Medicare Advantage 5-Star Rating of California Physician Organizations Results & Highlights Measurement Year December 2017

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1 Medicare Advantage 5-Star Rating of California Physician Organizations Results & Highlights Measurement Year 2016 December 2017

3 IHA Medicare Advantage 5-Star Reporting of Physician Organizations Centers for Medicare & Medicaid Services (CMS) publicly reports performance of Medicare Advantage (MA) health plans on a variety of clinical quality, member experience, and customer service measures through a 5-star rating system. Building on the MA plan rating system, IHA measures performance and awards star ratings at the physician organization (PO) level in California using a subset of CMS clinical quality measures. PO-level performance measurement allows IHA to aggregate data across participating MA plans to identify performance variations and help plans and POs target quality improvement efforts. IHA publicly reports PO-level star ratings to help Medicare beneficiaries identify highperforming POs Integrated Healthcare Association. All rights reserved. 3

4 Program Evolution First year IHA measurement commercial only IHA, using a subset of CMS measures for MA plans, expands measurement to MA & publicly reports star ratings for California POs IHA partners with the California Office of the Patient Advocate to publicly report PO MA star ratings CMS publicly reports clinical quality and patient experience using a 5-star rating system for MA health plans CMS pays bonuses of up to 5% to MA health plans with at least 4 stars 2017 Integrated Healthcare Association. All rights reserved. 4

Why Measure Medicare Advantage? 1 Jacobson, et al., Medicare Advantage 2017 Spotlight: Enrollment Market Update. Kaiser Family Foundation. Jun 2017. http://kff.

5 Why Measure Medicare Advantage? 1 Jacobson, et al., Medicare Advantage 2017 Spotlight: Enrollment Market Update. Kaiser Family Foundation. Jun Congressional Budget Office, Medicare Congressional Budget Office s January 2017 Baseline, January 24, Integrated Healthcare Association. All rights reserved. 5 Copyright 2015 Integrated Healthcare Association. All rights reserved. 5

6 Enrollment in California 27 health plans cover 2.3 million California MA beneficiaries POs contract with many MA plans for relatively small populations, making valid performance measurement and targeted quality improvement difficult Aggregation of results valuable for producing a single, valid summary of performance 2017 Integrated Healthcare Association. All rights reserved. 6

7 Colorectal Cancer Screening Rate (%) Aggregation Strengthens Quality Performance Signal Given a fragmented Medicare Advantage health plan market, aggregation of PO performance across plans creates a single summary of performance more credible than individual health plan estimates of PO performance. 100 Aggregated and Plan-Specific Rates for Colorectal Cancer Screening Physician organizations contracting with more than one health plan Aggregated Rate Min Plan-Specific Rate Max Plan-Specific Rate For example, the identified PO s aggregated performance across contracted plans is 75.94%. On plan-specific basis, the PO s performance ranges from 40 to 87.8% plan-specific results are more sensitive to variation in small numbers and reflect uncertainty about the PO s actual performance Integrated Healthcare Association. All rights reserved. 7

9 Number of Health Plan Contracts Measurement Includes Majority of MA Enrollees Five health plans with over 81% of MA enrollees in CA participate in IHA PO star rating program in MY 2016: o Blue Shield of California o Health Net o Kaiser Permanente o SCAN Health Plan o UnitedHealthcare POs by Number of Medicare Advantage Health Plan Contracts participating physician organizations Number of Physician Organizations Kaiser Permanente Non-Kaiser Department of Managed Healthcare Financial Summary Data, Integrated Healthcare Association. All rights reserved. 9

Measure Set Measurement focuses on CMS MA Star domains that relate directly to PO care delivery performance.

Staying Healthy: Screenings, Tests & Vaccines 1. Adult BMI Assessment 2. Breast Cancer Screening 3.

Diabetes Care Blood Sugar Controlled 7. Diabetes Care Kidney Disease Monitoring 8. Osteoporosis Management in Women Who Had a Fracture 9.

