Practice report cards generating elation, fear among medical groups

One group sees marketing opportunity from results

What if you were enrolled in medical school and the dean decided to post grades for each student on a bulletin board for anyone walking by to see? In this not-so-hypothetical situation, the dean represents a California managed care organization (MCO), and the students represent group practices and independent practice associations (IPAs) with a significant patient base among the MCO’s membership.

Such is the thought behind the Cypress, CA, MCO PacifiCare of California’s decision to release a public report on medical group performance. The Santa Ana, CA-based corporate office of PacifiCare plans to release similar reports in the eight other states — Arizona, Colorado, Nevada, Ohio, Oklahoma, Oregon, Texas, and Washington — in which it operates during the next 18 months.

Known as the Quality Index, the rankings were released to the press, employers, and insurance brokers in September. The complete report is also available on the corporate Web site (www.phs.com) and will be sent out to any member who requests it.

The index rates plan medical groups that have at least 1,000 commercial and 500 Secure Horizons Medicare members. The group practices and IPAs are rated on 14 different administrative, clinical, and service areas. (See the list of some of those areas, p. 142.)

Those practices which score in the 90th percentile or higher in a particular category are given "Best Practice" notations in the plan directory next to their names and in a chart at the beginning of the directory, which will list the areas in which those practices scored above 90. Beaver Medical Group, a Redlands, CA-based multispecialty practice with 135 physicians made the Best Practice thresholds in six of the 14 categories — more than any other ranked group.

According to Sharon Humphreys, vice president of marketing, that achievement is a huge marketing boost to the practice. "I think it confirms what people are thinking about us," she says. "If people hear about Beaver from a friend or employer and then look in the directory and see we are a best practice, it just reaffirms what they have already heard."

When the news broke, Humphreys put out a press release, which was picked up by local papers, and she plans to tout the Best Practice notation when she runs her open enrollment advertisements later this year. She will also do a flyer-size reproduction of the ad to insert into brochures and will note the performance on the corporate Web site (www.beavermedgrp.com).

While Humphreys hasn’t noticed an increase in patients since the news broke in early September, she says she expects that to change during open enrollment later this year.

Releasing patient satisfaction and medical outcomes rankings of medical group practices is becoming more common across the country. In addition to PacifiCare’s effort, Woodland Hills, CA-based HealtNet has released a report card covering 130 medical groups in a five-region area. The San Francisco-based Pacific Business Group on Health, an employer health care purchasing coalition, coordinates a voluntary effort that consolidates data from patient satisfaction surveys reported by area medical groups. And a Minneapolis employer coalition, the Buyers Action Health Care Group, publishes patient satisfaction reports on all participating medical groups and health systems that participate in its benefits program. (Companies who are members of Buyers Action select their health plan by provider rather than by an insurer. A carrier in town performs claims processing and other administrative functions.)

Not all providers are pleased with this trend. Certainly not every medical group or physician within PacifiCare’s network was happy when the plan decided to release its best practices list. According to Cheryl Brady, project manager for the Cypress, CA-based HMO, many physicians were concerned about the rankings. One way PacifiCare assuaged the fear was by letting them review the data before its release.

PacifiCare also hired Coopers & Lybrand, now PricewaterhouseCoopers, to evaluate the data and make sure that the survey design and methodology were sound.

Humphreys says that her physicians didn’t exhibit any of the qualms that others may have had when news of the ranking system came out. "I think that’s because we have scored so high in other surveys that they weren’t concerned," she notes. "PacifiCare outlined the reasons behind the Quality Index and worked with staff to get the data. We had no problem in providing them what they asked for."

When the report was issued by PacifiCare, the vice presidents, CEO, medical director, and CFO at Beaver Medical discussed it at the regular weekly meeting, shared the results with physicians and staff, and prepared the press release, says Humphreys. "And except for the press release, if the scores had been bad, we would have done the same thing."

There is one potential problem with the ranking, says Humphreys. Because Beaver Medical is already a popular practice, an increased patient load could make access difficult for new patients, which could have a detrimental effect on a future Quality Index report. The medical group is recruiting more physicians and considering extending the hours for their five clinics to ensure patients can see their physicians when they want to. "We’re just going to have to be creative so that there is more time to see patients."

Brady says that while PacifiCare knows people are accessing the report on the Web site, the MCO cannot track how many of those hits come from the 2.2 million members. The Quality Index will be released twice a year.

Sharon Humphreys, Vice President of Marketing, Beaver Medical Group, Redlands, CA. Telephone: (909) 478-5101.

Cheryl Brady, Project Manager, PacifiCare of California, Cypress. Telephone: (714) 226-3441.