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December 2017
Medicare Advantage 5-Star Rating of California Physician Organizations Results & Highlights Measurement Year 2016
© 2017 Integrated Healthcare Association. All rights reserved. 3
• Centers for Medicare & Medicaid Services (CMS) publicly reports performance of Medicare Advantage (MA) health plans on a variety of clinical quality, member experience, and customer service measures through a 5-star rating system.
• Building on the MA plan rating system, IHA measures performance and awards star ratings at the physician organization (PO) level in California using a subset of CMS clinical quality measures.
• PO-level performance measurement allows IHA to aggregate data across participating MA plans to identify performance variations and help plans and POs target quality improvement efforts.
• IHA publicly reports PO-level star ratings to help Medicare beneficiaries identify high-performing POs.
IHA Medicare Advantage 5-Star Reporting of Physician Organizations
© 2017 Integrated Healthcare Association. All rights reserved. 4
Program Evolution
2003
2008
2011
2012
2016
First year IHA measurement—commercial only
CMS publicly reports clinical quality and patient experience using a 5-star
rating system for MA health plans
IHA, using a subset of CMS measures for MA plans,
expands measurement to MA & publicly reports star ratings for California POs
CMS pays bonuses of up to 5% to MA health
plans with at least 4 stars
IHA partners with the California Office of the Patient Advocate to
publicly report PO MA star ratings
© 2017 Integrated Healthcare Association. All rights reserved. 5Copyright © 2015 Integrated Healthcare Association. All rights reserved. 5
5© 2017 Integrated Healthcare Association. All rights reserved.
Why Measure Medicare Advantage?
1 Jacobson, et al., “Medicare Advantage 2017 Spotlight: Enrollment Market Update”. Kaiser Family Foundation. Jun 2017. http://kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/2 Congressional Budget Office, “Medicare – Congressional Budget Office’s January 2017 Baseline,” January 24, 2017. https://www.cbo.gov/sites/default/files/recurringdata/51302-2017-01-medicare.pdf/
© 2017 Integrated Healthcare Association. All rights reserved. 6
Enrollment in California
• 27 health plans cover 2.3 million California MA beneficiaries
• POs contract with many MA plans for relatively small populations, making valid performance measurement and targeted quality improvement difficult
• Aggregation of results valuable for producing a single, valid summary of performance
© 2017 Integrated Healthcare Association. All rights reserved. 7
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Scr
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(%
)
Physician organizations contracting with more than one health plan
Aggregated and Plan-Specific Rates for Colorectal Cancer Screening
Aggregated Rate Min Plan-Specific Rate Max Plan-Specific Rate
Given a fragmented Medicare Advantage health plan market, aggregation of PO performance across plans creates a single summary of performance more credible than individual health plan estimates of PO performance.
Aggregation Strengthens Quality Performance Signal
For example, the identified PO’s aggregated performance across contracted plans is 75.94%. On plan-specific basis, the PO’s performance ranges from 40 to 87.8% – plan-specific results are more sensitive to variation in small numbers and reflect uncertainty about the PO’s actual performance.
© 2017 Integrated Healthcare Association. All rights reserved. 8
Program Elements
Common Measure Set & Methodology
Public Report Card
PO Recognition
88
© 2017 Integrated Healthcare Association. All rights reserved. 9
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Number of Physician Organizations
Nu
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of
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POs by Number of Medicare Advantage Health Plan Contracts
Kaiser Permanente Non-Kaiser
Measurement Includes Majority of MA Enrollees
• Five health plans with over 81% of MA enrollees in CA participate in IHA PO star rating program in MY 2016:
o Blue Shield of California
o Health Net
o Kaiser Permanente
o SCAN Health Plan
o UnitedHealthcare
• 181 participating physician organizations
Department of Managed Healthcare Financial Summary Data, 2016http://www.dmhc.ca.gov/DataResearch/FinancialSummaryData.aspx#.WhSukUqnGHu
© 2017 Integrated Healthcare Association. All rights reserved. 10
Measure Set
Measurement focuses on CMS MA Star domains that relate directly to PO care delivery performance. Of 21 PO-relevant measures in the three domains, IHA collects all 12 measures that do not require patient survey results or chart review.
