Online Program

Group dynamics: The relationship between provider group structure and patients' ratings on services central to the patient-centered medical home (PCMH) model

Sunday, November 3, 2013

S. Rae Starr, MPhil, MOrgBehav, HealthCare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Jasmine Mines, MPH, Quality Improvement Department, L.A. Care Health Plan, Los Angeles, CA
Healthcare is reforming care delivery systems through two complementary models, patient-centered medical homes (PCMHs) and accountable care organizations (ACOs). Medicaid is a niche of particular interest for measuring the interplay between provider group organization and the quality of services in programs characterized by limited reimbursement, serving the poor, the very young, the very old, and persons with disabilities.

The success of PCMH and ACO initiatives may depend on how effectively those models accommodate or transcend the structures into which doctors traditionally organized themselves for the business of prevention and treatment. PCMH and ACO remain in the formative, evidence-gathering stage -- requiring basic information to understand the interaction between provider group structure and the quality of healthcare services -- particularly for vulnerable populations.

(1) Study design: Data for this study come from an adaptation of the Patient Assessment Survey (PAS) fielded in 2011 to large samples of Medicaid members.

The study examines the relationship between provider group structure and patients' assessments of clinical services. 38 provider groups had sufficient members with recent visits for sampling. Provider group structure was analyzed in 4 categories: independent physician associations (IPAs); traditional medical groups; fully-integrated staff model settings; and county-operated clinics.

(2) Setting: The study examines the quality of healthcare services rendered through a large and complex network of provider groups, as reported by Medicaid members in a large and ethnically-diverse urban health plan in Los Angeles County, California.

(3) Findings: The presentation compares how different provider group structures perform on patients' ratings on PCMH-relevant measures: various facets within provider communication, and engagement of the patient in shared decision-making.

(4) Analysis: The analysis tests differences between different provider group structures to determine which are regularly effective at providing high-quality care and services. The analysis will then break down findings by common demographics to assess how well different provider group structures serve the various demographics comprising the Medicaid population.

(5) Implications: The briefing discusses ways to use tools designed to assess provider groups in a pay-for-performance (P4P) program for Medicaid providers. Differences in quality of services can guide targeted incentives toward the qualitative facets of care that the PCMH model requires. The study offers a best practice for augmenting surveys that health plans and provider groups do anyway, to join aspects of ACO and PCMH to encourage patient-centered care.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Planning of health education strategies, interventions, and programs
Program planning
Social and behavioral sciences

Learning Objectives:
Discuss provider group organizations and their purposes, from patients' and providers' perspectives. Describe different provider group structures, and which forms are prevalent in a complex network. Assess which provider group structures tend to deliver the best or worst performance on patients' CAHPS ratings of the quality of services provided by doctors and clinic staffs. Analyze how demographic groups are distributed among provider group structures. Describe ways in which patients choose (or are assigned to) particular provider group structures. Assess which demographic groups fare best or worst under different provider group structures, in their satisfaction with services as patients. Describe which structural features of high-performing provider groups can be emulated by poorer-performing provider groups. Discuss how to integrate the economic incentive logic in the ACO model with the qualitative drivers implicit to the PCMH model. Explain how findings about health care delivery systems can be made actionable for improving quality of services.

Keyword(s): Quality Improvement, Providers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Served seven years as Senior Biostatistician at the largest public health plan in the United States serving Medicaid and CHIP populations in an ethnically diverse urban county in the southwest United States. Designed and managed surveys of patients from 2006 to 2012 to assess the performance of provider groups and health plans on measures of service quality, and on measures of how well services are adapted to human and behavioral factors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.