10 Measure Set Measurement focuses on CMS MA Star domains that relate directly to PO care delivery performance. Of 21 PO-relevant measures in the three domains, IHA collects all 12 measures that do not require patient survey results or chart review. Staying Healthy: Screenings, Tests & Vaccines 1. Adult BMI Assessment 2. Breast Cancer Screening 3. Colorectal Cancer Screening Managing Chronic Conditions 4. All-cause Readmissions 5. Diabetes Care Eye Exam 6. Diabetes Care Blood Sugar Controlled 7. Diabetes Care Kidney Disease Monitoring 8. Osteoporosis Management in Women Who Had a Fracture 9. Rheumatoid Arthritis Management Drug Safety 10. Medication Adherence for Cholesterol (Statins) 11. Medication Adherence for Diabetes Medications 12. Medication Adherence for Hypertension (RAS Antagonists) 2017 Integrated Healthcare Association. All rights reserved. 10

11 Measure Set Aligned with National Quality Priorities As MACRA expands performance measurement into the Medicare fee-for-service realm, measure alignment is an imperative. Participants in IHA measurement initiatives are ahead of the curve the measures collected are well-aligned. IHA Measure CMS Medicare Advantage Plan Star Rating NCQA Medicare Plan Accreditation Adult BMI Assessment X X IHA Value Based P4P CMS Merit-Based Incentive Payment System (MIPS) All-Cause Readmissions X X X X Breast Cancer Screening X X X X Colorectal Cancer Screening X X X X Diabetes Care: HbA1c Poor Control >9% X X X X Diabetes Care: Kidney Disease Monitoring X X X X Diabetes Care: Eye Exam X X X Rheumatoid Arthritis Management X High-Risk Medication (info only) X X X Osteoporosis Management in Women Who Had a Fracture Medication Adherence: Hypertension (RAS Antagonists), Cholesterol (Statins), Diabetes Medications X X X X X 2017 Integrated Healthcare Association. All rights reserved. 11

12 Calculating PO-Level Medicare Advantage Star Ratings Collect and report measure results using VBP4P process Leverage better of audited PO results or plan-aggregated rates for awards and reporting POs review preliminary results prior to finalization Apply CMS star rating cut points to individual measures Stars assigned according to cut points released by CMS in the fall Calculate Overall star Rating for each PO Performance on 12 clinical measures combined to reflect an overall PO Medicare Advantage Star Rating Rating calculated by taking weighted average of the measure-level star ratings available for POs Award 4.5 & 5 Star and Most Improved POs Overall PO MA star ratings are used to determine high performing and most improved POs 1 2 Consistent with CMS methodology, outcome measures are triple-weighted Integrated Healthcare Association. All rights reserved. 12

14 High Performing POs (MY 2016) Integrated Healthcare Association and its stakeholder partners recognize the following physician organizations for earning the highest overall star ratings for the quality of care provided to its Medicare Advantage members in Measurement Year STAR RECOGNITION (10 of 181 participating) Kaiser Permanente Northern California Permanente Medical Group: San Jose Medical Center San Rafael Medical Center South San Francisco Medical Center Vallejo/Vacaville Medical Centers Kaiser Permanente Southern California Permanente Medical Group: Orange County Woodland Hills Sutter East Bay Medical Foundation Sutter East Bay Medical Group Sutter Palo Alto Medical Foundation - Mills-Peninsula Division/Mills-Peninsula Medical Group Sutter Palo Alto Medical Foundation Palo Alto Foundation Medical Group UC San Diego Health 2017 Integrated Healthcare Association. All rights reserved. 14

