integrated healthcare associationannual report 2013 | 3 this year, iha continued its engagement in...

Integrated Healthcare Association

Annual Report 2013

Innovation Through CollaborationTM

ii | Integrated Healthcare Association

How We Achieve Our MissionIHA promotes accountability and transparency through health care standards, measurement, rewards, and providing information to third parties for public reporting.

IHA leverages its distinctive strength, the ability to bring together leaders from key sectors of health care in California as a neutral convener, to promote innovation through both individual and collaborative efforts.

IHA provides a forum for its members to innovate, promote, and test new ideas.

IHA supports a visible, ongoing effort to promote health care improvement by educating and informing the general public, policy makers, other associations, and organizations through conferences, roundtable forums, reports, media, and other methods.

IHA seeks to influence policy issues that support its mission through information, education, public positions, and collaboration by key stakeholders.

IHA serves as a catalyst by initiating, coordinating, and managing projects that advance solutions for delivery system challenges.

The Principles That Guide UsIn organizing and carrying out its work, IHA:

n Operates a shared governance model based upon trust, and open dialogue;

n Seeks to remain a limited-membership policy board, but with representation from a broad cross-section of the health care industry;

n Solicits senior decision-maker participation from its member organizations;

n Considers academic, business/purchaser, and consumer perspectives in its discussions, including but not limited to, board representation;

n Promotes ideas, solutions, and points of view to policymakers, but does not lobby on specific pieces of legislation;

n Promotes incentives to align the interests of various health care stakeholders;

n Seeks to develop consensus, but believes open, active dialog and debate on important issues is productive, even if a consensus cannot be reached.

Innovation through CollaborationTM

Our VisionHealth care that promotes quality improvement, accountability,

and affordability, for the benefit of all California consumers.

Our MissionTo create breakthrough improvements in health care services for

Californians through collaboration among key stakeholders.

Accountability

Convener

Innovator

Knowledge Sharing

Policy Influence

Project Incubator

Table of ContentsLetter from the President and CEO 2 – 3

2013 Board of Directors 4 – 5

2013 Board

Highlights from of our Work in 2013 6 – 11

Performance Measurement and Payment Incentives 6 – 8

Value Based Pay for Performance

Medicare 5 Star Reporting

Measuring Cancer Care Quality in California

Physician Organization-Level Reporting in Managed Medi-Cal

Population Health: Measuring Clinical Quality by Geography

Direct Data Query Pilot

Bundled Payment 9

Policy and Research 10

ACO Impact Study

Informing and Influencing Policy and Practice

Special Projects 11

IHA Coded Division of Financial Responsibility (DOFR)

California ICD-10 Collaborative

Quality of Life Conversation

IHA Conferences 12 – 13

2013 Committees 14 – 16

2013 IHA Affiliate Organizations Inside Back Cover

2013 IHA Staff Inside Back Cover

2 | Integrated Healthcare Association

Dear IHA Members, Affiliates, Stakeholders, and Friends:

2013 was a momentous year as many elements of the federal Patient Protection and Affordable Care Act (ACA) moved closer to reality. Though many elements of

the ACA will not be fully realized until 2014 and beyond, payers and providers worked hard this year to implement healthcare reform laws, engage in the newly formed health insurance exchanges, and understand how the law will affect them. Similarly, families and consumers grappled with great uncertainty about their healthcare coverage, pricing, and eligibility — which kept the health reform debate on center stage.

The accelerated pace of change in the healthcare marketplace has been truly remarkable. And that change has brought us advances in accountable care, new federal and state exchanges, hybrid products, and new health plan and provider networks. Covered California — the new marketplace for affordable health insurance — was “open for business” by autumn and generated over 500,000 enrollees as of year-end. In the private sector, several Accountable Care Organizations (ACOs) were launched through health system mergers, acquisitions, or virtual collaboration, despite facing challenges. What remains central to all of these efforts is our collective need to lower costs of care and improve quality through integrated healthcare delivery and aligned payment incentives.

As the market transforms, our strategic priorities become even more relevant:

1. Integrated Healthcare: Develop and implement initiatives to promote clinical integration and better alignment of integrated care delivery systems with competitive insurance products; in particular, supporting the successful development of ACOs.

2. Payment Innovation: Transition IHA’s Pay for Performance program into a value based incentive program and leverage our performance measurement capabilities to support other incentive and payment methods to enhance quality and affordability.

3. Performance Measurement: Significantly expand IHA’s performance measurement “foot-print” to include new products, populations and providers, and advance the integration of cost and quality into the measurement of value.

4. State of the Art Data Collection and Aggregation: Implement a new state of the art system for data collection, aggregation, analytics and sharing to support measurement and payment.

Letter from the President and CEO

This year, IHA

continued its

engagement in

national and

California forums

to share knowledge

and influence policy.


Annual Report 2013 | 3

This year, IHA continued its engagement in national and California forums to share knowledge and influence policy. In September, we completed a three-year grant for a bundled payment demonstration funded by the Agency for Healthcare Research and Quality (AHRQ). Key findings on bundled payments and resources to support implementation are available on our website. With support from the Robert Wood Johnson Foundation, we are studying the evolution of ACOs in the California market and will begin to share findings in 2014. IHA played an active role supporting the California State Innovation Model (CalSIM) design initiative and development of the resulting State Health Care Innovation Plan.

