Advancing Healthcare Through Alignment: 2022 Year in Review
A message from Jeff Rideout, MD, MA
Season greetings! Collaborating with all of you this year has been a joy and a privilege. As we look back on 2022, I’d like to take a moment to thank you and share some highlights from the year:
We named Availity the single-source technology partner for Symphony to expand the platform’s reach to providers, efficiently onboard health plans and provider organizations, and deliver value that ultimately benefits patients.
We launched the Encounter Data Resource Hub, which houses tools and resources for providers and other stakeholders seeking to improve their encounter data processes.
Led by IHA and the California Quality Collaborative, the California Advanced Primary Care Initiative launched to standardize the way primary care is financed, supported, and measured.
Our Health Equity Committee guided our committees and Board on opportunities to focus on Equity across the organization, including a Board approved decision to update our mission, vision, and purpose statements.
We welcomed IHA team members from three different states, deepening our commitment to a remote first workplace.
Align. Measure. Perform. (AMP)
As IHA’s nationally recognized suite of performance measurement programs, AMP continues to drive meaningful changes that reduce costs and improve healthcare quality and outcomes. We successfully migrated the technology solution used to deliver AMP results, facilitating a more streamlined experience for AMP participants by allowing access to both provider organization- and member-level reporting in the same portal.
IHA continued to adapt accountability measures and incentive design in response to industry-wide dynamics, including COVID-19, the Great Resignation, and inflationary pressures. We also provided subject matter expertise to the Department of Healthcare Access and Information (formerly OSHPD) to support the state’s new All-Payer Claims Database, and to the Department of Managed Health Care (DMHC) through their Health Equity and Quality Committee.
Finally, earlier this month, we recognized 68 provider organizations in California, including 27 Excellence in Healthcare Award winners, who performed in the top 50% across clinical quality, patient experience, and cost. The public results will be available on the Office of the Patient Advocate’s medical group report card. Compared to the previous year, the 2021 AMP Commercial HMO results saw marked improvements that translate to meaningful impacts on patient care and the health of our communities, including:
55,000 more adults were screened for colorectal cancer
10,000 more patients with diabetes had their blood sugar within the suggested clinical range
30,000 more patients received eye exam screenings for diabetes
California Regional Healthcare Cost & Quality Atlas
The Atlas is a key statewide source for comparing healthcare performance across the state. The tool examines performance across clinical quality, hospital utilization, insurance type, and cost of care topics for nearly 16 million Californians. A recent Health Affairs research brief, Value-Based Payment As A Tool To Address Excess US Health Spending, cites Atlas as providing “the most plentiful evidence on savings from capitation at the delivery system level.”
Consistent with prior years, the 2020 results show:
Clinical quality composite rates for providers who accept full financial risk were 6.2 percent higher than providers who don’t (fee-for-service). This is based on a composite score from 11 health plans, representing 7.9 million lives in HMO, PPO, and EPO products, both fully insured and self-insured.
When providers share any level of risk, total cost of care is 4.9 percent lower than those who don’t.
On average, consumers’ out-of-pocket costs are significantly lower when cared for by risk-sharing providers ($246 vs. $636).
For additional insights into cost and quality of care, visit the Atlas website.
Symphony Provider Directory
As California’s centralized platform for provider data management, Symphony simplifies how providers and health plans share, reconcile, and validate provider data. With our new single-source technology partner, Availity, we’re building a more advanced platform that will be easier to use, more efficient and scalable, and drive improved data quality.
Beyond the technology transition, we also welcomed Scripps Health Plan and Provider Organization to Symphony in 2023. With these new participants, Symphony now includes participation from 19 health plans and purchasers and more than 100 provider organizations, with many more providers attesting through Availity’s Provider Data Management App. This year, we also completed a proof of concept project with Covered California for two of its Qualified Health Plans.
Symphony continues to influence conversations about provider data management on several fronts. We provided comments to DMHC on draft SB 137 regulations, focusing on standardizing network and product definitions. We also contributed to a study led by RTI as commissioned by ASPE with the Department of Health and Human Services, sharing insights from Symphony’s launch, implementation and lessons learned in standing up a provider directory in California. Throughout the year, our Data Governance Committee focused on data model, standard inbound formats, and future roadmap functionality.
In partnership with Availity, IHA responded to a Request for Information from the Centers for Medicare and Medicaid Services (CMS) to help inform the agency’s evaluation of the need for a national, single source of provider directory information. CMS is exploring the concept of creating a single, centralized directory of healthcare providers to reduce directory maintenance burden on providers and promote real-time accuracy for patients.
Nourishing families
As food costs skyrocket, more and more families are experiencing food insecurity and hunger. IHA’s staff continued its support of the Alameda County Food Bank’s important work to end hunger, collectively donating $2,000 in 2022.
Warm holiday wishes
Words can’t describe the pivotal role you played in our success in 2022. I’m grateful for the energy, perspectives, and fresh ideas each of you brings to drive better outcomes, equitable access, and lower costs. Thank you for being with us on this journey to make the healthcare system work better for everyone.
From all of us at IHA, we wish you the best this holiday season and in the year ahead.
Integrated Healthcare Association, 180 Grand Avenue, Suite 1365, Oakland, CA 94612