Staying Healthy: Screenings, Tests
& Vaccines
Managing Chronic Conditions
Drug Safety
1. Adult BMI Assessment2. Breast Cancer Screening3. Colorectal Cancer Screening
4. All-cause Readmissions5. Diabetes Care – Eye Exam6. Diabetes Care – Blood Sugar Controlled7. Diabetes Care – Kidney Disease Monitoring8. Osteoporosis Management in Women Who Had a Fracture9. Rheumatoid Arthritis Management
10. Medication Adherence for Cholesterol (Statins)11. Medication Adherence for Diabetes Medications12. Medication Adherence for Hypertension (RAS
Antagonists)
© 2017 Integrated Healthcare Association. All rights reserved. 11
As MACRA expands performance measurement into the Medicare fee-for-service realm, measure alignment is an imperative. Participants in IHA measurement initiatives are ahead of the curve – the measures collected are well-aligned.
Measure Set Aligned with National Quality Priorities
IHA MeasureCMS MedicareAdvantage Plan
Star Rating
NCQA Medicare Plan Accreditation
IHA Value BasedP4P
CMS Merit-Based Incentive Payment
System (MIPS)
Adult BMI Assessment X X
All-Cause Readmissions X X X X
Breast Cancer Screening X X X X
Colorectal Cancer Screening X X X X
Diabetes Care: HbA1c Poor Control >9% X X X X
Diabetes Care: Kidney Disease Monitoring X X X X
Diabetes Care: Eye Exam X X X
Rheumatoid Arthritis Management X
High-Risk Medication (info only) X X X
Osteoporosis Management in Women Who Had a Fracture
X X X
Medication Adherence: Hypertension (RAS Antagonists), Cholesterol (Statins), Diabetes Medications
X X
© 2017 Integrated Healthcare Association. All rights reserved. 12
Calculating PO-Level Medicare Advantage Star Ratings
Collect and report measure results using VBP4P process
• Leverage better of audited PO results or plan-aggregated rates for awards and reporting
• POs review preliminary results prior to finalization
Apply CMS star rating cut points to individual measures
• Stars assigned according to cut points released by CMS in the fall
Calculate Overall star Rating for each PO
• Performance on 12 clinical measures combined to reflect an overall PO Medicare Advantage Star Rating
• Rating calculated by taking weighted average of the measure-level star ratings available for POs
• Consistent with CMS methodology, outcome measures are triple-weighted
Award 4.5 & 5–Star and Most Improved POs
• Overall PO MA star ratings are used to determine high performing and most improved POs
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© 2017 Integrated Healthcare Association. All rights reserved. 13
Program Elements
Standard Measure Set
& Methodology
Public Report Card
PO Recognition
1313
© 2017 Integrated Healthcare Association. All rights reserved. 14
5 STAR RECOGNITION (10 of 181 participating)
• Kaiser Permanente Northern California Permanente Medical Group:
‒ San Jose Medical Center
‒ San Rafael Medical Center
‒ South San Francisco Medical Center
‒ Vallejo/Vacaville Medical Centers
• Kaiser Permanente Southern California Permanente Medical Group:
‒ Orange County
‒ Woodland Hills
• Sutter East Bay Medical Foundation – Sutter East Bay Medical Group
• Sutter Palo Alto Medical Foundation - Mills-Peninsula Division/Mills-Peninsula Medical Group
• Sutter Palo Alto Medical Foundation – Palo Alto Foundation Medical Group
• UC San Diego Health
High Performing POs (MY 2016)Integrated Healthcare Association and its stakeholder partners recognize the following physician organizations for earning the highest overall star ratings for the quality of care provided to its Medicare Advantage members in Measurement Year 2016.
© 2017 Integrated Healthcare Association. All rights reserved. 15
• AMVI Medical Group
• Central Valley Medical Group
• Desert Oasis Healthcare
• Edinger Medical Group
• Family Practice Medical Group of San Bernardino, Inc.
