Five of CAPP’s California-based medical groups achieved outstanding ratings from the state’s Office of the Patient Advocate in their recently released 2017 Medical Group report card for Medicare Advantage Plans.
The Permanente Medical Group, Palo Alto Medical Foundation, Southern California Permanente Medical Group, Sharp Rees-Stealy and HealthCarePartners Medical Group all received ratings of 4.5 stars or higher on a 5-star scale.
“The California OPA ratings are further evidence that CAPP’s multispecialty medical groups and health systems provide superior quality care compared to a majority of their peers in the marketplace,” said CAPP Executive Director Laura Fegraus. “Our groups draw on CAPP’s five pillars to offer patients coordinated, physician-led, technologically-enabled health care. The evidence speaks for itself.”
OPA’s Medicare Report Cards provide unbiased, precise ratings on 186 medical groups from 39 different counties in California. The report card serves as an online tool that allows users to search for medical groups by county or alphabetically and easily compare quality ratings side by side. It includes information on 13 separate clinical measures.
CAPP congratulates our member groups on their outstanding performance.
Recommend Emphasis on Healthcare Delivery System Changes to Improve Care, Lower Overall Costs
As the “repeal or replace” debate over the structure of America’s healthcare system continues, the Council of Accountable Physician Practices (CAPP) urges decisionmakers to focus on healthcare delivery initiatives that are improving patient care, reducing medical errors and lowering the overall cost of healthcare.
“In the debate over healthcare reform, we must not ignore the importance of improving how healthcare services are organized and delivered,” noted Robert Pearl, M.D., Chairman of the Council of Accountable Physician Practices, a coalition of high-performing multi-specialty medical groups and health systems, as well as CEO of The Permanente Medical Group and president and CEO of the MidAtlantic Permanente Medical Group.
“If we do not continue to emphasize the need for care initiatives that promote physician-led, value-based, patient-centered, technologically-enabled care, we will lose ground in quality, innovation and outcomes that lower the cost of healthcare, while making it more available and convenient to patients. The consequences of inaction for our patients, their communities and the nation are significant.”
The foundation of healthcare delivery improvement rests on changes in payment incentives to providers, who instead of being paid fees for every service (the “fee-for-service” payment model), are now increasingly paid based on outcomes and performance. Innovations like electronic medical records and digital communications between healthcare teams, video visits with doctors, access to data to determine if patients are at risk, and improvements in preventive services are being adopted more rapidly to achieve better patient care and outcomes.
Pearl notes, “The CAPP medical groups are pioneers in linking physicians and patients with technology and digital communication, in delivering coordinated, connected care, and in forging patient/physician relationships that are both high touch and high tech. Physician leadership is behind all these improvements, ensuring that the welfare of the patient is first and foremost. When these enhancements are in place, patients get higher quality, faster care, medical errors are reduced, and better clinical decisions are made because information is available in real-time to all members of the team. “
CAPP physician leaders recommend:
Accelerated movement toward value-based payment for healthcare.
More widespread and coordinated use of health information technology so that care teams can access information related to patients’ health and treatment anywhere and anytime.
Simplification and standardization of quality measurement and reporting so that patients can identify healthcare providers with the best clinical outcomes.
These high performers can then help others to match their success and raise the national level of performance.
In this H&HN video interview, CAPP Chair Robert Pearl, MD, discusses a significant problem with new health care technology: HIT designers create the technology and then look at ways to apply it to healthcare. The better way to approach HIT development is to find the problem that needs to be solved and then figure out the technology that can help solve it, says Dr. Pearl, who is also executive director and CEO, The Permanente Medical Group; president and CEO, Mid-Atlantic Permanente Medical Group; and co-CEO, the Permanente Federation, LLC.
The Council of Accountable Physician Practices partnered with CAPG — a trade association that promotes accountable care — to host a panel at the CAPG Colloquium held in Washington DC, on September 29, 2016.
The panel, “Physician Leadership in the Movement Toward Accountable Care,” featured four CAPP medical group leaders who discussed best practices for recruiting, training and developing physician leaders.
The panelists represented a diverse range of medical groups in size, geography and model. The panelists were Dr. Marc Klau, Southern California Permanente Medical Group; Dr. Philip Oravetz, Ochsner Health System; Dr. Lee Sacks, Advocate Physician Partners; and Dr. Nick Wolter, The Billings Clinic. Dr. Robert Pearl, Chairman of CAPP and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, served as the panel moderator.
