Medical team_meeting

State leaders, health plans, and provider organizations have announced major results of the largest collaborative initiative in history to improve healthcare quality, and discuss next steps.

With more than $52 million in grants from the Centers for Medicare and Medicaid Services (CMS) under its Transforming Clinical Practice Initiative, the Pacific Business Group on Health (PBGH), L.A. Care Health Plan, and the Southwest Pediatric Practice Transformation Network (a partnership of Children's Hospital of Orange County and Rady Children's Hospital) each led a practice transformation network and worked with 9,800 California physicians serving 5.9 million patients over four years as part of the largest quality improvement effort ever under way in the state. The overall goals of the CMS-supported effort were to improve the quality of patient care and spend healthcare dollars more wisely.

Each network focused on separate projects to improve clinical outcomes while sharing information that suits best practices: 

  • The Southwest Pediatric Practice Transformation Network targeted quality metrics across six conditions: acne, acute gastroenteritis, bronchiolitis, asthma, community-acquired pneumonia and headache.

  • The Pacific Business Group on Health focused on diabetes, hypertension, asthma, cervical cancer screening and imaging for lower back pain. 

  • 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 results of this initiative show:

  • $345 million in cost avoidance, $6 saved for every $1 invested 

  • 67,000 avoided emergency department visits 

  • 57,000 avoided hospital admissions 

  • 750,000 patients with improved health outcomes (e.g., diabetes, hypertension, asthma) or improved processes of care (e.g., treated using new and improved clinical guidelines)

"This effort shows that proactively investing in high-quality care and care coordination brings value to patients, providers, payers and the overall system. Helping primary care practices transform is both achievable and important. We need to continue to collaborate and scale investment in multi-payer support for advanced primary care," says Michael Weiss, DO, FAAP, vice president population health, CHOC Children's.

The announcement was made at the California Transformation Summit with leaders emphasizing the need for multi-payer alignment, measure alignment, and a stronger focus on recognizing and rewarding high-performing practices. Leaders participating in the summit included  Elizabeth Mitchell, CEO, Pacific Business Group on Health; John Baackes, CEO, L.A. Care Health Plan; Peter Lee, Executive Director, Covered California; Mary Watanabe, Acting Chief Deputy Director of the Department of Managed Health Care; and Peter Long, SVP, Health Care and Community Transformation, Blue Shield of California.  They discussed how to leverage the success of the initiative and ways to foster further state transformation efforts.

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