California: How do you measure up to HEDIS quality rates for IHA Value Based P4P?


As some may say, the West Coast is the best coast—at least when it comes to healthcare pay for performance.

Over the last 15 years, California’s statewide Pay for Performance (P4P) program, administered by the Integrated Healthcare Association (IHA), has become one of the largest alternative payment models in the United States. Renamed the Value Based P4P program in 2014, it now includes 10 health plans and more than 200 California physician organizations caring for 9 million Californians enrolled in commercial health maintenance organization (HMO) and point of service (POS) products.

The IHA Value Based P4P program leverages a common set of quality measures that are reported on across all participating health plans and physician organizations. Earlier this year, IHA released a tool on their website called HEDIS By Geography that aggregates results by geography and product line, making the data usable by healthcare consumers and other interested stakeholders. The tool currently includes information on six clinical quality measures, five resource use measures, and six demographic categories.

A Look at the Health of Diabetes Patients in California

We decided to take a closer look at two of the clinical quality measures, both related to diabetes care, to see which parts of the state may have room for improvement.

  • Diabetes Care: Hemoglobin A1c Screening
  • Diabetes Care: Hemoglobin A1c Poor Control (>9%)

We chose these two measures for analysis because in 2014, the American Diabetes Association estimated the cost of treating diabetes in the United States to be $245 billion. Needless to say, this is definitely an area that physician organizations should be thinking about as it relates to delivering high quality care and reducing costs. For the purposes of our analysis, we focused on HEDIS results at the level of the 19 Covered California regions in the state.

The chart below, produced by Able Health, shows in blue the percentage of members (health plan patients) between the ages of 18 and 75 years old, with diabetes, who had a hemoglobin A1c test during the measurement year (2013). In red is the percentage of patients, with diabetes, whose most recent hemoglobin A1c test was below 9% (or patients who did not have a test in 2013).

Members 18-75 with diabetes and appropriate care, by region

Regular hemoglobin A1c screenings are associated with better diabetes control. Based on the data presented by IHA, the Northern Counties of California (Region 1) are performing the lowest on this particular measure of health care quality at 80.59% and the North Bay Counties (Region 2) are performing the best at 93.82%. It is important to note, however, that several factors may contribute to performance on this measure, including patient compliance with follow-up visits and access to care. It is interesting, however, that the highest and lowest performers on this measure are so close geographically.

In addition to regular hemoglobin A1c screenings, another important measure for diabetes control is the actual value of the screening. The American Diabetes Association recommends a hemoglobin A1c value of less than 7% for most adults, and values greater than 9% typically indicate uncontrolled diabetes. The chart shows which California regions are doing the best at keeping diabetic patient hemoglobin A1c values lower than 9%.

After controlling for age, gender, enrollment date, race, payer type, and comorbidities, researchers have found that reducing a member’s hemoglobin A1c result from 8% to 7% was associated with $992 per year in savings and from 9% to 8% with $1,445 per year in savings.1 While exactly how much can be saved by controlling diabetes in the various regions of California, this data does show that simply ensuring that diabetics are getting regular hemoglobin A1c tests is not enough to help them control their hemoglobin A1c levels, which is what can lead to other health issues most in the short term and in the patient’s long term health.

How does your California physician organization measure up to your county-level rates? Setting clear targets can yield not only significant health outcomes and but equally large financial rewards from pay-for-performance programs like IHA Value Based P4P.

Photo credit: Giuseppe Milo

Lafeuille, M. Grittner, A. et al. Quality Measure Attainment in Patients with Type 2 Diabetes Mellitus. Am J Manag Care. 2014;20:S5-S15

Further reading:
Should I just do the minimum? 3 Reasons clinicians and groups are going all out in MIPS this year
MIPS Advancing Care Information: Frequently Asked Questions

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