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Comprehensive medical group report card boosts health care transparency

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Two California organizations have teamed up to release a state-wide medical group report card that kicks health care transparency up a notch.

Oakland-based Integrated Healthcare Association and the Sacramento-based Office of the Patient Advocate have released a medical group report card that puts clinical quality, patient experience and cost-of-care ratings on display to encourage better health care value among providers.

The report card, which the organizations say is the first of its kind, rates more than 150 medical groups caring for 9 million patients enrolled in commercial health maintenance organizations and point-of-service programs offered by 10 health plans, according to a statement released Wednesday by the Integrated Healthcare Association.

There are various services that provide medical group cost ratings and others that offer quality measures, but this undertaking is the first to put all the information side-by-side, according to the associations. Minnesota, for example, in December published a report that compared cost of medical care at 115 medical groups.

The California medical group report card has for years included clinical quality and patient experience ratings. The addition of the average cost rating will help employers and consumers make better decisions on where to access health care, the organizations say.

“What we want to do is to be able to differentiate good outcomes and pair it up with lower than average costs,” said Elizabeth Abbott, Sacramento-based director of the Office of the Patient Advocate. “It's a terrific tool for both purchasers and for consumers.”

The report card uses a four-star system to rate each medical group by category. Clinical quality ratings are based on thousands of clinical measures endorsed by the National Quality Forum, a health care measurement organization, said Dr. Jeffrey Rideout, president and CEO of the Integrated Healthcare Association. Patient experience measures are based on direct survey responses taken yearly, he said.

And the cost ratings are determined by the average annual cost of care for each patient, including all pharmacy, hospital, ambulatory and out-of-pocket costs, he said. The data is provided by the medical groups. Mental health and chemical dependency costs are excluded from the measurement because of differences in benefit designs, Dr. Rideout said, and the calculation also excludes claims costs above $100,000, as such cases are extraordinary and could skew results. The report card awards a four-star cost rating for medical groups with the lowest average payment by the patient and health plan for care.

Dr. Rideout hopes the published data will prompt medical groups to do better in areas they might be struggling in. “What we are trying to do is get people information to do performance improvement, not necessarily to eliminate” providers, he said.

According to the Integrated Healthcare Association statement, total cost of care across the state varies widely, ranging from less than $3,158 on average per patient for 4-star medical groups in the least costly 10% to more than $4,744 for 1-star medical groups in the costliest 10%.

“There are 23 groups, which is about 10%, that actually perform well in all three (categories), and that's actually pretty tough to do, because sometimes the ones that are lower costs aren't necessarily higher quality,” Dr. Rideout said.

Employers can use these ratings to “promote quality improvement” at their provider organizations, he said, and they could also use the report card to design networks around organizations that are performing well in clinical quality, patient experience and cost categories.

According to Ms. Abbott, it's important for users of the data to view it holistically. “Price should not be the only consideration,” she said. “What you would want to do if you were a consumer or if you were picking for your family members or if you were picking as the health benefit manager for a company or a union, would be to get a good result, to have healthier employees, to have healthier family members, have healthier people who have good health outcomes.”