- Three large networks of medical practices in California saved more than $345 million over four years in costs that payers would have otherwise incurred from emergency department visits, hospital admissions, diagnostic tests and other services, in results under a CMS initiative announced Wednesday.
- The Pacific Business Group on Health, L.A. Care Health Plan (a publicly operated organization offering health plans to vulnerable and low income consumers) and Southwest Pediatric Transformation Network (a partnership of CHOC Children’s Hospital and Rady Children’s Hospital-San Diego) each led one of the three networks.
- A total of 9,800 physicians — or 14% of the state’s primary care providers and 4% of specialists — serving 5.9 million patients (or 15% of Californians) including adults, teens and children participated in the statewide effort. They improved outcomes in such common medical issues, as diabetes, depression, asthma and hypertension.
CMS’ Transforming Clinical Practice Initiative is designed to help medical practices develop quality improvement strategies and move toward value-based and patient-centered care. The initiative is based on the concept of peer-to-peer learning and collaboration, with practice transformation networks coaching individual medical practices.
The agency awarded $685 million to 39 national and regional networks, including more than $52 million to the three practice networks in California.
To calculate how much money they saved during the four-year grant period, which officially ends September 30, the California networks tracked patients’ use of medical services during the program and compared it with their historical usage data. They also tracked improvements in specific clinical outcome and process measures — such as A1c levels or completed suicide risk assessments — and assigned a dollar value to those scores. They also included the dollar value of any bonuses the medical practices received from payers for meeting quality metrics.
The cost savings included $280.8 million in 57,000 avoided hospital admissions, $53.3 million in 67,000 avoided ED visits, $10.8 million in avoided testing and $900,000 from improved clinical outcomes, according to the groups. Based on this analysis, the networks calculated a ROI of $6.63 per $1 of grant funding.
Each of the networks pursued separate projects to improve clinical outcomes, although they shared information about best practices, according to Michael Weiss, vice president of population health for CHOC Children’s Hospital in Orange County.
For example, the Southwest Pediatric Practice Transformation Network targeted 12 quality metrics across six conditions: acne, acute gastroenteritis, bronchiolitis, asthma, community-acquired pneumonia and headache.
Meanwhile, the Pacific Business Group on Health — which includes such large employers in its membership as Microsoft and Bank of America — focused on diabetes, hypertension, asthma, cervical cancer screening and imaging for lower back pain. Its patient mix included consumers enrolled in plans with commercial payers.
L.A. Care Health Plan concentrated on diabetes and depression, including screening for suicide risk for vulnerable patients, such as enrollees in Medi-Cal, California’s Medicaid program.
The biggest challenge the transformation networks faced was the distributed nature of outpatient medicine in California because many clinicians work in small practices of one or two providers. However, the clinicians also join independent practice associations to contract with payers, making those IPAs the logical starting point for reaching out to individual medical practices with coaching and tools, Weiss said.
"The second biggest challenge was data. You have so many doctors on so many different electronic health records or on paper and seeing patients from so many different payer sources that aggregating data was a very challenging process," Weiss said.