“It will not be possible to move the country toward accountable, value-based care without strong physician leadership at all levels of the organization,” said Dr. Pearl. “Healthcare systems should view physician leadership as a capital investment for the future with huge ROI. The CAPP medical groups are committed to sharing their considerable experience to help all provider organizations face the challenges ahead.”
Development starts at recruitment
Over the course of the discussion, the panel touched on key aspects of their physician leadership development approaches. All agreed that leadership development starts at the moment of recruitment into the organization. “Every physician is a leader. We start with that assumption,” said Dr. Klau. “Take every physician on as a leader and then expand their capability, because you never know when you will need them.“
Each of the medical groups has their own leadership training programs that have evolved over the years. Ochsner Health System, for example, has several tiers of leadership training that are designed to match physicians with their age and career experience. “We believe every physician is a leader by definition, but some exhibit their ability to lead more than others, or earlier in their career,” said Dr. Oravetz. “Our program exposes these folks to what a management career might look like.”
Regardless of the specifics of the training and development programs, the panelists overwhelmingly agreed that two critical traits for physician leaders are emotional intelligence and proven clinical excellence. “The best leaders are going to be visionary but anchored in reality,” said Dr. Klau.
“Self awareness is important to put on the table. What’s your humility? How do you develop people to create trust that’s necessary for good teamwork?” said Dr. Wolter.
Physician leadership as a strategy
Dr. Wolter stressed that physician leadership development should be considered outside of health care system payment as a strategy to improve care quality and patient outcomes. “No matter how the payment system evolves, if you leverage team care and leadership, that’s going to lead to better outcomes.”
Dr. Sacks agreed, saying that his group places leadership development at a premium. “It’s about improving care. The finances will follow,” he said. “Focus on what really resonates, which is improving outcomes.”
Following the discussion, the CAPG audience posed questions to the panel about the how-to’s of physician leadership development. The panelists agreed that physicians who aspire to lead their health system should start small. They mentioned that emerging physician leaders could join clinical improvement committees or attend the first stage of a leadership program as ways to determine if the track is right for them.
The panel was comprised of four of the 11 medical groups that contributed their case studies to CAPP’s five-part journal series about physician leadership development, which was published in the journal Healthcare: Delivery Science Innovation. The articles can be read in full here.
Photos courtesy of Thomas Van Veen of Documentary Associates
With thousands of political offices up for election this November, health care will continue to be a complex and frequently debated issue. To help focus discussions, the Council of Accountable Physician Practices has produced an original primer, “What Every Candidate Should Know About Health Care.” This primer is for candidates running for local and national elected office and details the most critical health reform topics they must understand to ultimately improve the medical care their constituents receive.
The three primary issues highlighted in “What Every Candidate Should Know About Health Care” are:
Payment system reform to enable acceleration of the move towards value-based payment and away from the current volume-based fee-for-service model, aligning incentives to reward better patient outcomes, safety and efficiency.
Expanded use of health information technology so care providers always have the information they need to make the best care decisions.
Consistent and meaningful quality measurements to accurately identify high-performing medical groups and health systems.
By bringing these healthcare issues into the political discourse, the leaders of CAPP believe they can educate and inform elected politicians on the accountable approaches that produce the highest quality and best health outcomes for patients.
The American Journal of Managed Care recently published a second round of research sponsored by the Council of Accountable Physician Practices (CAPP) on the prevalence and magnitude of capitation and other alternative payment contracts among CAPP’s organized physician groups.
CAPP partnered with Brandeis researchers Robert Mechanic and Darren Zinner in 2011 to launch a longitudinal study. The focus of the research is to gauge the incidence of alternative payment contracts among CAPP groups, understand these groups’ previous experience with managing risk, and to define the approaches to physician compensation utilized by these groups. This published report is the second round of research conducted.
“This is one of the only published analyses examining payment and contracting practices for a variety of organizations across the full range of their payers. This allows us to better assess the relationship between contracting structures and organizational practices likely to positively impact performance” said Mechanic.
Twenty-two CAPP groups have participated in the survey’s second round, as well as 11 member groups of the Group Practice Improvement Network. The survey asked for information about quality and cost management programs, risk contracting, physician compensation changes and other factors to evaluate risk-based payment models.
