Health Center Controlled Network Pay for Performance A Bridge to - - PowerPoint PPT Presentation
Health Center Controlled Network Pay for Performance A Bridge to Health Conference November 9, 2006 Ralph Silber, MPH Chief Executive Officer Community Health Center Network 1320 Harbor Bay Parkway, Suite 250 Alameda, CA 94502
Ralph Silber, MPH Chief Executive Officer Community Health Center Network 1320 Harbor Bay Parkway, Suite 250 Alameda, CA 94502 www.chcn-eb.org
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3 Sex % Female 61 Age % Male 39 <15 29 15-24 16 25-34 15 35-44 13 45-54 10 55-64 8 65+ 9 Race/Ethnicity % Asian 22 White 11 None/Uninsured 23 Missing 6 100% Patient Pymt 8 Other Public Ins 11 Medi-Cal 40 Medicare 3 Healthy Families 3 Private Insurance 5 Missing 17 Payor % African-American 11 Latino 32 Native American 1 Other 6
* Patients with 1 or more encounters
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HMO Full Risk Premium CHCN Receives PMPM for Professional Risk Trustee for Community Health Centers CHCN MSO Fee 11% of Total Premium Clinic 1 $ Clinic 2 $ Clinic 3 $ Clinic 4 $ Clinic 5 $ Clinic 6 $ Clinic 7 $ Risk Pool
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Member Months 70% Quality Indicators 20% Reserves 10%
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Pay-for-Performance Quality Indicators Community Health Center Executive Directors, Medical Directors Select 3-5 Performance Measures/Year Audit using Standardized Methodology QI Performance Results Risk $ Distribution Clinical Report Cards and Technical Reports
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Population-based, HEDIS-like clinical performance measures (DW and hybrid with medical chart audits)
Commercial lab 2 health plans
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# ISSUE Measure 1. Patient Satisfaction Response to the question on overall patient satisfaction. 2. Access to Care Response to question on ease of getting seen at clinic. Response to the question on ease of getting through on the phone during business hours. Percent of patients with diabetes who have had A1c measured in 12 month period. LDL frequency once every two years 3. %LDL <100 mg/dl Diabetes
12 # ISSUE Measure Asthma Severity Classification Percent of patients with severity classification documented in the chart Controller Medications Percent of patients with persistent asthma with evidence of controller medication prescribed 4. 5. Preventive Visits Children aged 1- 15 months, 3-6 years, & 12-21 years, with all appropriate preventive visits 6. Breast Cancer Screening % of women > 40 years of age
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Performance Measure Average Health Center Score Overall Patient Satisfaction Floor: 80% 89.4% Ease of Being Seen Floor: 75% 85.9% Phone Access During Business Hours Floor: 60% 75.2% Well Child Visits, 1 – 15 Months (Floor: 30%) 64.0% Well Child Visits, 3 – 6 Years (Floor: 30%) 48.0% Well Child Visits, 12 – 21 Years (Floor: 10%) 15.3%
14 Performance Measure Average Health Center Score Asthma Controller Medication Floor: 60% 79.4% Smoking as a Vital Sign – Patient Asked at Last Encounter Floor: 40% 85.0% Diabetes (HbA1c), % Tested/12 Months Floor: 70% 89.3% Diabetes (HbA1c), % < 9 Floor: 40% 61.7% Diabetes (LDL), % Tested/2 Years Floor: 75% 88.9% Diabetes (LDL), % LDL < 100 Floor: 25% 28.9%
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50 80 90 10 20 30 40 50 60 70 80 90 100 Healthy People 2010 Goal HEDIS Average CHCN Average
Percent
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Frequency of 1 or More HbA1c Tests by Demographics and Insurance Coverage, CHCN, 2001
91 85 93 92 79 84 93 93 92
20 40 60 80 100
Medicare Commercial Medi-Cal Uninsured White African Am. Asian/PI Native Am. Latino
% of Patients with 1 or More HbA1c Tests, 10/1/00 to 9/30/01 Ethnicity/Race Insurance Coverage
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Prevalence of Asthma Controller Medication Use by Clinic and Patient Demographics, CHCN, 7/1/02 to 6/30/03
77 85 91 93 64 64 87
20 40 60 80 100
White Latino Asian/PI African Am. HEDIS CA Dept. of Managed Health Care CHCN % of Patients with Documented Controller Medication
Based on 338 patients with 3 or more ICDs of 493, 4 or more pharmacy claims for an asthma medication, or 1 or more asthma hospitalizations (7/01/01 to 6/30/02) and not classified as “mild intermittent” asthma in medical chart
Ethnicity/Race Medication Use Averages
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Admissions per 100,000
141 165 113
100 150 200 250
CHCN Alameda California
County
* Adjusted to U.S. 2000 population Note: 65 admissions for CHCN, 2003
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Prevalence (%) of Asking Adults about Tobacco Use During 1 or More Encounters, CHCN, 2002 - 2003
59% 85%
20 40 60 80 100
CHCN 2002 Ave. (N=649) CHCN 2003 Ave. (N=900)
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$6.67 $7.71 $5.78 $9.07 1 2 3 4 5 6 7 8 9 10 2001 2002 2003 2004 FYE $