California Adds Cost Data to Report Card on Medical Groups

The state of California is adding cost information to a report card that rates the quality and patient experience scores for major medical groups practicing in the state.

The report card allows consumers to find detailed information about more than 150 medical groups—such as whether they meet medical guidelines for managing chronic conditions or recommend routine screening tests. Scores are provided on a four-star scale.

The report card was developed as part of a partnership between the Integrated Healthcare Association, a not-for-profit group based in Oakland, Calif., and the California Office of the Patient Advocate.

The latest cost information comes from 2014 claims data and includes average annual payments from health plans and patients.

The move to add cost data to the quality report card began about five years ago, when the IHA sought a standardized definition for the total cost of care.

The definition that resulted includes costs for professional, pharmacy, hospital and ancillary services, but excludes claims over $100,000, which are likely for catastrophic conditions and can skew the data, said IHA’s president and CEO, Dr. Jeffrey Rideout.

It also doesn’t include certain services such as chiropractic, vision and substance-abuse care.

California is a state where managed care is deeply rooted, but the medical groups in the analysis vary in how they’re paid, whether capitated or on a fee-for-service basis. As benefit designs change, consumers also are picking up a greater share of their healthcare bills.

“I want people to recognize that this data exists,” Rideout said. “Without that, no one has a chance to improve anything. We view this as a quality improvement plan as much as anything else.”

The report card found 23 medical groups that achieved a four-star performance across all three report card categories. But the practices as a group also have shown improvement each year.

“Total cost of care interestingly has been trending down. We actually saw that going negative last year,” Rideout said. “These groups are doing what we asked them to do.”

California is the largest state to publicize this data, but similar initiatives also are underway in Maine and Minnesota.

In the Golden State, physicians can see how they perform relative to their peers in a geographic area, but the data is otherwise blinded. The IHA has started to perform some of its own analyses of the data, such as whether there’s a correlation between how a medical group performs on chronic care management and inpatient days, Rideout said.

One such analysis found significant variation in the cost of care. A medical group that performs in the top 10% for cost—and would have a four-star rating—provides care that averages less than $3,158 per patient. In contrast, medical groups in the costliest 10%—with a one-star rating—provide care that averages $4,744 per patient.

A number of groups across California have sought to provide greater transparency around cost and quality. Some of those data releases have included the number of cancer surgeries hospitals perform and the number of cesarean sections in low-risk, first-time mothers.

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