According to survey findings, medical groups that received a high portion of revenue from risk contracts were able to more successfully implement advanced programs to avoid hospitalizations and provide care management. It also found that these groups placed greater emphasis on quality and patient experience in their physician compensation models and relatively less on the amount of care provided.
“Groups that had a higher proportion of risk contracts generally had physician compensation models with more emphasis on quality, patient experience and performance, compared to groups in fee-for-service models,” said Mechanic.
He predicted that future rounds of this survey would show a slow and steady movement toward alternative payment models. “Taking on risk is not easy or straightforward, so you really have to have an organization that believes in managing care and physicians that buy into the culture,” he said.
“The Brandeis findings are clear evidence that risk-based payment models allow physicians and medical groups to focus on the patient and their needs, not just on a bottom line,” said Laura Fegraus, Executive Director of CAPP. “CAPP is excited to be a part of this ongoing project to track payment reform progress and provide both current analysis and consistent historical accounting of the “pay-for-value movement.”
A third round of this survey is currently in the field. Results are expected in early 2017.
“Better Together Health: High Tech and High Touch – The Patient-Physician Relationship in the New Millennium,” the first of the annual campaigns sponsored by the Council of Accountable Physician Practices, has won the PR World Award with its public relations partner, Scott Public Relations. The campaign, designed to raise awareness of the effectiveness of multispecialty medical groups and systems of care in improving care quality and cost, was honored for its effective promotion and media relations work. View the highlights of this event here.
Experts, Patient Advocates at “Better Together Health” Recommend Payment Reform, Digital Technology, and Standard Quality Measures; Keynote Sen. Johnny Isakson Calls for Focus on Wellness and Disease Prevention
The event was sponsored by the Council of Accountable Physician Practices (CAPP), a coalition of leading integrated multi-specialty medical groups and health systems across the United States and the Bipartisan Policy Center.
”Today, half of Americans live with a chronic condition,” said Robert Pearl, M.D., Chairman of CAPP, and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. “The challenges for American health care are to prevent chronic illnesses in the first place, intervene early to avoid complications and use 21st century technology to support patients throughout their lives. Multi-specialty medical groups with strong physician leadership can accomplish each of these better than the rest of the nation, and the beneficiaries are their patients.”
Panelists discussed results from the Nielsen survey of over 30,000 American consumers and over 600 physicians that revealed only about half of Americans reported receiving patient care from coordinated care teams and about one third have 24/7 access to care other than through the emergency room.
Policy improvements suggested to support the continued development of an effective integrated healthcare delivery system include improved EMR interoperability, a movement toward paying for value and modernized, patient-focused quality measures.
Event keynote speaker Sen. Johnny Isakson, (R-GA), co-chair of the Senate Finance Committee Chronic Care Work Group, reiterated the group’s commitment to helping Medicare patients with chronic illnesses receive the care coordination they need. “We must ensure that wellness and disease prevention are top priorities for the next Administration,” Isakson said.
Tim Gronninger, Deputy Chief of Staff at the Centers for Medicare and Medicaid Services, spoke about new legislation designed to bring about payment incentives to help support the adoption of integrated care. Other panelists included:
Ceci Connolly, moderator, President/CEO, Alliance of Community Health Plans
Karen Cabell, DO, Chief of Quality and Patient Safety, Billings Clinic
Regina Holliday, Patient Rights Activist, Artist and Author
Marc Klau, MD, Assistant Regional Medical Director, Southern California Permanente Medical Group
WASHINGTON, D.C. (June 15, 2016) – A new Council of Accountable Physician Practices (CAPP)-sponsored Nielsen Strategic Health Perspectives survey released today reveals that only half of patients are experiencing the benefits of coordinated care and only about one-third have 24/7 access to care outside of the emergency department. The report also finds sluggish progress in the use of health information technology to connect doctors and patients, and that patients, including those who are obese and at risk for chronic illness, do not report receiving prevention counseling from their physicians.
The 2016 Nielsen Strategic Health Perspectives surveyed 30,007 U.S. consumers and 626 physicians. It is the second annual survey that CAPP sponsored to monitor the progress of meaningful healthcare delivery reform and the movement toward accountability.