We made great strides in broadening our performance measurement “footprint” in 2013. The Value Based P4P design was finalized, incorporating Total Cost of Care, and implementation is underway. We developed a new web platform to conduct quality data aggregation and reporting in-house. IHA began working with the California Cancer Registry to measure the quality of cancer care. A Medi-Cal performance measurement and reporting pilot was initiated with four managed care plans in southern California. IHA also began a community-based measurement pilot aimed at geographic reporting of clinical quality across the state. The last two initiatives reflect IHA’s intent to share its expertise in measurement and payment innovations with new communities.

Finally, I would like to thank our Board of Directors and the many hardworking stakeholders that contribute their time and energy to our growing portfolio of initiatives. Working together, we can realize “Innovation through Collaboration” and create solutions to improve healthcare quality and affordability for all Californians. We look forward to working with you in 2014!

Sincerely,

Tom Williams, DrPH President and CEO



IHA is unique by virtue of its broad and balanced representation of hospitals/health systems, health plans, and physician organizations.

Our Board membership additionally includes representatives from govern-ment, academic, purchaser, consumer and other sectors to ensure that “all are

at the table.” Our ability to convene cross-sector organizations to collaborate on challenging industry issues and projects is one of our greatest assets.

2013 Board MembersPhysician GroupsBeaver Medical Group (EPIC Management), Charles Payton, MD,

Vice President and Chief Medical Officer

Family Care Specialists Medical Group, Hector Flores, MD, Medical Director

HealthCare Partners, Donald Rebhun, MD, Regional Medical Director

Hill Physicians Medical Group, David Joyner, Chief Operating Officer

Monarch HealthCare, Bart Asner, MD, Chief Executive Officer

Palo Alto Medical Foundation, Richard Slavin, MD, President and Chief Executive Officer

The Permanente Medical Group, Philip Madvig, MD, Associate Executive Director

Santé Health System, Scott Wells, President and Chief Executive Officer

Sharp Rees-Stealy, Don Balfour, MD, President and Medical Director

Hospitals and Health SystemsCedars-Sinai Health System, Richard Jacobs, Senior Vice President, System Development

Dignity Health, Tammy Wilcox, Senior Vice President, Managed Care

John Muir Health, Calvin Knight, President and Chief Executive Officer,

John Muir Physician Network

Martin Luther King Jr. Community Hospital, Elaine Batchlor, MD, Chief Executive Officer

MemorialCare Health System, Barry Arbuckle, PhD, President and Chief Executive Officer

Providence Health and Services, Michael Hunn, Senior Vice President and Regional

Chief Executive

Stanford Hospital & Clinics, Jenni Vargas, Chief Strategy Officer

Sutter Health, Jeffrey Burnich, MD, Senior Vice President and Executive Officer

UCLA Health System, Santiago Muñoz, Chief Strategy Officer

Health PlansAetna, Greg Stevens, Senior Vice President — Network Management, West

Anthem Blue Cross, Aldo De La Torre, Vice President, Provider Engagement and Contracting

Blue Shield of California, Juan Davila, Executive Vice President, Healthcare Quality and

Affordability

CalOptima, Richard Helmer, MD, Chief Medical Officer

Cigna Healthcare of California, Peter Welch, President and Chief Executive Officer

ChairElaine Batchlor, MDChief Executive Officer, Martin Luther King Jr. Community Hospital

Chair-ElectDavid JoynerChief Operating Officer, Hill Physicians Medical Group

Past ChairBart Asner, MDChief Executive Officer, Monarch HealthCare

TreasurerBarry Arbuckle, PhDPresident and Chief Executive Officer, MemorialCare Health System

SecretaryMartha SmithChief Program Officer, Dual Eligible Demonstration, Health Net

2013 Board of Directors


Health Plans (cont.)Health Net, Martha Smith, Chief Program Officer, Dual Eligible Demonstration

Kaiser Foundation Health Plan, William B. Caswell, Senior Vice President, Operations

L.A. Care Health Plan, Trudi Carter, MD, Chief Medical Officer

UnitedHealthcare, Sam Ho, MD, Executive Vice President and Chief Medical Officer

Purchasers and ConsumersCalPERS, Ann Boynton, Deputy Executive Director, Benefit Programs Policy and Planning

Center for Healthcare Decisions, Marjorie E. Ginsburg, Executive Director

Disney Worldwide, Barbara Wachsman, Senior Executive, Employee Health Benefits

Keenan, Henry Loubet, Chief Strategy Officer

At LargeCEP America, Mark Spiro, MD, President and Chief Operating Officer

Genentech, Michael Dubroff, DO, Senior Director, Payer Support

GlaxoSmithKline, Karen Hamby, Vice President, Integrated Healthcare Markets

McKesson Corporation, David Nace, MD, Vice President and Medical Director

Merck & Company, David Abrahamson, MD, Senior Medical Director — Western Region

Pfizer, Dennis Kozak, Regional Business Director

Stanford University, Graduate School of Business, Alain Enthoven, PhD, Marriner S. Eccles

Professor of Management

Trizetto Corporation, Jeff Rideout, MD, Senior Vice President and Chief Medical Officer

