blood
  Sugar Control - Diabetes
• Chlamydia Screening Kidney
  Testing - Diabetes
• Cholesterol Testing - Heart Treating
  Children with URI
• Overall Clinical Composite Rating ( Chart )

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PATIENT EXPERIENCE DATA (PAS)2008 Medical Group
Quality Report Card

• Patient Experience Scores (Bar Charts) - 4
• Communicating with Patients
• Coordinating Patient Care
• Helpful Office Staff
• Timely Care Service
• Overall Rating ( Chart )
• Patients Rate Medical Group

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MEDICAL GROUPS SELECTORS2008 Medical Group
Report Card Website
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MEDICAL GROUPS MAIN PAGE Sacramento County 2008
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MEDICAL GROUPS ASTHMA (HEDIS)Sacramento County
2008
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MEDICAL GROUPS COMMUNICATING (PAS)Sacramento
County 2008
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MEDICAL GROUPS INDIVIDUAL PAGE2008 Medical
Group Quality Report Card
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TOP RATED MEDICAL GROUPS IHA2008 Medical Group
Quality Report Card
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• Outreach
• Education

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CHALLENGE Behavior Change

• Creating materials that consumers understand

• Providing information that consumers will use
  (need vs. want)

• Finding or creating the teachable moment

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CALIFORNIAS HMO GUIDESGeneral and Senior
Editions
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Where to get help
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DISTRIBUTION OF PRINTED SUMMARIES2008 Health
Care Quality Report Card

• Local Pharmacies
• Public Libraries
• Community Outreach
• Website Downloading/Printing
• Order Copies Toll-Free _at_ 1-866-HMO-8900

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LOCAL OUTREACH EVENTSOPA HEROICs
In FY 2008-09, OPA and its 15 local partners
(HEROICs) participated in over 1,000 local events
and made face-to-face contact with over 85,000
consumers.
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TARGETED POPULATION INITIATIVES Office of the
Patient Advocate

• Seniors
• (California Health Advocates)
• Women Making Decisions
• (California Health Collaborative)
• Mental Health Access Initiative
• (Mental Health Association in California)
• African-American Initiative
• (African-American Health Initiative of San
  Bernardino)

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SOCIAL MARKETING STRATEGIESOffice of the Patient
Advocate

• Increase Internet presence
• Expand and secure long-term distribution
  channels
• Traditional Multi-language Media (TV,
  Newspaper, etc.)
• Improve Effectiveness of Outreach Events

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PERFORMANCE METRICSReport Card Visitors Visits
by Fiscal Year
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PERFORMANCE METRICSReport Cards Distributed by
Fiscal Year
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Awareness and Use of Quality Ratings

• Hospitals Health Plans Physicians
• Saw rating
• Information 23 26 22
• Based on these
• ratings, considered
• a change 2 4 5
• Based on these ratings,
• actually made a change 1 1
  2
• Publication "Just Looking Consumer Use of the
  Internet to Manage Care." California HealthCare
  Foundation, 2008. www.chcf.org

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WHAT DO CONSUMERS SAY?OPA Health Care Quality
Report Card

• More interested in customer service than quality
• Want more data on the website (e.g., cost,
  physician)
• Prefer a detailed website to a printed summary
• Prefer health topics rather than summary
  categories
• Want to be able to customize the data
• Prefer public reporting from an objective
  third party

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Lessons Learned ENGAGING CONSUMERS

• Consumers are diverse and have complex needs.

• Information needs to be simple, personalized, and
  action-oriented (e.g., check lists, flow charts)

• The source of the information is as important as
  the information itself.

• All information competes in an environment of
  information overload.

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ISSUES CONSIDERATIONSMedical Group Quality
Report Card

• ? Rating Methodology
• Overall Composite Rating
• Sub-Topic Ratings (New for 2009)

? Consumer Use vs. Industry Accountability
? Consumers Desires vs. Available Data
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ACKNOWLEDGMENTS2008 Health Care Quality Report
Card

• Participating Health Plans (9) Medical Groups
  (200)
• California Cooperative Healthcare Reporting
  Initiative
• Integrated Healthcare Association
• Pacific Business Group on Health
• OPA Cultural Linguistic Services Work Group
• California Association of Health Plans
• Local Health Plans of California
• Walgreens, Leader, Independent Pharmacies

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COMING SOON !2009 Health Care Quality Report Card
VISIT
HealthCareQuality.ca.gov