Health Center Controlled Network Pay for Performance A Bridge to - PowerPoint PPT Presentation

Health Center Controlled Network Pay for Performance “A Bridge to Health” Conference November 9, 2006 Ralph Silber, MPH Chief Executive Officer Community Health Center Network 1320 Harbor Bay Parkway, Suite 250 Alameda, CA 94502 www.chcn-eb.org

Our Community Health Centers Asian Health Services Axis Community Health La Clinica de La Raza LifeLong Medical Care Native American Health Center Tiburcio Vasquez Health Center Tri-City Health Center 2

Demographics of CHCN Patients*, 2005 (N=130,185) Sex % * Patients with 1 or more encounters Male 39 Race/Ethnicity % Female 61 Asian 22 African-American 11 Latino 32 Age % Native American 1 White 11 <15 29 Missing 17 15-24 16 Other 6 25-34 15 Payor % 35-44 13 None/Uninsured 23 100% Patient Pymt 8 45-54 10 Other Public Ins 11 55-64 8 Medi-Cal 40 Medicare 3 65+ 9 Healthy Families 3 Missing 6 3 Private Insurance 5

Pay-for-Performance Revenue Comes From: 1. CHCN Year End Savings 2. HMOs Pay for Performance Risk Distribution 4

CHCN Year End Savings HMO Full Risk Premium CHCN Receives PMPM for Professional Risk Trustee for Community Health Centers CHCN MSO Fee 11% of Total Premium Clinic 1 $ Clinic 2 $ Clinic 3 $ Clinic 4 $ Clinic 5 $ Clinic 6 $ Clinic 7 $ Risk Pool -$ or +$ 5

Distribution Pay-for-Performance funds are distributed to member community health centers based on Board and Medical Director approved Risk Distribution Policy. 6

Pay-for-Performance Distribution Pools Quality Indicators 20% Member Reserves Months 10% 70% 7

Pay-for-Performance Quality Indicators Community Health Center Executive Directors, Medical Directors Select 3-5 Performance Measures/Year Audit using Standardized Methodology QI Performance Results Clinical Report Cards Risk $ and Technical Reports Distribution 8

CHCN Data Warehouse The data warehouse contains demographic, diagnosis, service and lab data on all community health center patients (managed care & non-managed care) from our 7 health centers, and laboratory vendors. 9

Inputs-Outputs of Data Warehouse Inputs Outputs Encounters Population-based, Commercial HEDIS-like clinical lab Laboratory Data performance measures Warehouse (DW and hybrid with Registries + medical chart audits) • Diabetes Linkage • Asthma 2 health algorithms • Preventive Visits plans Enrollment Pharmacy Other Managed Care Data 10

2005 Quality Indicators # ISSUE Measure 1. Patient Satisfaction Response to the question on overall patient satisfaction. 2. Access to Care Response to question on ease of getting seen at clinic. Response to the question on ease of getting through on the phone during business hours. 3. Percent of patients with diabetes who have had A1c Diabetes measured in 12 month period. LDL frequency once every two years %LDL <100 mg/dl 11

# ISSUE Measure 4. Asthma Controller Medications Percent of patients with persistent asthma with evidence of controller medication prescribed Severity Classification Percent of patients with severity classification documented in the chart 5. Preventive Children aged 1- 15 months, 3-6 years, & 12-21 years, with all appropriate preventive visits Visits 6. Breast Cancer Screening % of women > 40 years of age 12

2004 Quality Indicator Results Performance Measure Average Health Center Score Overall Patient Satisfaction 89.4% Floor: 80% Ease of Being Seen 85.9% Floor: 75% Phone Access During Business Hours 75.2% Floor: 60% Well Child Visits, 1 – 15 Months 64.0% (Floor: 30%) Well Child Visits, 3 – 6 Years 48.0% (Floor: 30%) Well Child Visits, 12 – 21 Years 15.3% (Floor: 10%) 13

Performance Measure Average Health Center Score Asthma Controller Medication 79.4% Floor: 60% Smoking as a Vital Sign – Patient Asked at Last 85.0% Encounter Floor: 40% Diabetes (HbA1c), % Tested/12 Months 89.3% Floor: 70% Diabetes (HbA1c), % < 9 61.7% Floor: 40% Diabetes (LDL), % Tested/2 Years 88.9% Floor: 75% Diabetes (LDL), % LDL < 100 28.9% Floor: 25% 14

Percentage of Diabetics with 1 or More HbA1c Tests, 7/1/03-6/30/04 Percent 100 90 90 80 80 70 60 50 50 40 30 20 10 0 Healthy People 2010 HEDIS Average CHCN Average Goal 15

Frequency of 1 or More HbA1c Tests by Demographics and Insurance Coverage, CHCN, 2001 Ethnicity/Race Latino 92 Native Am. 93 Asian/PI 93 African Am. 84 White 79 Insurance Coverage Uninsured 92 Medi-Cal 93 Commercial 85 Medicare 91 0 20 40 60 80 100 % of Patients with 1 or More HbA1c Tests, 10/1/00 to 9/30/01 16

Prevalence of Asthma Controller Medication Use by Clinic and Patient Demographics, CHCN, 7/1/02 to 6/30/03 CHCN 87 CA Dept. of Managed Health Care 64 Medication Use HEDIS Averages 64 African Am. 93 Ethnicity/Race Asian/PI 91 Latino 85 White 77 0 20 40 60 80 100 % of Patients with Documented Controller Medication Based on 338 patients with 3 or more ICDs of 493, 4 or more pharmacy claims for an asthma medication, or 1 or more asthma hospitalizations (7/01/01 to 6/30/02) and not classified as “mild intermittent” asthma in medical chart 17

Age-Adjusted* Asthma Hospitalization Rates, CHCN, Alameda County, and California, 2003 250 Admissions per 100,000 200 165 141 150 113 100 CHCN Alameda California County * Adjusted to U.S. 2000 population Note: 65 admissions for CHCN, 2003 18

Prevalence (%) of Asking Adults about Tobacco Use During 1 or More Encounters, CHCN, 2002 - 2003 100 85% 80 59% 60 40 20 0 CHCN 2002 Ave. (N=649) CHCN 2003 Ave. (N=900) 19

20 $5.78 2004 Per Member Per Month $7.71 2003 Distributions FYE $9.07 2002 $6.67 2001 10 9 8 7 6 5 4 3 2 1 0 $