(replaced by Jeffrey Rose, MD, Chief Medical Information Officer in September 2013)

UC Berkeley School of Public Health, James Robinson, PhD, Leonard D. Schaeffer Professor

of Health Economics

Liaison (Non-Voting)California Children’s Hospital Association, Cindy Ehnes, President and Chief Executive

Officer (through June 2013)

California Department of Managed Health Care, Brent Barnhart, Director

(replaced by Shelley Rouillard, Director in November 2013)

Centers for Medicare and Medicaid Services (CMS), David Sayen, Region IX Administrator

Covered California, Jeff Rideout, MD, Senior Medical Advisor (after September 2013)

PriMed Management Consulting, Steve McDermott, Chairman of the Board

Redwood Community Health Coalition, Mary Maddux-Gonzalez, MD,

Chief Medical Officer

Stanford University School of Medicine, Arnie Milstein, MD, Director, Clinical Excellence

Research Center

UC Berkeley School of Public Health, Stephen Shortell, PhD, Dean

IHA FundingThe sources of IHA revenue are from program administration fees, grants from private foun-dations and federal agencies, Board membership dues, Affiliate membership dues, conferences, and other sources. The majority of IHA expenses are for program services, with a relatively small percentage for management and general operations, and member-ship development.

Grants 33%

Program Services 82%

Program Administration Fees 45%

Membership Development 9%Management

and General 9%

Membership and Affiliate Dues 17%

Other Revenue (conferences and other) 5%

2013 Revenue Sources

2013 Expenses


Highlights from our Work in 2013Performance Measurement and Aligned Incentives

IHA’s strategy for 2011-2015 includes expanding our performance measurement activities to include more products, populations, units of measurement, and

robust outcomes measures. During 2013, IHA made significant progress on this strategic focus.

As IHA gains experience and builds internal capacity in performance measurement and reporting, staff has identified an array of opportunities to apply those core capabilities to new populations and emerging products in a way that informs decision-making about both care delivery and payment.

Value Based Pay for PerformanceIHA’s California Pay for Performance (P4P) program was designed to create a compelling set of incentives to drive improvements in clinical quality, patient experience, and more recently, resource use. IHA administers the program on behalf of participating health plans and is respon-sible for collecting data, deploying a common measure set, and reporting results for approximately 35,000 physicians in over 200 physician organizations. In 2013, the P4P program welcomed two additional health plan participants — Chinese Community Health Plan and Sharp Health Plan. This increases program participation to 10 health plans representing approximately 9 million commer-cial HMO/POS enrollees.

In response to unsustainable growth in the cost of care, the P4P program identified value as the ultimate goal in its strategy for 2011-2015. Toward this goal, IHA is transitioning the program to Value Based P4P — a shared savings model that holds physician organizations accountable for the total cost, cost trend, and resources used for all care provided to their commercial HMO/POS members, as well as the quality of this care. Over the last two years, significant time and effort was invested to reach a broad consensus among health plans and physician organizations on key param-eters of the Value Based P4P design. Based on these efforts and the developed recommendations, the first health plan is rolling out Value Based P4P for 2013 physician organization performance measurement and several additional health plans will follow in 2014.

IHA also launched a performance measurement and analytics web reporting platform. This platform establishes an interface that will be used by health plans and physician organizations to access their P4P measurement reports and supports real-time data aggregation and results graphs. Additional features will allow P4P program participants to manage their profile, user, contact, and contracting information.

Medicare 5 Star ReportingIHA continued its physician organization-level reporting of Medicare Stars measures in 2013, aligning with the Centers for Medicare and Medicaid Services (CMS) to determine which measures to collect and report. Medicare Stars remains a focus for health plans, as it is the basis for quality payments from CMS. Reporting physician organization-level rates allows health plans to target quality improvement initiatives, and potentially pass payments from CMS through to physician

In response to unsus-

tainable growth in the

cost of care, the P4P

program identified value

as the ultimate goal in its

strategy for 2011-2015.

Towards this goal, IHA is

transitioning the program

to Value Based P4P — a

shared savings model that

holds physician organi-

zations accountable for

the total cost, cost trend,

and resources used for

all care provided to their

commercial HMO/POS

members, as well as the

quality of this care.


organizations based on performance on the measures. All administratively-derived measures relevant to care delivery are reported. Two new measures are being tested in 2013: high risk medications and medication adherence for hypertention in diabetics.

IHA currently contracts with NCQA to publicly report the results of the Medicare Stars measure-ment. It is expected that results will be reported by the California Office of the Patient Advocate (OPA) going forward. Based on the results, IHA released a list of the 72 out of 189 physician organizations that earned 4.5 or 5 overall Stars at the Pay for Performance Stakeholder’s meeting in September 2013.

Measuring Cancer Care Quality in CaliforniaIHA is partnering with the California HealthCare Foundation (CHCF) on a “proof on concept” pilot to measure cancer care quality in California. At present, a dearth of information leaves cancer patients with little guidance on how to select providers and limits the ability of purchasers and plans to evaluate, designate, and reward high-performing providers.

