senate committee presentation - senate health committee

California Regional Health Care Cost & Quality Atlas Jeff Rideout MD, MA, FACPPresident and CEO

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The Integrated Healthcare Association (IHA)- a 501(c)6, NFP founded in 1994- advancing integrated care

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IHA’s Align. Measure. Perform. (AMP) & Atlas

AMP• Measures: 50 highly aligned

measures of clinical quality, utilization, total cost of care

• Who’s Included: Commercial HMO, commercial ACO, Medicare Advantage, and Managed Medi-Cal

• What’s Viewable: physician organization level performance

Atlas• Measures: Over two dozen

standardized measures of clinical quality, utilization, total cost of care

• Who’s Included: 29 million Californians inclusive of commercial HMO, PPO, Medicare FFS, Medicare Advantage and Medi-Cal

• What’s Viewable: geographic and product line performance information

Built on a single data platform with standardization throughout

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Key Takeaways from Atlas and AMP Analysis

• There is wide variation in quality and cost in California that is persistent over time

regardless of health plan product or provider delivery model

• Northern California and urban areas generally perform better on quality

• Southern California generally performs better on cost

• Less variation in Medi-Cal; comparability to commercial and MA is limited

• Health plan products that use integrated networks show superior cost and quality

overall and much lower patient cost sharing

• Financial risk sharing (capitation) between plans and providers tracks to higher

quality and lower costs—the more capitation, the better the performance

• Accountable Care Organizations (“ACOs”) have variable cost and quality performance but are

superior to non-integrated care networks

• Lack of Medi-Cal data limits Atlas’ ability to do comparable analysis

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Chronic Care Management - Wide Variation*-same pattern for preventive health screenings

* Lower is Better

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100

Diabetes Care:Blood Sugar

Control <8.0%

Diabetes Care:Poorly

ControlledBlood Sugar*

Appropriate Useof Imaging

Studies for LowBack Pain

AsthmaMedication

Ratio

Diabetes Care:Kidney Disease

Monitoring

Diabetes Care:Blood SugarScreening

Perfo

rman

ce R

ate

(%)

State Average

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100


Control <8.0%





AsthmaMedication

Ratio


Monitoring


Perfo

rman

ce R

ate

(%)

State Average

0102030405060708090

100


Control <8.0%





AsthmaMedication

Ratio


Monitoring


Perfo

rman

ce R

ate

(%)

State Average

0102030405060708090

100


Control <8.0%





AsthmaMedication

Ratio


Monitoring


Perfo

rman

ce R

ate

(%)

State Average

Los Angeles County

Santa Clara

CountyNorth Bay Counties

Alameda County

Contra Costa County

Alameda County

*commercial enrollees

3000

4000

5000

6000

Northern Central SouthernRis

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Wide Variation in Cost within and between CA Regions*-available at the county or Covered CA regional level


The Delivery Model Matters - Integrated Care Outperforms (typically HMO)*

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10

20

30

40

50

60

70

80

90

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18% difference

Integrated Care

Average55.65%

Best Integrated Care Average65.17%

Statewide Average47.11%

Highest Regional Average55.71%

78,500 More Diabetics with Blood Sugar Controlled


Commercial Cost Breakdowns

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Another View - Degree of Financial Risk Sharing Impact on Quality & Cost*

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No Risk (FFS) Professional Risk Only Full Risk

4,300

4,400

4,500

4,600

4,700

4,800

4,900

5,000

62

63

64

65

66

67

68

69

70

71

72

73

4,300

4,400

4,500

4,600

4,700

4,800

4,900

5,000

62

63

64

65

66

67

68

69

70

71

72

73

commercial enrollees

W

*

Medi-Cal Measurement - an Atlas Outlier Now

What Would High Value Care in California Deliver?

If care for all commercially insured Californians were provided at the same quality as the top-performing region:

205,000 more people would have been screened for colorectal cancer

30,500 more women would have been screened for breast cancer

If care were provided at the same cost as a relatively high-quality, low-cost region:

overall cost of care would decrease by an estimated $6.2 billion annually, a >10% decrease

Atlas 3 will be released in early April, t

hen annually going forward

Possible Actions*

• Focus investments on geographies and conditions in most need of improvement• Help define a uniform and practical definition of “value”• Support higher value care through plan designs and provider networks• Preferentially support integrated care models and financial risk sharing between

plans and providers• Drive full inclusion of Medi-Cal data into the Atlas program

*more complete list provided as a handout

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Questions?

senate committee presentation - senate health committee

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