15 High Performing POs (MY 2016) Integrated Healthcare Association and its stakeholder partners recognize the following physician organizations for earning the highest overall star ratings for the quality of care provided to its Medicare Advantage members in Measurement Year STAR RECOGNITION (39 of 181 participating) AMVI Medical Group Central Valley Medical Group Desert Oasis Healthcare Edinger Medical Group Family Practice Medical Group of San Bernardino, Inc. Greater Newport Physicians HealthCare Partners Medical Group Kaiser Permanente Northern California Permanente Medical Group: Diablo/Antioch Medical Centers Fremont/San Leandro Medical Centers Fresno Medical Center Modesto/Manteca/Stockton Medical Centers Redwood City Medical Center Roseville/Sacramento Medical Centers San Francisco Medical Center Santa Clara Medical Center Santa Rosa Medical Center South Sacramento Medical Center Kaiser Permanente Southern California Permanente Medical Group: Antelope Valley Baldwin Park Downey Fontana/Ontario Kern County Los Angeles Panorama City Riverside San Diego South Bay West Los Angeles Northwest Orange County Medical Group Physicians Medical Group of Santa Cruz Riverside Medical Clinic Sansum Clinic Scripps Clinic Medical Group Sharp Rees-Stealy Medical Group Sutter Gould Medical Foundation Gould Medical Group Sutter Medical Foundation Sutter Medical Group Sutter Pacific Medical Foundation Sutter Medical Group of the Redwoods Woodland Clinic Medical Group UC Davis Medical Group 2017 Integrated Healthcare Association. All rights reserved. 15

16 Most Improved POs (MY 2016) Integrated Healthcare Association and its stakeholder partners recognize the following physician organizations for outstanding improvement between Measurement Year 2015 and 2016 in overall star ratings for the quality of care provided to their Medicare Advantage members. MOST IMPROVED RECOGNITION 1.5-Star Improvement Universal Care Medical Group 1-Star Improvement Woodland Clinic Medical Group UC San Diego Health.5-Star Improvement Angeles IPA AppleCare Medical Group St. Francis Brown & Toland Physicians Alta Bates Medical Group Central Valley Medical Group Chaffey Medical Group Desert Valley Medical Group Inc. Dignity Health Medical Group - Inland Empire Family Practice Medical Group of San Bernardino, Inc. Genesis Healthcare Greater Newport Physicians.5-Star Improvement cont. Hill Physicians Medical Group - Sacramento Region John Muir Health Kaiser Permanente Northern California Permanente Medical Group: - San Rafael Medical Center - South San Francisco Medical Center - Vallejo/Vacaville Medical Centers Kaiser Permanente Southern California Permanente Medical Group - Woodland Hills Noble AMA IPA Northwest Orange County Medical Group Riverside Medical Clinic Santa Clara County IPA (SCCIPA) Sutter East Bay Medical Foundation Sutter East Bay Medical Group Sutter Palo Alto Medical Foundation - Mills-Peninsula Division/Mills-Peninsula Medical Group UC Davis Medical Group 2017 Integrated Healthcare Association. All rights reserved. 16

Public Reporting of PO-Level Performance IHA MY 2016 Medicare Advantage PO Star Ratings will be publicly reported via the Office of the Patient Advocate s Medical Group Medicare Advantage

18 Public Reporting of PO-Level Performance IHA MY 2016 Medicare Advantage PO Star Ratings will be publicly reported via the Office of the Patient Advocate s Medical Group Medicare Advantage Report Card in early Report card features overall star ratings, as well as individual measure rates and star ratings Integrated Healthcare Association. All rights reserved. 18

20 Physician Organizations PO Performance Drives Health Plan Clinical Quality Performance Overall PO performance on largely clinical subset of CMS measures in IHA s Medicare Advantage Stars program contributes to overall health plan star ratings, which are tied to strong CMS financial and enrollment incentives. 30% 25% 24% 22% 20% 18% 18% 15% 10% 5% 0% 8% 6% 3% 0% 1% Overall MA Star Ratings CMS MA Plan Financial Disincentives CMS MA Plan Financial Incentives Enrollment Advantage 2017 Integrated Healthcare Association. All rights reserved. 20