The goal of the pilot is to explore how state cancer registry data can be combined with commercial claims information and encounter data to measure cancer care quality for physician organiza-tions. However, existing electronic data sources alone are insufficient for measuring the quality of cancer care. Healthcare claims data contains a wealth of information on diagnoses and costs from all providers, but lacks clinical information, such as cancer stage and tumor morphology. Cancer registry data contains key clinical information, but lacks consistent information for ongoing treat-ments and outpatient-based therapies. Bringing the two sources together will enable more robust measurement of clinical quality than is currently possible.

A major success was achieved in July when the project received permission from the California Cancer Registry to utilize cancer registry data. Nine quality measures for breast and colon cancer have been selected from among measures endorsed by the National Quality Forum and used by the American Society of Clinical Oncology’s Quality Oncology Practice Initiative as the core measure set for the project. Upcoming phases of the project include the creation and assessment of the linked data, as well as the generation and analysis of measure results. We look forward to sharing the findings of the pilot in late 2014.

Physician Organization-Level Reporting in Managed Medi-CalExpansion of Medi-Cal eligibility and an increasing role for managed care in the Medi-Cal program highlight the growing importance of actionable quality measurement among Medi-Cal providers. Based on our extensive experience with performance measurement and reporting in the commer-cial market, IHA received funding from the Blue Shield of California Foundation to explore physi-cian organization-level reporting in managed Medi-Cal. The one-year grant launched in July 2013, and focuses on four counties in southern California: Los Angeles, San Bernardino, Riverside and Orange. The four participating health plans — L.A. Care, Health Net, Inland Empire Health Plan,

Expansion of Medi-Cal

eligibility and an

increasing role for

managed care in the

Medi-Cal program

highlight the growing

importance of actionable

quality measurement

among Medi-Cal

providers.


and CalOptima — reported data to IHA in November of 2013. Results will be shared with health plans and physician organizations in early 2014 using IHA’s new performance measurement web reporting platform. We plan to continue and expand work with Medi-Cal managed care plans and providers in 2014 and beyond.

Population Health: Measuring Clinical Quality by GeographyCurrent clinical quality performance measurement efforts in California and across the country tend to focus on health plans and physician organizations, resulting in public reporting of plan- and physician organization-specific results. While useful for informing provider quality improvement efforts and consumer decision-making, results currently do not allow for a clear picture of popu-lation health in a geographic area. To fill this information gap, IHA is launching a geographic-spe-cific measurement initiative.

In partnership with participating health plans, IHA is working to collect Healthcare Effectiveness Data and Information Set (HEDIS) data by geography and product line and make the results avail-able to interested stakeholders. IHA staff will aggregate the data by geographic unit across multiple health plans and populations (commercial, Medi-Cal, Medicare) to highlight differences in health-care quality between regions of California, as well as across populations within regions. Results will be available by the end of 2014, providing California health plans, hospitals, providers and policy makers with actionable information to identify geographic-specific quality improvement opportunities and to inform policy efforts around reducing disparities.

Direct Data Query PilotA systematic, simple process for clinical data exchange between health plans, physician organiza-tions, and hospitals has been lacking, which has impacted patient care and system efficiency. New technologies are available that could address this data gap by allowing point to point on-demand sharing of data. Streamlined data exchange has great potential to be transformative by increasing the availability of data to guide patient care and quality improvement activities. IHA was funded by the California Office of Health Information Integrity (CalOHII) to use such technology to conduct two data exchange pilots.

The first pilot focuses on exchanging data related to eight Medicare Stars outcomes measures between two health plans and two physician organizations. Installation and data mapping were completed, and live data exchange has begun. The second pilot focuses on the feasibility of trans-mitting admission, discharge, and transfer (ADT) notifications from hospitals to health plans, with relevant clinical information being returned by the health plans to the hospitals. Two hospitals and one health plan worked with IHA to determine the details of exchanging ADT information, and all have agreed that this type of exchange is feasible and would be valuable. We look forward to sharing results in late 2014.

Highlights from our Work in 2013 (cont)

In partnership with

participating health plans,

IHA is working to collect

Healthcare Effectiveness

Data and Information

Set (HEDIS) data by

geography and product

line and make the results

available to interested

stakeholders.


Bundled Payment

In 2013 IHA completed a three-year bundled payment demonstration funded by the Agency for Healthcare Research and Quality (AHRQ). The primary goals of the demonstration were to:

1) encourage financial alignment between hospitals and physicians in order to support process re-engineering and improvements in patient care quality and efficiency; 2) allow for shared savings among health plans, providers, employers, and patients; and 3) develop and test solu-tions to bundled payment implementation issues.

Over the three-year period, demonstration participants encountered and resolved an array of hurdles required for successful bundled episode payment implementation. Despite great initial support, enthusiasm and effort, a limited number of cases were covered by the episode of care contracts over the three years of the project, leading to the conclusion that episode-of-care payment is not the silver bullet that will align incentives among California’s payers and providers. However, the demonstration produced a wealth of lessons learned as well as a variety of useful resources. Specifically, the demonstration:

1. Produced ten code-based episode definitions, an important first step in any bundled payment strategy. The episode definitions, created with guidance from clinical experts, represent a strong consensus across participating health plans, hospitals and physician organizations.

2. Defined and successfully deployed a contracting structure with a common framework. Contract templates developed for the demonstration have been adapted and used by national health plans and participants in other bundled payment initiatives.

