We hope everyone had an excellent July 4th! In our latest Stakeholders’ series newsletter, we bring you exciting updates on the Symphony Provider Directory, a significant redesign of our Align. Measure. Perform. (AMP) program, a recap of our recent Healthcare Policy Pulse webinar, and more!
Symphony Chosen as Provider Data Source for Covered California, Featured in Case Study
Last March, IHA and Covered California finalized contracts to utilize IHA’s Symphony Provider Directory data for all Qualified Health Plans. Symphony’s platform will ensure Covered California’s online provider directory data is accurate and up-to-date, making it easier for consumers to make informed decisions about their care and health plan coverage. Work is underway with Availity, Symphony’s single-source technology partner, to prepare for the expected go live with Covered California in early 2025.
In other Symphony news, Symphony’s role as California’s statewide provider directory was cited in a study on improving provider data accuracy. RTI International, commissioned by the Assistant Secretary for Planning and Evaluation (ASPE) at the Secretary of the US Department of Health and Human Services (HHS), conducted the study. The study included a scan of peer-reviewed journal articles, interviews with key informants, and case studies. You can find the full report here.
IHA’s Align. Measure. Perform. (AMP) program recently underwent a significant redesign to amplify industry-wide performance goals. The changes to AMP emphasize improving clinical quality, accelerating race and ethnicity reporting to improve health equity, addressing data quality challenges, and aligning with regulator and public purchaser priorities.
Changes to AMP’s program components include:
Common measure set: The new measure set focuses on 16 measures, including 14 clinical quality and two resource use measures. The highest-priority Core 4 measures (colorectal cancer screening, childhood immunizations, blood pressure control, and diabetes blood sugar control) are double-weighted.
Health plan incentive design: The new incentive model aligns providers, plans, and purchasers on shared goals. It features a universal design for all providers, regardless of risk type, and meets their desire for simplicity, transparency, and consistency in payments. Payments are based primarily on clinical quality and providers are rewarded for achieving a high standard of care or improving substantially from the previous year. Incentives earned are adjusted up or down based on total cost of care performance. There are no longer eligibility gates for quality or cost.
Many thanks to our Technical Measurement Committee, Technical Payment Committee, and Program Governance Committee for their ongoing collaborative work on the AMP redesign. These committees have equal representation from health plans and provider organizations, ensuring balanced consensus on our program decisions that drive value-based care in California.
This September, IHA will release its first-ever encounter data performance reporting. These reports will be essential to identifying where encounter data-related issues need to be addressed to improve encounter data completeness and accuracy. Watch for more information later this summer!
Proposal Submitted for DHCS Encounter Data Improvement Program
IHA recently submitted a proposal to the Department of Health Care Services (DHCS) to provide third-party administrative management overseeing the Encounter Data Improvement Program (EDIP). EDIP is a grant program to help Medi-Cal providers identify and address persistent encounter data reporting issues.
As part of Health Net’s Encounter Data Improvement Program, IHA currently serves as California’s Encounter Data Governance Entity (EDGE). IHA is coordinating initiatives through EDGE to improve how encounter data is collected, reported, and used. A cornerstone of the initiative is IHA’s Encounter Data Resource Hub, a free repository of best practices, helpful tools, and easy-to-use guidance for providers, health plans, and other stakeholders.
We hope to expand our encounter data improvement expertise to support DHCS’s EDIP program and will share an update in the coming months.
Experts Discuss Legislative and Policy Updates and the Quality and Equity Landscape During Healthcare Policy Pulse Webinar
IHA held its 2nd annual Healthcare Policy Pulse webinar on June 27. During the Stakeholders’ Series event, speakers discussed timely legislative and policy updates and California’s quality and equity landscape.
The legislative and policy session updated attendees on the California State Budget. The final budget reduces the rate increases under the managed care organization tax while reallocating some of the funds to certain provider types. The final budget maintains funding for expanding Medi-Cal to all eligible Californians, regardless of immigration status. It also preserves funding for behavioral health and supports the expansion of behavioral health treatment and infrastructure capacity to serve children. The budget reduced funding for the new DHCS Equity and Practice Transformation Payments program by about 80%.
The session also highlighted healthcare legislation of interest. Senate Bill 1290, Essential Health Benefits, passed unanimously out of the Assembly Health Committee and is awaiting hearing in the Appropriations Committee. Assembly Bill 2200, Guaranteed Healthcare for All (single payer proposal), did not make it out of the Policy Committee and is dead for this legislative session. Senate Bill 236, Provider Directories, made it out of the Senate Health Committee and is headed to the Senate Appropriations Committee in August. SB 236 would require health plans and insurers to annually audit and delete inaccurate listings from provider directories and ties existing requirements to accuracy benchmarks and associated penalties.
Speakers next discussed the heightened industry focus on healthcare quality and equity in California. The state’s regulators and purchasers are increasingly focused on accountability for quality performance, especially on the “Core 4” measures. Speakers highlighted how AMP’s redesign amplifies these industry priorities. The California Advanced Primary Care Initiative, co-led by IHA and the CQC/PBGH, has informed and helps prepare stakeholders for the state’s goals for increasing investment in primary care and the adoption of alternative payment models to better manage cost growth. The session concluded with updates on encounter data improvement efforts.
If you missed the webinar or would like to replay a session, the recording and slides are now available.
