California Multi-Payer Collaborative Pilots Advanced Primary Care Measure Set

Jan. 19, 2024
Integrated Healthcare Association dataset used to identify over 10,000 primary care practices’ performance on the measure set, which includes clinical quality, utilization, and total cost of care measures

The Purchaser Business Group on Health (PBGH)’s California Quality Collaborative (CQC) and Integrated Healthcare Association (IHA) partnered with health plans and purchasers to pilot an Advanced Primary Care Measure Set to assess performance across a key set of outcomes-focused measures to understand variations. 

In the pilot, IHA’s dataset was used to identify over 10,000 primary care practices and generate results at the practice level on the measure set, which includes clinical quality, healthcare utilization, and total cost of care measures.

The initiative represents a voluntary joint effort among payers to standardize the way they finance, support and measure the delivery of Advanced Primary Care (APC).

A vendor called Cozeva is serving as the common reporting platform to provide aggregated results reporting for practices and payers participating in the initiative. Cozeva is a population health solution for clinical quality performance, risk adjustment, and total cost of care management. Cozeva’s platform will give providers a payer-agnostic unified actionable registry to measure and track outcomes through a single source of performance information on a set of advanced primary care measures.

The initiative includes a focus on the “Core 4,” a critical part of the advanced primary care measure set. These four clinical measures are colorectal cancer screening, diabetes blood sugar management, high blood pressure management, and childhood immunizations. The Core 4 is also a major component of performance expectations for health plans contracted with or regulated by Covered California, CalPERS, the Department of Managed Health Care (DMHC), and the Department of Health Care Services (DHCS).

According to initiative leaders, the measurement pilot uncovered several needs for the California healthcare system:

• Expansion of clinical data exchange through enhanced reporting capabilities and payer/purchaser collaborative efforts to reduce administrative hassles for providers. 

• Comprehensive views of practice-level performance for providers to facilitate meaningful point-of-care insights for improving care quality and reducing health disparities. Interoperability of systems, standard data specifications and alignment of formats can facilitate bringing data together effectively.

• Improved performance in population health management through practice-level data visibility, focusing on critical primary care quality indicators like blood pressure control, depression screening, and childhood immunizations.

• Additional resources for primary care practices to enhance quality of care, including shared tools, technical assistance, and team support.

During a December 2023 webinar, Lance Lang, M.D., a clinical consultant to the California Quality Collaborative, noted that the California Legislature, in establishing the Office of Health Care Accountability (OCHA), called for increased investment in primary care. "IHA and CQC have been recruiting payers to collaborate on getting ahead of the coming OCHA requirements on a voluntary basis to rebalance expenditures to invest more in primary care,” he said. “The Advanced Primary Care Measures have provides a way to track those outcomes in order to shift requirements.”

Lang stressed that this is a big deal because payers won't invest more unless they have a way to track outcomes. He said earlier attempts to do this were too focused too much on processes rather than outcomes. He said that the measures will improve to include more of the key skills that account for why primary care is so important, such as tolerance of uncertainty or helping patients set priorities among all their various issues that they bring to a visit.

Todd May, M.D., vice president and medical director for insurer Health Net, said the key theme here is alignment. “What’s really important is that the industry is aligning around quality, and one way to do that is to align on a relatively small set of high-impact metrics, rather than having PCPs chase down dozens or hundreds of different metrics coming from different demands,” he said. “Let’s get down to the really core measures. Now we have multiple health plans aligning on this key measure set. When all the plans align, that reduces reporting burden for PCPs and allows them to focus on those key metrics.”

May added that value-based payment arrangements provide resources for practices to achieve these goals. “The APC project is also providing technical assistance for practice transformation — changing processes and workflows to optimize outcomes — and this is especially important for smaller practices with limited resources,” he explained. “Deploying a common reporting platform is absolutely critical. This makes it easier for practices to track the performance across multiple plans and not have to go to various different data sources. This is the kind of industry alignment around quality that we need.”

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