3. Uncovered and addressed the challenges to electronic adjudication of episode bundled payments, showing that prospective episode payment is administratively feasible and providing a framework for further market development of administrative solutions to address the challenges of payment reform.

4. Facilitated the completion of contracts for three health plans and two hospitals. Hoag Orthopedic Institute signed contracts with Aetna and Blue Shield of California for knee replacements and with CIGNA for both hip and knee replacements. Sutter Health East Bay signed contracts with Aetna and Blue Shield for both hip and knee replacements.

At the same time, the project produced a range of publicly available resources (e.g. episode defi-nitions, model contracts, etc.) and extensive documentation of technical issues and approaches to resolution that have already proven valuable in informing others undertaking bundled payment initiatives across the country. IHA staff presented findings at many venues, including Academy-Health, Network for Regional Healthcare Improvement, AHRQ Chartered Value Exchange, and various California meetings.

In 2013 IHA completed

a three-year bundled

payment demonstration

funded by the Agency

for Healthcare Research

and Quality (AHRQ).

The demonstration

produced a wealth of

useful, publicly available

resources.


Policy and Research

IHA expanded activities in the policy and research arena in 2013, pursuing a range of efforts intended to inform and influence decision-makers in both the public and

private sectors regarding the design, implementation, and effects of healthcare payment and delivery innovations.

ACO Impact StudyIHA was awarded a grant from the Robert Wood Johnson Foundation to study the impact of Accountable Care Organizations on clinical quality, cost, patient experience, disparities, and vulnerable populations. The two-year project, conducted in collaboration with Professor James Robinson, PhD (an IHA board member) and Kimberly MacPherson, both of the University of California at Berkeley, launched in April 2013. The study focuses on five California provider organizations implementing ACOs in the commercial, Medicare, and/or Medi-Cal market. The research team conducted the first round of interviews with the five sites over the summer of 2013, interviewing as many as ten individuals within each ACO to obtain a comprehensive and multi-layered organizational view of the impact of ACO contracts and operations across all aspects of the organization. Interviews were also conducted with executives at health plans that contract with ACOs. The second round of interviews will take place during the summer of 2014.

Informing and Influencing Policy and PracticeIn 2013, IHA contributed expertise and on-the-ground learning to a variety of state and national efforts to improve the healthcare system. IHA staff participates in numerous boards and commit-tees, including:

n Blue Shield of California Foundation’s Triple Aim Measurement Instrument Advisory Group

n California Department of Managed Health Care’s Financial Standards Solvency Board

n California Health eQuality

n California State Innovation Model (CalSIM)

n National ARRA HITECH Technical Expert Panel

n Network for Regional Healthcare Improvement

n National Committee for Quality Assurance’s Overuse Measurement Advisory Panel

n National Committee for Quality Assurance’s Shared Decision Making Panel

n National Quality Forum’s Measure Applications Partnership

n National Quality Forum’s Resource Use Steering Committee

n Pacific Business Group on Health’s California Quality Collaborative

Staff presented to a wide array of audiences — both policy and practitioner — on core topics, including performance measurement, transparency, total cost of care, value based purchasing, and bundled payment. IHA published a number of issue briefs and other resources, highlighted prog-ress on moving from quality-based to value based pay for performance in a blog posting in Health

Affairs, and contributed multiple commentaries to California Healthline’s Think Tank.

Highlights from our Work in 2013 (cont)

In 2013, IHA contrib-

uted expertise and

on-the-ground learning

to a variety of state and

national efforts to improve

the healthcare system.


Special ProjectsIHA Coded Division of Financial Responsibility (DOFR)A Division of Financial Responsibility (DOFR) is a section of a capitated contract agreement used by health plans and providers to identify the financially responsible entity for services rendered by service category. The coded IHA DOFRTM is a unique template, developed in partnership with a number of healthcare stakeholders, that includes a grid of service categories drilled down to the code level, rather than broad service categories, for commercial HMO/POS and Medicare Advantage contracts. The IHA DOFRTM is not a standardized risk matrix — risk assignment is determined by proprietary contract negotiations. It is a useful tool for provider contracting, financial management, and claims administration of capitation/risk arrangements resulting in clarification of capitation agreements, reduction in misdirected claims, facilitation of financial analysis, and similar configuration of systems by contracting parties. The multi-stakeholder workgroup, convened by IHA, completed releases 3.0 through 3.2 in 2013. In 2014, IHA will be implementing a new strategic plan to improve functionality of the coded DOFR and increase its use and adoption by all stakeholders.

California ICD-10 CollaborativeIn October 2014, the ICD-9 code sets used to report medical diagnoses and inpatient proce-dures will be replaced by ICD-10 code sets. The California ICD-10 Collaborative is a statewide multi-stakeholder group that joined forces to increase efficiencies and reduce costs associated with ICD-10 implementation and compliance. IHA served as the Collaborative’s host organization for 2013, providing the foundational infrastructure and ongoing administration, including logo and web development, newsletter design, member registration, dues payment, and other services.