• Greater Newport Physicians
• HealthCare Partners Medical Group
• Kaiser Permanente Northern California Permanente Medical Group: ‒ Diablo/Antioch Medical Centers‒ Fremont/San Leandro Medical Centers‒ Fresno Medical Center‒ Modesto/Manteca/Stockton Medical Centers‒ Redwood City Medical Center‒ Roseville/Sacramento Medical Centers‒ San Francisco Medical Center‒ Santa Clara Medical Center‒ Santa Rosa Medical Center‒ South Sacramento Medical Center
• Kaiser Permanente Southern California Permanente Medical Group: ‒ Antelope Valley‒ Baldwin Park‒ Downey‒ Fontana/Ontario‒ Kern County‒ Los Angeles‒ Panorama City‒ Riverside‒ San Diego‒ South Bay‒ West Los Angeles
• Northwest Orange County Medical Group
• Physicians Medical Group of Santa Cruz
• Riverside Medical Clinic
• Sansum Clinic
• Scripps Clinic Medical Group
• Sharp Rees-Stealy Medical Group
• Sutter Gould Medical Foundation – Gould Medical Group
• Sutter Medical Foundation – Sutter Medical Group
• Sutter Pacific Medical Foundation – Sutter Medical Group of the Redwoods
• Woodland Clinic Medical Group
• UC Davis Medical Group
High Performing POs (MY 2016)Integrated Healthcare Association and its stakeholder partners recognize the following physician organizations for earning the highest overall star ratings for the quality of care provided to its Medicare Advantage members in Measurement Year 2016.
4.5 STAR RECOGNITION (39 of 181 participating)
© 2017 Integrated Healthcare Association. All rights reserved. 16
MOST IMPROVED RECOGNITION
Most Improved POs (MY 2016)Integrated Healthcare Association and its stakeholder partners recognize the following physician organizations for outstanding improvement between Measurement Year 2015 and 2016 in overall star ratings for the quality of care provided to their Medicare Advantage members.
1.5-Star Improvement• Universal Care Medical Group
1-Star Improvement• Woodland Clinic Medical Group• UC San Diego Health
.5-Star Improvement• Angeles IPA• AppleCare Medical Group St. Francis• Brown & Toland Physicians – Alta Bates Medical Group• Central Valley Medical Group• Chaffey Medical Group• Desert Valley Medical Group Inc.• Dignity Health Medical Group - Inland Empire• Family Practice Medical Group of San Bernardino, Inc.• Genesis Healthcare• Greater Newport Physicians
.5-Star Improvement cont.• Hill Physicians Medical Group - Sacramento Region• John Muir Health• Kaiser Permanente Northern California Permanente Medical
Group:- San Rafael Medical Center- South San Francisco Medical Center- Vallejo/Vacaville Medical Centers
• Kaiser Permanente Southern California Permanente Medical Group - Woodland Hills
• Noble AMA IPA• Northwest Orange County Medical Group• Riverside Medical Clinic• Santa Clara County IPA (SCCIPA)• Sutter East Bay Medical Foundation – Sutter East Bay Medical
Group• Sutter Palo Alto Medical Foundation - Mills-Peninsula
Division/Mills-Peninsula Medical Group• UC Davis Medical Group
© 2017 Integrated Healthcare Association. All rights reserved. 17
Program Elements
Common Measure Set & Methodology
Public Report Card
PO Recognition
1717
© 2017 Integrated Healthcare Association. All rights reserved. 18
• IHA MY 2016 Medicare Advantage PO Star Ratings will be publicly reported via the Office of the Patient Advocate’s Medical Group Medicare Advantage Report Card in early 2018.
• Report card features overall star ratings, as well as individual measure rates and star ratings.
Public Reporting of PO-Level Performance
© 2017 Integrated Healthcare Association. All rights reserved. 19
Measurement Year 2016 Results & Highlights
© 2017 Integrated Healthcare Association. All rights reserved. 20
Enrollment Advantage
PO Performance Drives Health Plan Clinical Quality Performance
CMS MA Plan Financial Incentives
0% 1%
3%
8%
18%
24%
18%
22%
6%
0%
5%
10%
15%
20%
25%
30%
1 1.5 2 2.5 3 3.5 4 4.5 5
Ph
ysi
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Overall MA Star Ratings
CMS MA Plan Financial Disincentives
Overall PO performance on largely clinical subset of CMS measures in IHA’s Medicare Advantage Stars program contributes to overall health plan star ratings, which are tied to strong CMS financial and enrollment incentives.
