Using a quality scorecard to measure and improve medical groups' performance

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Health Services Research

Background:

• Blue Cross of California (BCC) utilizes an annual Quality Scorecard to assess participating medical groups (PMGs) and independent practice associations (IPAs).
• The scorecard informs PMGs/IPAs of their performance across various domains relative to network averages.
• Financial incentives (bonuses) are provided to PMGs/IPAs demonstrating superior quality performance.

Purpose of the Study:

• To design and implement a structured intervention aimed at enhancing the performance of PMGs/IPAs identified as low performers on the Quality Scorecard.
• To evaluate the impact of this targeted intervention on specific quality metrics.

Main Methods:

• A cohort study was conducted within a large California health maintenance organization in 1997.
• Twenty-two underperforming PMGs/IPAs (scoring more than 1 standard deviation below the mean) were identified and targeted for intervention.
• These targeted groups received detailed feedback on their performance, supplementary information on deficient areas, and direct assistance from a BCC quality team.

Main Results:

• Targeted PMGs/IPAs demonstrated significant improvements in their annual audit of quality scores.
• Member satisfaction metrics, including satisfaction with access, last visit, and overall experience, showed marked improvement.
• Performance in mammography screening and the overall total quality score also saw significant positive changes.

Conclusions:

• A structured quality improvement intervention effectively addressed deficiencies in poorly performing PMGs/IPAs.
• The intervention led to measurable improvements across several critical performance indicators, highlighting the efficacy of targeted support.