Quality of Life ConversationThe IHA Quality of Life (QOL) Conversation initiative is an education and awareness campaign on advance care planning and a “call to action” to expand the use of advance directives. It is a voluntary educational campaign for IHA Board and Affiliate organizations to implement for their workforce. IHA partnered with the Coalition for Compassionate Care of California for training and tools. The program aligns with the End-of-Life: Maintaining Dignity and Independence goals set forth by the State Health Care Innovation Plan “Let’s Get Healthy California” initiative.

Several IHA Board organizations championed the program within their organizations and customized the program to meet their organizational needs. Organizations that participated in 2013 include CalPERS, HealthCare Partners, Hill Physicians Medical Group, John Muir Health, Sharp HealthCare, CEP America and Med America. Some healthcare organizations launched the program with clinical staff and then broadened the scope to non-clinical staff; others provided information as part of their employee health fairs and wellness programs.

The IHA Quality of Life

(QOL) Conversation

initiative is an education

and awareness campaign

on advance care planning

and “call to action”

to expand the use of

advance directives.


IHA Conferences8th National Pay for Performance Summit: San Francisco, CAAs we planned for the 8th National Pay for Performance Summit in February 2013, healthcare delivery in the U.S. was undergoing unprecedented change. With implementation of the Afford-able Care Act gaining renewed momentum after the 2012 elections, numerous payment reform pilots and demonstration projects were launched in both the public and private sectors nationwide. And while political leaders continued to debate over many challenges, both sides of the aisle agreed that moving from volume to value based payment would be a necessary part of any solution. Over 500 attendees participated in person and online, gaining in-depth perspectives from experts in performance measurement, data collection, public reporting, incentive design, and payment inno-vation. Participants engaged in a robust discussion of how to tie these key elements together to improve quality and efficiency in the next generation of value based pay for performance.

3rd National Bundled Payment Summit: Washington, DCEarly adoption has been slow and often difficult, but the bundled payment model is receiving close attention from policy makers and innovators as a way to lower healthcare costs and improve care quality. The CMS Innovation Center fueled this interest with its January announcement that over 500 participants would begin testing four models of bundling payments in 2013. IHA’s 3rd National Bundled Payment Summit offered a forum for nearly 250 attendees to explore the critical elements of bundled payment just as more organizations began to pursue implementation. The June Summit featured national policy makers, and emphasized the learnings from hospital and physician leaders with real-life implementation experience. Care redesign, the backbone of the bundled payment model, was a central focus; other topics included implementation case studies, data and analytics, gainsharing, employer perspectives, and how bundling fits in the spectrum of value based payment.

12th California Pay for Performance Stakeholders Meeting: Burbank, CAValue Based P4P made great strides in 2013, with one plan fully implementing the new design and three more plans committed to implementing for 2014. At the time of the P4P Stakeholders Meeting in September, the core design for Value Based P4P had been in place for one year, and the optional design elements were being finalized. The meeting offered the perfect forum to provide a progress update to our California stakeholders, as well as to solicit feedback. The meeting also featured a number of outstanding sessions, including a keynote panel on strategies for delivering high value care. Breakout sessions included managing high cost patients, palliative care programs, reducing readmissions and ER visits, digging into Value Based P4P, improving the P4P reports, and California Office of the Patient Advocate’s healthcare quality report cards. We were delighted to recognize the accomplishments of the physician organizations that demonstrated the highest level of overall achievement, as well as the physician organization in each P4P region that demonstrated the greatest overall quality improvement.


4th National Accountable Care Congress: Los Angeles, CAAccountable care continues to gain momentum, with a growing number and variety of organiza-tions adopting accountable care delivery models. The 4th National Accountable Care Congress, held in November, brought together leading policymakers, experts, and those working on the front line of ACO implementation and operations to provide in-depth insight into current status and future prospects. The three-day conference drew over 500 attendees and featured lessons learned by the Pioneer ACOs; commercial health plan and hospital-centric ACOs; clinical integration to maximize population health management; accountable care in Medicaid and Dual Eligible popu-lations; political forecasts from leading healthcare advisers and futurists; updates from CMS; and insights from the private sector.

1st National Health Insurance Exchange Summit West: Los Angeles, CAHealth Insurance Exchanges are a vital pillar in the overall architecture of the Affordable Care Act. By November 2013, we had a clear picture of which states were opting to run their own state-operated exchanges, participate in a state-federal partnership, or defer to a federally facil-itated exchange. The first wave of Qualified Health Plans had been selected. Populations were targeted and aggressive marketing campaigns were underway. Private exchanges were emerging, health plans were developing varied strategic responses to the exchange movement, and health-care providers were seeking to integrate exchange participation strategies into their ACO and value-based payment reform initiatives. The National Health Insurance Exchange Summit West provided an ideal setting for over 200 participants to discuss progress, implementation challenges, and emerging opportunities in the new “marketplaces” for healthcare in America.

Cassidy Tsay, MD, Greater Newport Physicians; Greg Denton, Intelligent Healthcare; and Laura Clark, AbbVie

Susan Bangasser, PhD, San Bernardino Valley College and Tom Williams, DrPH, Integrated Healthcare Association

Mark Schafer, MD, MemorialCare Medical Foundation and Rick Jacobs, Cedars-Sinai Health System


2013 CommitteesIHA Executive CommitteeChair: Elaine Batchlor, MD: MLK Jr. Community Hospital

Members:

Barry Arbuckle, PhD: MemorialCare Health System

Bart Asner, MD: Monarch HealthCare

Alain Enthoven, PhD: Stanford University

Richard Jacobs: Cedars-Sinai Health System

David Joyner: Hill Physicians Medical Group

Martha Smith: Health Net

Frequency: Monthly (except months with IHA Board meetings)

Role: Handle IHA business between Board meetings including the approval of budgets, operating policies, employee compensation, pilot projects, etc.