© 2017 Integrated Healthcare Association. All rights reserved. 21
Participating California Health Plans Outperform National Plan Average on Quality MeasuresThe average health plan star rating for program participants is higher than the national plan average for 11 of the 12 measures collected.
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Adult BMI Assessment
Plan All-Cause Readmissions
Rheumatoid Arthritis Management
Medication Adherence for Diabetes Medications
Diabetes Care – Blood Sugar Controlled
Diabetes Care – Eye Exam
Medication Adherence for Cholesterol
Diabetes Care - Kidney Disease Monitoring
Colorectal Cancer Screening
Medication Adherence for Hypertension
Osteoporosis Management in Women who had a Fracture
Breast Cancer Screening
Health Plan Average Star Rating
IHA Participating HP Average National HP Average
© 2017 Integrated Healthcare Association. All rights reserved. 22
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Medications Adherence forHypertension (RAS
Antagonists)
Medical Adherence forDiabetes Medications
Medical Adherence forCholesterol (Statins)
Diabetes Care: HbA1c PoorControl >9.0%
All-Cause Readmissions
PO
Av
era
ge
Ra
te (
%)
MY 2015 MY 2016
Marked Gains on Outcome Measures
Higher-is-better measure Lower-is-better measure
Five measures collected by IHA are CMS triple-weighted outcome measures. Overall physician organization performance in MY 2016 improved on all five outcome measures, with statistically significant gains on 3 measures (denoted by *).
+2.9%*+2.2%* +3.2%*
-0.6% -0.4%
© 2017 Integrated Healthcare Association. All rights reserved. 23
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Adult BMIAssessment
Rheumatoid ArthritisManagement
Breast CancerScreening
Diabetes Care: EyeExam
Colerectal CancerScreening
Diabetes Care:Medical Attention for
Nephropathy
OsteoporosisManagement in
Women Who had aFracture
PO
Av
era
ge
Ra
te (
%)
MY 2015 MY 2016
Process Measures Steady or Improving
+3.1% -0.1%
+2.7%
+4.9%* +1.5%
+0.1%
+2.7%
Seven measures collected by IHA are CMS single-weighted process measures. Physician organization performance in MY 2016 improved on 6 of the 7 measures and 1 measure saw statistically significant improvement (denoted by *).
© 2017 Integrated Healthcare Association. All rights reserved. 24
Comparing results for POs participating in VBP4P and Medicare Advantage star ratings measurement suggests measure performance across populations and products is closely related; the correlation between PO performance in commercial VBP4P and Medicare Advantage Stars ranges from 0.56 to 0.84 for measures collected in both populations except readmissions (not shown).
Performance in Commercial HMO Correlated to Medicare Advantage Performance
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Me
dic
are
Ad
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Ra
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Commercial HMO/POS Rate
Diabetes Care - Blood SugarControlled
Breast Cancer Screening
Medication Adherence forHypertension (RAS Antagonists)
Medication Adherence forDiabetes Medications
Medication Adherence forCholesterol (Statins)
Colorectal Cancer Screening
Diabetes Care - MedicalAttention for Nephropathy
© 2017 Integrated Healthcare Association. All rights reserved. 25
• Health Plan Medicare Advantage star ratings tied to significant financial & enrollment incentives
• PO performance on quality measures drives plan ratings
• IHA Medicare Advantage star ratings aggregate PO performance across plans, increasing validity and amplifying performance improvement signal to POs
• PO performance improvement impacts all lines of business, not just Medicare Advantage
• IHA participating health plans and POs ahead of the curve, both on performance and measure alignment
Implications
© 2017 Integrated Healthcare Association. All rights reserved. 26
• Program Fact Sheet: Medicare Advantage 5-Star Reporting of Physician Organizations
• Press Release: California Medical Groups Honored for High-Quality Care of Medicare Advantage Patients
• Measure Specifications: Measurement Year 2016 VBP4P Manual
• Measure Set: Measurement Year 2016 Measure Set
Additional Resources