New IHA Cost & Quality Atlas data suggests benefits of risk-based payment models

The Integrated Healthcare Association (IHA) released the third California Regional Health Care & Cost Quality Atlas this month. The Atlas includes over two dozen standardized measures of clinical quality, utilization, and total cost of care for close to 30 million Californians and is freely and publicly available.

According to Jeffrey Rideout, MD, President and CEO of IHA, the Atlas project grew out of a desire on the part of plans, California DHHS, and other stakeholders to have an infrastructure for data that could be used for multiple use cases. Ultimately, the California Health Care Foundation stepped in to fund the program and IHA was selected to administer the program.

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IHA has been aggregating data from health plans and physician organizations for several years from the perspective of risk bearing organizations, but the Atlas project provided an opportunity to explore and organize data in new classifications such as by geography or product lines.  The tool itself is searchable by over 10 topics and many, many more separate measures based on quality, utilization, cost, and demographics.

Though IHA publishes reports based on what it sees to be the most salient stories found in the data, in a recent conversation Dr. Rideout explained that what the data’s message really depends on the questions of each user.

“As we poke around ourselves and as we start to look at different things that come out, some of the stories tell themselves. And with each iteration of the Atlas, the commitment of the plans to give us additional data and additional fields on the data so that we can look at different things has increased, which is great.

The thing I try and leave in most people’s minds is that a common data infrastructure can do a lot of things. It’s really the business rules that drives who gets to see what, what gets analyzed and what the use cases are. Our goal is really to provide that platform so that different trading partners can actually do credible measurement and benchmarking.”

The most prominent data story of this most recent iteration of the Atlas is highlighted by the first of IHA’s accompanying reports which examines the degree to which financial risk sharing impacts cost and quality. The three main take-aways of the report:

  • Capitation associates with better quality performance – Statewide, the quality composite score for members with either professional risk (composite score of -0.75, which corresponds to an average performance rate of 65.6% across the 8 measures) or full risk providers (-0.61 or 67.1%) was better than for providers with no risk sharing (-1.44, or 57.9%).
  • Capitation associates with lower costs to the health care system and patients – Financial risk sharing was associated with up to 3.5% lower total cost of care, a trend that also held true for pharmacy costs and patient cost sharing.
  • Geographic variation persists across the state – 45% of the commercially insured population in Southern California were cared for by providers sharing risk, compared to only 18% in Central California and 24% in Northern California.

 

Other interesting points that IHA will continue to explore are that cost sharing burden for individuals in terms of out-of-pocket costs is dramatically higher for product types that do not share risk,  the ACO performance on quality emerged even higher than HMOs and also measured better on total cost of care, and that pharmacy costs were lower in groups that shared some form of risk, indicating that risk-bearing groups tend to manage pharmacy costs better.

Dr. Rideout confirmed that additional reports will be forthcoming including Medicare versus Medicare Advantage information expected soon, an ACO specific report, and a third focusing on chronic care performance due the end of May. He explained,

“As always one question begets many others. It’s an important project and there are important findings, but I would also say that one of the reasons that we want the tool to be accessible is that people will find their own projects and find their own things to look into.

It’s not possible nor would we want to be the arbitrator of what the Atlas says. We do our best to pull out the things that we think are the most interesting, and we don’t want to be advocating for a particular thing, but if the data screams, the data screams I guess I would say.”