P4P Report: Information Technology Spurs Improved Clinical Quality Measures

The more that California physician groups use information technology (IT) to support patient management and care, the better they score on average on a range of important clinical quality measures, according to the Integrated Healthcare Association (IHA), which released pay-for-performance (P4P) program results.

California physician groups participating in the P4P program (now in its fourth year of public reporting) continued to improve across all three areas of performance measurement: clinical quality, patient experience and the use of IT.

The physician groups meeting all P4P criteria for IT had clinical scores 18 percent higher than those groups that did not meet any of the IT criteria.

"There is a significant difference in clinical achievements between groups that demonstrate little or no use of IT and those groups that have made a significant commitment to using IT to support patient care," said Steve McDermott, CEO of Hill Physicians Medical Group and an IHA board member.

"Pay-for-performance is proving to be an effective tool for motivating physician groups to invest in IT and to strive for higher levels of clinical performance and patient satisfaction," he said.

The program’s IT measures examine two areas: how physician groups use IT to manage patient populations, e.g., use of patient registries; and how IT is used at the point of care, e.g., e-prescribing, drug interaction checks, monitoring lab results, electronic messaging and preventive and chronic care reminders.

"When P4P results were first published in 2003, two-thirds of physician groups did not meet any IT criteria," said Tom Williams, executive director of IHA. "Today, only one-third do not meet any of our IT criteria."

According to Williams, the percentage of physician groups achieving the maximum score for IT increased by 23 percent. P4P program results are collected and analyzed by the National Committee for Quality Assurance (NCQA). Results  included:

• Fifty percent of physician groups showed improvements across all 14 of P4P’s clinical quality measures (including screening for cervical cancer, breast cancer, chlamydia and diabetes; childhood immunization; and asthma and cholesterol management).

• Patient experience ratings have slowly improved since the program’s inception, with patients reporting the most satisfaction overall with their doctor (87 percent) and doctor interaction (88 percent); but the lowest levels of satisfaction are with getting appointments with specialists (73 percent), access to care (74 percent) and coordination of care (75 percent).

"When incentives are appropriately aligned and when quality becomes more transparent to the public, physicians respond in ways that matter to both their patients’ health and care experience," said Dr. Robert J. Margolis, managing partner and CEO of HealthCare Partners and chairman of NCQA’s board of directors.

The  measurement  results will be used by health plans to calculate incentive payments for distribution to physician groups later this year.

Health plans have already distributed over $145 million in payments to physician groups as a result of meeting P4P quality measures. Each health plan develops its own formula to determine payments based on their physician group’s performance in relation to clinical quality and patient experience measures and adoption of IT.

Complete results for the clinical, patient satisfaction and IT measures are available now at www.iha.org. Scores for each participating physician group reflecting  performance on clinical and patient experience measures will be posted on the California Office of Patient Advocate Web site, www.opa.ca.gov, by mid-September.

Address: Integrated Healthcare Association, 344 Thomas L Berkley Way, Suite 350, Oakland, CA 94612; (510) 208-1740, www.iha.org.