California group unveils new quality award

In an effort to raise the profile of the organization and its members, the California Assn. of Physician Groups plans to implement a "gold star" system to recognize doctors' quality care.

The program will not provide the same financial motivation as the Integrated Healthcare Assn.'s "Pay for Performance" initiative in the state but could be another marketing tool for groups looking to differentiate themselves from their competition.

"They're going to be able to say to their patients or purchasers, 'Look, we have the CAPG gold star because we deliver a high level of quality,' " said Donald Crane, CAPG's president and CEO. "Purchasers will say they want a gold star group in their network. Individual employees will say they want to go to a gold star group."

The "gold star" will be an award of distinction for groups that satisfy a variety of criteria, including existing IHA metrics, Crane said. Groups that qualify also will exhibit several "programmatic attributes," such as using hospitalists and case managers for high-risk cases, he said. The full list of criteria is being developed, Crane said.

The association, which represents more than 150 large physician groups largely involved in capitated managed care contracts, will rely on members to self-report results rather than run a full-time accreditation program, Crane said.

The program, though, will serve as a way to both trumpet the accomplishments of CAPG members and bring all groups up to a demonstrable level of quality.

Quality measurement has been an elusive target for physician groups, and health plans have made it more difficult by rewarding physicians different bonus amounts based on different sets of criteria. The IHA program, launched in 2002, attempted to address that issue by involving seven of California's largest health plans, with a common set of measurable metrics. Measurements started in 2003, and groups received their first bonus payments in 2004.

In addition to their bonus payments, top performing groups receive awards at the IHA's annual meeting, said Tom Williams, executive director of the association.

Jack Lewin, MD, executive vice president and CEO of the California Medical Assn., said the CAPG program, like the efforts before it, is a noble one, but he warned fairness has been an issue with quality programs.

"The difficulty is in making sure any such standard of excellence is both fair and risk-adjusted," Dr. Lewin said.