Hospital and Physician Update

September – October 2020

Clinical Quality Initiative statistics show that physicians continue to improve quality

We recently received some updated statistics for the Clinical Quality Initiative showing that physicians participating in our Physician Group Incentive Program have made significant quality improvements over the past two years.

The PGIP Clinical Quality Initiative aims to improve the quality of health care delivered by PGIP-participating physicians. It rewards physician organizations for adopting evidence-based medical guidelines, such as Medicare star rating measures and Healthcare Effectiveness and Data Information Set, or HEDIS^®, measures* into their practices.

For the two-year period ending in 2019, we’ve seen a 4.5 percentage point improvement among Michigan physicians in their ability to close quality gaps and ensure that our members are getting the necessary screenings and tests.

The following chart provides a look at how our monthly composite scores for 2018 compare to our 2019 data.

Here are some highlights:

• Eleven of the 15 measures that were included in both our 2018 and 2019 programs showed improvement:
• Adult BMI Assessment
• Appropriate Treatment for Children with Upper Respiratory Infection
• Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
• Breast Cancer Screening
• Cervical Cancer Screening
• Colorectal Cancer Screening
• Comprehensive Diabetes Care — Eye Exam
• Comprehensive Diabetes Care — HbA1c Adequate Control
• Proportion of Days Covered — Diabetes All Class
• Proportion of Days Covered — RAS Antagonists (ACE/ARB)
• Proportion of Days Covered — Statins

  Note: “Proportion of Days Covered” refers to the days that the same medication — or another in its therapeutic category — was used to treat a specific condition.

• Seven out of 15 measures performed in the 90^th percentile, including Adult BMI Assessment, Breast Cancer Screening, Cervical Cancer Screening, Colorectal Cancer Screening, Proportion of Days Covered — Diabetes All Class, Proportion of Days Covered — RAS Antagonists and Proportion of Days Covered — Statins.
• The Controlling High Blood Pressure measure continued to perform in the 75^th percentile for two years in a row.

The NCQA calculates these percentiles by looking at data from health plans across the country. It establishes national benchmarks that are broken up into five categories: 90^th, 75^th, 50^th, 25^th and less than 25^th.

“The Controlling High Blood Pressure measure continued to perform in the 75^th percentile for two years in a row and that’s a significant achievement,” said Vicki Boyle, director of the Physician Group Incentive Program. “Helping members control their blood pressure is important in preventing strokes, heart attacks and maintaining their quality of life.”

Karen Kopytek, health care manager, Value Partnerships, added: “We’re also very proud that preventive measures, such as breast cancer screenings, cervical cancer screenings and colorectal exams performed in the 90th percentile for both 2018 and 2019. Preventive care is essential for keeping our members of all ages healthy.”

Every physician organization that participates in the Physician Group Incentive Program is eligible for the Clinical Quality Improvement Initiative. Health care providers who want to learn more about the program should contact their PGIP-participating physician organization.

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