The California Healthcare Performance Information System (CHPI) is a 501(c)(4) nonprofit, public benefit corporation whose mission is to serve as a trusted source of healthcare data to measure the quality and affordability of care, report performance ratings to and educate the public about healthcare value, and drive improvements in healthcare in California.
CHPI’s key objectives are to:
Produce performance ratings of physicians, medical groups, hospitals and other providers;
Educate the public about performance information and support policies to reduce barriers to such information;
Achieve measurement system efficiencies by serving as a central claims data resource in California:
Create and administer a multi-payer claims database – aggregate, score and report data supplied by multiple California health plans, Medicare, and other data suppliers; and
Starting in 2017, consumers can use CHPI’s information about the quality of care of doctors and medical groups. For example, a person with heart disease who is searching for a doctor, perhaps because he/she is new in town or has recently changed health plans, could look-up quality ratings on cardiologists or primary care doctors to find one who is highly rated for caring for patients with heart problems.
Quality, efficiency and utilization metrics will be produced and reported for various medical care delivery organization levels including physician, medical practice, and hospital. These metrics will be drawn from claims and administrative data, though other data may be added in the future.
Blue Shield of California made an initial community grant to fund the launch of the new entity. At this time, CHPI receives funding from several large health plans, and PBGH contributes support on behalf of its member purchasers.
CHPI’s multi-stakeholder Board has representation from purchasers, health plans, consumers, and providers. Health plans and purchasers represent two-thirds of the Board seats and consumers and providers represent one-third. The committee structure includes members drawn from all stakeholder groups.
Providers and medical groups will participate in the CHPI governance through Board and committee representation. Additionally, some physicians who appear in CHPI's results may choose to participate in a Review and Corrections process prior to each cycle's publication.
As a Qualified Entity, CHPI is eligible to receive Medicare fee-for-service claims and enrollment datasets for California beneficiaries. These Medicare datasets will be combined with the health plan data to create provider performance ratings. The quality for many more providers can be reliably reported by combining data from the three million Medicare beneficiaries with the private sector data. Per the Qualified Entity designation, these quality performance ratings must be reported to the public.
The CHPI measurement system is centered on a multi-payer claims and eligibility data aggregation process. CHPI will maintain 3+ years of claims history. The datasets do not include allowed amounts or provider fee schedule information. In CHPI's initial work, the focus is on quality, efficiency and appropriateness of care performance.
CHPI will aggregate claims and eligibility data from the commercial and Medicare HMO and PPO products of the three largest California health plans – Anthem Blue Cross, Blue Shield of California and UnitedHealthcare. Additionally, as a designated Medicare Qualified Entity, CHPI will integrate Medicare data for California. And, we welcome the participation of other California data suppliers and will discuss with the State the opportunity to add the Medi-Cal data.
CHPI benefits from this recently enacted California law which prevents healthcare providers from contractually prohibiting health plans from reporting medical claims data to a Medicare Qualified Entity in California. This legislation ensures that CHPI can provide all Californians with more complete and meaningful information about the quality and efficiency of patient care.
CHPI’s key objective is to put the performance information to use in consumer choice, payment and program management applications. Our primary customers are the general public, health plans, and the members and purchasers they serve. CHPI also will work with physicians, medical groups, and hospitals in using performance data to improve the quality and affordability of care.
CHPI will use the most granular-level available data, services rendered to patients, to assemble performance information at all organization levels ranging from the individual physician and hospital to the medical group and service area. Aggregating the data across lines of business and payers will provide reliable results for those providers that care for most Californians.
The Patient Assessment Survey contains a set of patient experience measures on access, patient-doctor interactions, office staff interactions, coordination of care, health promotion, and overall ratings of care.
Reliable reporting at an individual physician level requires a sufficient sample of surveys to ensure accurate results. We are researching cost effective ways to collect surveys on individual physicians.
A medical group is a group of physicians who contract with a health plan to provide patient care. Physicians may be employees of the medical group, or they may practice independently and work under contract to the medical group. The latter type of medical group is known as an independent practice association (IPA). The Patient Assessment Survey includes ratings for both types of medical groups.