California Multi-Payer Collaborative Pilots Advanced Primary Care Measure Set

California Quality Collaborative (CQC) and Integrated Healthcare Association (IHA) of the Purchaser Business Group on Health (PBGH) partnered with health plans and purchasers to pilot a Advanced Primary Care Package Assess performance across a key set of outcome-focused measures to understand variance.

In the pilot, the IHA data set was used to identify more than 10,000 primary care practices and generate practice-level results across the suite of measures, including clinical quality, healthcare utilization, and total cost. of care measures.

The initiative represents a voluntary joint effort among payers to standardize how they fund, support and measure the delivery of Advanced Primary Care (APC).

A vendor called Cozeva serves as a common reporting platform to provide aggregated outcomes reporting for practices and payers participating in the initiative. Cozeva is a population health solution for clinical quality performance, risk adjustment, and total cost of care management. Cozeva’s platform will provide providers with a unified, payer-agnostic actionable record to measure and track outcomes through a single source of performance information across a suite of advanced primary care measures.

The initiative includes a focus on “Core 4,” a critical part of the advanced primary care suite. These four clinical measures are colorectal cancer screening, diabetes blood sugar control, high blood pressure control, and childhood vaccines. Core 4 is also an important component of performance expectations for health plans contracted with or regulated by Covered California, CalPERS, the Department of Managed Health Care (DMHC), and the Department of Health Care Services (DHCS).

According to initiative leaders, the measurement pilot uncovered several needs for the California health system:

• Expanded clinical data sharing through enhanced reporting capabilities and collaborative efforts between payers and purchasers to reduce administrative burdens for providers.

• Comprehensive views of practice-level performance for providers to facilitate meaningful insights at the point of care to improve quality of care and reduce health disparities. Systems interoperability, standard data specifications, and format alignment can facilitate effective data collection.

• Improved performance in population health management through practice-level data visibility, focusing on critical primary care quality indicators such as blood pressure control, depression screening, and childhood vaccines.

• Additional resources for primary care practices to improve quality of care, including shared tools, technical assistance, and team support.

During a December 2023 webinar, Dr. Lance Lang, a clinical consultant with the California Quality Collaborative, noted that the California Legislature, in establishing the Office of Healthcare Accountability (OCHA), called for greater investment in care primary. “IHA and CQC have been recruiting payers to collaborate to get ahead of OCHA’s upcoming requirements on a voluntary basis to rebalance spending and invest more in primary care,” he said. “Advanced Primary Care Measures have provided a way to track those outcomes.” to change the requirements.”

Lang emphasized that this is a big problem because payers won’t invest more unless they have a way to track results. He said previous attempts to do this focused too much on processes rather than outcomes. He said the measures will improve to include more key skills that explain why primary care is so important, such as tolerance for uncertainty or helping patients prioritize among all the various problems they bring to a visit.

Todd May, MD, vice president and chief medical officer at insurer Health Net, said the key issue here is alignment. “What’s really important is that the industry is aligning around quality, and one way to do that is to align on a relatively small set of high-impact metrics, rather than PCPs chasing dozens or hundreds of different metrics.” coming from different demands. ” he said. “Let’s get to the really critical measures. We now have several health plans aligned on this set of key measures. When all plans are aligned, it reduces the reporting burden for PCPs and allows them to focus on those key metrics.”

May added that value-based payment arrangements provide resources for practices to achieve these goals. “The APC project also provides technical assistance for clinic transformation – changing processes and workflows to optimize outcomes – and this is especially important for smaller clinics with limited resources,” she explained. “Implementing a common reporting platform is absolutely critical. This makes it easier for practices to track performance across multiple plans and not have to go to several different data sources. “This is the kind of industry alignment around quality we need.”

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