IHA Membership and Nominating CommitteeChair: Bart Asner, MD: Monarch HealthCare

Members:

Elaine Batchlor, MD: MLK Jr. Community Hospital

Michael Hunn: Providence Health & Services

Henry Loubet: Keenan

Richard Slavin, MD: Palo Alto Medical Foundation

Barbara Wachsman: Disney Worldwide Services, Inc.

Frequency: Quarterly

Role: Review and nominate candidates for IHA Board membership and officer positions. Guide IHA staff on membership and recruitment related activities.

P4P Governance CommitteeChair: Bart Wald, MD: Providence Health & Services

Members:

Carol Aroyan: Health Net (through April 2013)


Lori Ballendine: Health Net (after April 2013)

Juan Davila: Blue Shield of California (through April 2013)

Larry DeGhetaldi, MD: Sutter Health

Richard Fish: Brown & Toland Physicians

Don Hufford, MD: Western Health Advantage

Brian Jeffrey: UnitedHealthcare

Phil Madvig, MD: The Permanente Medical Group

Steve McDermott: PriMed Management Consulting

Arminé Papouchian: Blue Shield of California

(after April 2013)

Ernie Schwefler: Anthem Blue Cross

Robert Severs: GEMCare Mercy Memorial Health System

Greg Stevens: Aetna

Mike Weiss, DO: Monarch HealthCare

Peter Welch: Cigna Healthcare of California


Role: Set the strategy and direction for the P4P program and serve as its governing body.

P4P Technical Measurement CommitteeChair: Mike Weiss, DO: Monarch HealthCare

Members:

Christine Castano, MD: HealthCare Partners

Cheryl Damberg, PhD: RAND

Ellen Fagan: Cigna Healthcare of California

John Ford, MD: Family Practice Physician

Peggy Haines: Health Net (after August 2013)

Maureen Hanlon: Kaiser Foundation Health Plan

Jennifer Hobart: Blue Shield of California

Chris Jioras: Humboldt-Del Norte IPA

Kim Kochan: AppleCare Medical Management

(after July 2013)

Ranyan Lu, PhD: UnitedHealthcare

Eileen O’Connor: Health Net (through August 2013)

Dawn Rezente: The Permanente Medical Group (alternate)

Leticia Schumann: Anthem Blue Cross

Kristy Thornton: Pacific Business Group on Health

Susanne Turnbull: Aetna (through July 2013)

Michael van Duren, MD: Sutter Medical Network

Ralph Vogel, PhD: Southern California Permanente

Medical Group


Role: Advise the P4P Governance Committee on technical issues related to measurement.


P4P Technical Payment CommitteeChair: Brian Jeffrey: UnitedHealthcare

Members:

Dan Ayala: Hill Physicians Medical Group

Adam Cheung: Anthem Blue Cross

Teresa David: Facey Medical Foundation

Michelle Demonteverde: Cigna Healthcare of California

Ritu Grover: Aetna

Travis Herzog: Anthem Blue Cross (alternate)

Stacey Hrountas: Sharp Rees-Stealy

Leigh Hutchins: NAMM Cal

Michelle Scanlon: Health Net (after August 2013)

Judy Shubin: MemorialCare Medical Group

Heather Stanley: Health Net (through August 2013)

Alexander Vojta: Blue Shield of California


Role: Advise the P4P Governance Committee on technical issues related to incentive payment design.

Performance Measurement Advisory CommitteeChair: TBD

Members:

Daniel Bluestone, MD: Santé Community Physicians

Michael-Anne Browne, MD: Blue Shield of California

(through April 2013)

Jennifer Curtis: Anthem Blue Cross

Cheryl Damberg, PhD: RAND

Marge Ginsburg: Center for Healthcare Decisions

Jennifer Gutzmore, MD: Cigna Healthcare of California

Patti Harvey: Kaiser Foundation Health Plan

Sam Ho, MD: UnitedHealthcare (through November 2013)

Janet Holdych, PharmD: Dignity Health

David Hopkins, PhD: Pacific Business Group on Health

Joel Hyatt, MD: Southern California Permanente Medical Group

Jennifer Lenz: National Committee for Quality Assurance

Cynthia Litt: Cedars-Sinai Medical Care Foundation

Ranyan Lu, PhD: UnitedHealthcare (after November 2013)

Helen Macfie, PharmD: MemorialCare Health System

Steve McDermott: PriMed Management Consulting

Arnie Milstein, MD: Stanford University School of Medicine

Terri Schroeder: Aetna

Maribeth Shannon: California HealthCare Foundation

Lawrence Shapiro, MD: Palo Alto Medical Foundation

Neil Solomon, MD: Blue Shield of California

(after April 2013)

Frequency: 2-3 times per year

Role: Advise IHA on priorities for its broad performance measurement strategy, including expansion into new product areas (i.e. Medicare Advantage) and populations being measured.

