Highlights

2013-14 PCP QIP

Evaluation

Background

- The QIP provides financial incentives, data reporting, and technical assistance

- Fixed Pool Measures and Unit of Service Measures - All primary care providers with Medi-Cal assigned members

are automatically enrolled - 217 providers participated in the QIP; 122 in Southern

Counties and 95 in Northern Counties - In 2013-14, the base rate committed on a per member per

month basis is $5.5 - The total pay-out was $18 million

Research Questions

Continuing questions: • Has quality of care improved for PHC members in the

measures targeted through the QIP? • Have providers improved in their performance across

the measures? • How were total points and earnings distributed across

provider sites? • How engaged were providers in the program?

Has quality of care improved?

PHC Internal Use Only

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

CervicalCancer

Screening*

Child BMI* Well Child Adol Iz HbA1cControl*

LDL Control* BloodPressure

Retinal EyeExam

HbA1cTesting

LDL Testing* Nephropathy

Population-level performance rates by clinical measure in Southern Region

2011-12 2012-13 2013-14

*Demonstrates statistically significant improvement (p

Has quality of care improved?

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Child BMI CCS Well Child HbA1c good control ≤ 9%

LDL good control

Population Level Rate Comparisons

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Cervical Cancer Screening DTaP

Northern Region Southern Region

Has quality of care improved?

PHC Internal Use Only

*Demonstrates statistically significant improvement (p

Population Level Rate Comparisons

Measure Northern

Region

Southern

Region

Generic Prescription Rate 89.64% 88.07%

Formulary Prescription Rate 98.20% 98.08%

Outpatient Visits 2.76 2.63

Avoidable ED Visits 46.42 36.94

Has performance improved?

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Avoidable ED PCP Office Visits Open Practice

% of Sites that Met the Requirement in Southern Counties

2011-2012

2012-2013

2013-2014

Has performance improved?

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

IP Days/1000 Readmissions Pharmacy

% of Sites that Met the Requirement

2011-2012

2012-2013

2013-2014

Region Level Rate Comparisons

Measures Percent of eligible provider sites in

NR (85 sites) that met 50th

percentile target in 2013-2014

Percent of eligible provider sites in

Marin and Mendocino (29 sites)

that met 50th percentile target in

2011-2012

Cervical Cancer Screening 7% 8%

Measures Percent of eligible provider sites in

NR (4 sites) that met 50th percentile

targets in 2013-2014

Percent of eligible provider sites

in SR (122 sites) that met 50th

percentile targets in 2013-2014

DTaP 0% 43%

Region Level Rate Comparisons

Measures

Percent of eligible

Northern Region

provider sites that

met targets

Percent of eligible

Southern Region

provider sites that

met targets

Pharmacy Utilization 98% 99%

Avoidable ED visits 60% 62%

Practice open to PHC members 79% 58%

PCP office visits 66% 62%

How were points distributed?

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100

Distribution of Adjusted Points Weighted by Member Volume in Southern Counties

2012-13 2013-14

Region Level Rate Comparisons

Southern Region Northern Region

Average 66.7 65.8

Median 66.1 70.3

Lowest 20.0 20.0

Highest 100.0 100.0

How engaged are providers?

Number of Participants

2013-14 Kick-Off (Southern Region only) 56

3NA & Operations (Southern Region only) 26

eReports 66

Advance Care Planning 45

California Immunization Registry 40

3NA & Operations 49

Advance Care Planning – Peer Sharing 52

2013-14 Wrap-Up 81

List of Webinars and Number of Participants

Conclusion

- Quality of care received by our members has improved, as measured by the QIP

- More providers earned points in the Clinical and Appropriate of Resources domains

- The sites that received high earnings are taking care of the majority of our capitated members

- The Northern Region performed at comparable levels as the Southern Region, except in the clinical domain where data submission is crucial

Questions?

0

20

40

60

80

100

120

0 10000 20000 30000 40000 50000 60000 70000 80000

Adjusted Total Points Earned by Member Volume - Southern Counties

0

20

40

60

80

100

120

0 10000 20000 30000 40000 50000 60000

Adjusted Points Earned by Member Volume - Northern Counties