Value Milestone: Public Reporting By Physician Organizations Of Costs Alongside Quality

On the winding road from volume to value in health care payment, today marks a milestone with the public reporting of total cost of care, alongside clinical quality and patient experience, at the physician organization level in California. The culmination of a partnership between the nonprofit Integrated Healthcare Association (IHA) and the state Office of the Patient Advocate (OPA), the Medical Group Report Card is the largest statewide multi-payer public report card to provide side-by-side assessments of physician organization performance on all three key aspects of value: clinical quality, patient experience, and costs. California physician organizations have reported publicly on quality measures through IHA’s Value Based Pay for Performance (Value Based P4P) program for years; data to support clinical quality ratings come from IHA, while patient experience ratings rely on the Patient Assessment Survey. But publicly reporting cost data is new for the more than 150 participating physician organizations caring for 9 million Californians enrolled in commercial health maintenance organization (HMO) and point of service (POS) products offered by 10 health plans. The four-star rating system for total cost of care shown in the exhibit below, is based on actual risk-adjusted annual payments made for the care of each physician organization’s HMO/POS enrollees, including professional, pharmacy, hospital, ancillary services, and consumer cost-sharing amounts. Agreeing on a commo...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Health Professionals Medicaid and CHIP Medicare Payment Policy Quality Alternative Payment Models California MACRA measures physician perspective value-based payment Source Type: blogs