A Prominent Peer-Reviewed Journal Highlights the Results
Healthcare quality in the United States lags behind that found in other developed high-income countries. Compared to other industrialized nations, the U.S. has the lowest life expectancy at birth and the highest death rates for avoidable or treatable conditions. L.A. Care Health Plan, the nation’s largest publicly operated health plan, developed a comprehensive provider quality improvement program to improve the quality of care for its more than 2.9 million members. The program, which is called Value Initiative for IPA (Independent Practice Association) Performance (VIIP), was recently featured in the well-renowned BMJ, a weekly peer-reviewed medical trade journal.
There is no industry standard for grading IPAs, often called medical groups, but with Medi-Cal moving toward value-based contracts and reimbursement, a system for measuring performance is critical. After months of testing, in 2015, L.A. Care settled on a standard set of metrics to provide a clear assessment of IPA performance, resulting in Pay-for-Performance incentives.
Provider engagement was critical to the success of the VIIP program. A multipronged approach was developed that included various means of outreach and interactions with IPAs, plan partners, clinics and physicians to discuss Quality Improvement (QI) efforts. Providers receive important data to help them improve their practices. There are regular meetings and webinars, in addition to the incentive dollars, for high performing and improving providers.
An analysis of 10 years of data found that the program improved several important measures of health care quality, which were laid out in the BMJ article. After the introduction of the VIIP program, L.A. Care found that trends on five out of ten quality measures either continued in a positive direction or changed completely from declining to improving. This included such measures as the percentage of members receiving cervical cancer screenings, and those getting prenatal and postpartum care.
L.A. Care continues to improve the VIIP program every year, watching trends carefully to ensure that the quality of health care keeps getting better for its members.