Bundled Payment Technical CommitteeChair: Jacob Asher, MD: Cigna Healthcare of California

Members:


Ron Caviness: Aetna

Benjamin Katz: Cigna Healthcare of California

Thomas Lynn, MD: Optum

Megan North: Cap Management Systems

Ginny Ripslinger: St. Joseph Health System

Colleen Thilgen: Optum

Frequency: As needed

Role: Review and approve clinical and technical aspects of bundled payment projects.

Bundled Payment Technical Workgroup-Hysterectomy DefinitionChair: Jacob Asher, MD: Cigna Healthcare of California

Members:

Allyson Brooks, MD: Hoag

Nathana Lurvey, MD: California Hospital Medical Center

Thomas Lynn, MD: Optum

Colleen Thilgen: Optum

Frequency: As needed

Role: Provide clinical expertise to refine and finalize the hysterectomy episode definition.


DOFR Work GroupMembers:

Linda Barney: Sharp HealthCare

Jackie Bright: Brown & Toland

Nicole Brown: Anthem Blue Cross

Margo Carroll: Health Net

Penny Clarygoetz: UnitedHealthcare

Shirley Conley: Aetna

Kenny Deng: Blue Shield of California

Silva DerMugerdichian: Cigna Healthcare of California

Kristina Edson: UnitedHealthcare

Susan Galzerano: UnitedHealthcare

Heather Garcia: Cigna Healthcare of California

Jackie Ghelfi: Dignity Health

Sylvia Gonzalez: UnitedHealthcare

Anna Grijalva: Cigna Healthcare of California

Jennifer Hastie: UnitedHealthcare

Brian Jeffrey: UnitedHealthcare

Denise La Moglia: Blue Shield of California

Greg Labow: Receivable Optimization, Inc.

David Lankford: Blue Shield of California

Steve Linesch: Torrance Hospital IPA

Janet Marcus: Altegra Health

Valerie Morse: UnitedHealthcare

Daniel Murray: UnitedHealthcare

Margaret Nevarez: Aetna

Kahn Nguyen: Hill Physicians Medical Group

Cecil Nyein: Anthem Blue Cross

Edie Parker: Blue Shield of California

Ramona Saragosa: Sharp HealthCare

Randy Stein: Sansum Clinic

Carol Wanke: Sharp HealthCare

Angela Young: Blue Shield of California

Bruce Young: Cedars-Sinai

Frequency: Weekly for 3-4 months/year during period of annual coding revisions.

Role: Maintain IHA Coded DOFR.

2013 Committees

Panel discussion at one of IHA’s conferences, moderated by President & CEO Tom Williams.

2013 IHA Affiliate Organizations

IHA’s Affiliate Program allows organizations to formally engage with IHA, its leader-ship, and programs. This special status provides the opportunity for non-board

organizations to participate in IHA through strategic networking opportunities, communica-tions and IHA sponsored events, and for IHA to be more engaged and knowledgeable about Affiliate members and their respective organizations.

Healthcare Services Affiliatesn AbbVien Aver Informaticsn BDC Advisorsn Bristol-Myers Squibbn The Camden Groupn Davis Wright Tremaine LLPn Genomic Healthn Intelligent Healthcaren Novo Nordiskn Patient Engagement Systemsn TransUnion Healthcare

2013 IHA StaffTom Williams, DrPH, President and Chief Executive Officer

Policy and Researchn Jill Yegian, PhD, Vice President, Policy and Researchn Sarah Lally, Project and Policy Analyst

Performance Measurement and Analyticsn Dolores Yanagihara, Vice President, Performance Measurement and Analyticsn Ann Woo, PharmD, Clinical and Technical Advisorn Gail Rusin, Manager, Pay for Performance Programn Brian Goodness, Manager, Data and Analyticsn Lindsay Erickson, Senior Project Analystn Kelly Miller, Project Analystn Cayman Nava, Web Engineer/Developer

Office Administration and Communicationsn Cindy Ryan Ernst, Vice President, Administration and Communicationsn Jett Stansbury, Director, Member Servicesn Jennifer Kellar, Manager, Communicationsn Eileen DeGrazia, Office Administrator n Holli Gaskell, Executive Assistant

Healthcare Delivery Affiliatesn Children’s Physicians Medical

Groupn Molina Healthcare of Californian Santa Clara County IPAn Scan Health Plan

About the Integrated Healthcare AssociationThe Integrated Healthcare Association (IHA) is a not-for-profit multi-stakeholder lead-ership group that promotes quality improvement, accountability and affordability of healthcare in California. IHA administers regional and statewide programs, serves as an incubator for pilot programs and projects, and actively convenes all healthcare parties for cross sector collaboration on healthcare topics. IHA principal projects include the California Value Based Pay for Performance program (the largest private physician incentive program in the U.S.), the measurement and reward of efficiency in health-care, administrative simplification, healthcare affordability, bundled episode of care payments, and accountable care organizations.

IHA moved to a new office in 2013. Our new address is:

Integrated Healthcare Association500 12th Street, Suite 310Oakland, California 94607Phone: 510.208.1740Fax: 510.444.5842www.iha.org

integrated healthcare associationannual report 2013 | 3 this year, iha continued its engagement in...

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