“This survey is evidence of the failure of American healthcare to provide coordinated, technologically enabled, high-quality healthcare to the majority of people,” said Robert Pearl, M.D., Chairman of CAPP, and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. “We know that CAPP members, all committed to the multi-specialty medical group model, are best positioned to deliver superior outcomes to the patients they treat. CAPP stands ready to help others improve their care delivery systems, and to work with policymakers to facilitate these changes. These findings reinforce CAPP’s long-held belief that patient-centered care models are critical to closing the gaps between what patients need and what they are currently receiving.”
The survey measured respondents’ experiences with the five patient benefits associated with effective accountable care: care team coordination, prevention, 24/7 access, evidence-based medicine, and patient and physician access to and use of robust information technology.
Data from the survey shows that:
Eighty-nine percent of primary care physicians say they often remind patients about preventive screenings, but only 14 percent of patients say they get these reminders. More than two-thirds of adult Americans are overweight or obese, yet only 5 percent of patients report that their physicians recommended a weight-loss program.
Only half of patients are experiencing physicians who better know their history, primarily due to the ability to share information through electronic medical records. However, patients with multiple chronic illnesses, who would most benefit from care coordination, receive only slightly more follow-ups and care management as everyone else.
Patients’ electronic engagement with physicians is increasing but still low, with 20 to 30 percent of the total surveyed reporting that they have various forms of digital access like online submission of medical questions, email or text reminders. Roughly 44 percent report access to online information, such as appointment scheduling, obtaining lab test results, or viewing information via portals. Older Americans are less likely to want to use digital technology for healthcare, which presents a challenge in fully leveraging this technology to improve care delivery to this population.
Only about one-third have 24/7 access to care through their physician’s office other than the emergency room.
Sixty-five percent of physicians report using evidence-based guidelines to help determine treatment, with 39 percent of patients recalling discussions on new treatment options.
The leaders of CAPP, a coalition of leading integrated multi-specialty medical groups and health systems across the U.S. have long been committed to accountable, physician-led, patient-centered care. CAPP Executive Director Laura Fegraus said, “Our survey found that while it is encouraging that the use of care teams and care coordination seem to be increasing, access and the effective use of technology still need improvement, and tactics that help to prevent illness are still woefully ineffective.”
While these results show that delivery system reform is beginning to move in the right direction, the work is far from over. CAPP supports policy initiatives that can expedite performance in accountable care, including payment reform to support “system-ness” and better outcomes; more robust health information technologies to improve sharing of information among providers and easier access by consumers; and standardized quality measures in language consumers can understand.
For more information on the survey findings, click here.
Featuring Sen. Johnny Isakson (R-GA), co-chair of the Senate Finance Committee Chronic Care Working Group.
By Laura Fegraus, Executive Director, Council of Accountable Physician Practices
CAPP has long been engaged in educating American consumers and policymakers about accountability in health care, the multi-specialty medical group model, and the need for robust delivery system reform. However, we continue to observe a persistent knowledge gap and low expectations surrounding the transformation in the care available to consumers in the post-ACA environment. Additionally, we are concerned that two important voices—the patient’s and the physician’s—are conspicuously absent in the national dialogue.
In 2015, CAPP launched the first of our Better Together Health events, a forum through which we hope inform the national dialogue on care delivery. (Highlights and the dedicated website from the first event in the series, Better Together: High Tech and High Touch, can be viewed here.)
This month, on June 15th, CAPP will host Better Together Health 2016 with the Bipartisan Policy Center at The Center for Total Health in Washington, DC. Titled “Patient Expectations and the Accountability Gap,” this event will present the results of CAPP’s 2016 Nielsen Strategic Health Perspectives consumer and physician survey; highlight chronic care patient stories that showcase how accountable care can improve care delivery and the patient experience; and feature a panel discussion on what is possible in chronic care management when clinicians collaborate effectively within a truly accountable health care system.
We are pleased that our keynote speaker will be Sen. Johnny Isakson (R-Ga), Co-chair of the Senate Finance Committee Chronic Care Working Group. We also welcome Dr. Leana Wen, Health Commissioner of the city of Baltimore; patient advocate Regina Holliday; Dr. Karen Cabell of Billings Clinic; and Dr. Marc Klau of the Southern California Permanente Medical Group. Ceci Connolly, CEO of the Alliance of Community Health Plans, will be our moderator for the day.
For those of you in the DC area on June 15, please join us! Others can watch a live-stream of our event. Just click here for more information about both the in-person and live-streaming registration.