The Pay for Performance initiative is a statewide program that focuses on developing and evaluating financial and non-financial incentives to improve the quality of health care being delivered in California. The California HealthCare Foundation has provided support, within the context of the national Robert Wood Johnson Foundation's "Rewarding Results" program, to the Integrated Healthcare Association (IHA) to lead one of the most comprehensive and ambitious programs in the country.
IHA is composed of top decision-makers from the major health care stakeholder groups in California. Members include health plans, physician groups, hospital systems, researchers, businesses or purchasing groups, and consumers. CHCF is also supporting RAND and the University of California, Berkeley to evaluate the impact of the IHA Pay for Performance initiative in California.
The Pay for Performance measurement set has been adopted wholly or substantially by seven major health plans in California: Aetna, Blue Cross, Blue Shield, CIGNA, Health Net, PacifiCare, and Western Health Advantage, which joined in 2004. These plans have introduced the program for their commercial HMO members, which represent about 6.2 million enrollees in California. In 2005 more than 225 physician organizations participated in at least one of the three performance measurement domains: clinical performance, patient experience, and information technology.
Pay for Performance data collection and aggregation is performed by the National Committee of Quality Assurance (NCQA). All seven participating health plans have submitted clinical data to NCQA. A number of physician groups have chosen to augment this information with self-reported data. The health plans are using these data to make quality performance incentive payments to physician organizations. In 2004 (2003 performance year) these payments totaled approximately $35 million.
The performance information is used for a public scorecard that ranks physician group performance. To prepare this scorecard, IHA is working with the California Office of Patient Advocate, which annually produces a scorecard on health plans and physician group performance on patient experience. This use of the Pay for Performance information marks the first time clinical performance information will be available on physician groups.