21 Participating California Health Plans Outperform National Plan Average on Quality Measures The average health plan star rating for program participants is higher than the national plan average for 11 of the 12 measures collected. Breast Cancer Screening Osteoporosis Management in Women who had a Fracture Medication Adherence for Hypertension Colorectal Cancer Screening Diabetes Care - Kidney Disease Monitoring Medication Adherence for Cholesterol Diabetes Care Eye Exam Diabetes Care Blood Sugar Controlled Medication Adherence for Diabetes Medications Rheumatoid Arthritis Management Plan All-Cause Readmissions Adult BMI Assessment Health Plan Average Star Rating IHA Participating HP Average National HP Average 2017 Integrated Healthcare Association. All rights reserved. 21

22 PO Average Rate (%) Marked Gains on Outcome Measures Five measures collected by IHA are CMS triple-weighted outcome measures. Overall physician organization performance in MY 2016 improved on all five outcome measures, with statistically significant gains on 3 measures (denoted by *) %* +2.2%* +3.2%* MY 2015 MY % -0.4% 10 0 Medications Adherence for Hypertension (RAS Antagonists) Medical Adherence for Diabetes Medications Higher-is-better measure Medical Adherence for Cholesterol (Statins) Diabetes Care: HbA1c Poor Control >9.0% Lower-is-better measure All-Cause Readmissions 2017 Integrated Healthcare Association. All rights reserved. 22

23 PO Average Rate (%) Process Measures Steady or Improving Seven measures collected by IHA are CMS single-weighted process measures. Physician organization performance in MY 2016 improved on 6 of the 7 measures and 1 measure saw statistically significant improvement (denoted by *). MY 2015 MY % +3.1% -0.1% +4.9%* +1.5% +0.1% +2.7% Adult BMI Assessment Rheumatoid Arthritis Management Breast Cancer Screening Diabetes Care: Eye Exam Colerectal Cancer Screening Diabetes Care: Medical Attention for Nephropathy Osteoporosis Management in Women Who had a Fracture 2017 Integrated Healthcare Association. All rights reserved. 23

24 Medicare Advantage Rate Performance in Commercial HMO Correlated to Medicare Advantage Performance Comparing results for POs participating in VBP4P and Medicare Advantage star ratings measurement suggests measure performance across populations and products is closely related; the correlation between PO performance in commercial VBP4P and Medicare Advantage Stars ranges from 0.56 to 0.84 for measures collected in both populations except readmissions (not shown) Diabetes Care - Blood Sugar Controlled Breast Cancer Screening Commercial HMO/POS Rate Medication Adherence for Hypertension (RAS Antagonists) Medication Adherence for Diabetes Medications Medication Adherence for Cholesterol (Statins) Colorectal Cancer Screening Diabetes Care - Medical Attention for Nephropathy 2017 Integrated Healthcare Association. All rights reserved. 24

25 Implications Health Plan Medicare Advantage star ratings tied to significant financial & enrollment incentives PO performance on quality measures drives plan ratings IHA Medicare Advantage star ratings aggregate PO performance across plans, increasing validity and amplifying performance improvement signal to POs PO performance improvement impacts all lines of business, not just Medicare Advantage IHA participating health plans and POs ahead of the curve, both on performance and measure alignment 2017 Integrated Healthcare Association. All rights reserved. 25

26 Additional Resources Program Fact Sheet: Medicare Advantage 5-Star Reporting of Physician Organizations Press Release: California Medical Groups Honored for High-Quality Care of Medicare Advantage Patients Measure Specifications: Measurement Year 2016 VBP4P Manual Measure Set: Measurement Year 2016 Measure Set 2017 Integrated Healthcare Association. All rights reserved. 26

Advances in Alignment, Measurement, and Performance MY 2017 Results Highlights

Advances in Alignment, Measurement, and Performance MY 2017 Results Highlights Align. Measure. Perform. (AMP) Programs Launched in 2003, VBP4P is a statewide performance improvement program and one of