Clinical Quality Measures Used in Report

CPPI assessed physician performance using clinical quality measures that are evidence-based, nationally standardized and endorsed by major standard-setting bodies (i.e., the National Quality Forum and the AMA's Physician Consortium on Performance Improvement).  The measures address preventive care and chronic condition management.  The measures were reviewed and approved by the CPPI Physician Advisory Group.

The 16 measures listed below are relevant to the commercial population and can be scored using the administrative claims data available in California.  CPPI uses measure specifications from the National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), and the Physician Consortium for Performance Improvement measurement systems.

A list of clinical quality measures used in the report may be found here.

Adult Diagnostic and Preventive Care

• Breast cancer screening (pdf)
• Colorectal cancer screening (pdf)
• Cervical cancer screening (pdf)

Diabetes Care for Adults

• Diabetes care - LDL screening (pdf)
• Diabetes care - HbA1c screening (pdf)
• Diabetes care - nephropathy screening (pdf)

Cardiovascular Disease Care

• Cardiovascular care - cholesterol management for patients with cardiovascular conditions (pdf)
• Cardiovascular care - beta blocker therapy at six months after a heart attack (pdf)
• Coronary artery disease - LDL drug therapy (pdf)
• Coronary artery disease - LDL drug therapy for CAD patients who also have diabetes (pdf)
• Heart failure patients - left ventricular ejection fraction testing (pdf)
• Heart failure patients - warfarin therapy for patients with atrial fibrillation (pdf)

Medication Management

• Monitoring patients on persistent medications (pdf)

Chronic Obstructive Pulmonary Disease Care (COPD)

• COPD care - pharmacotherapy management of COPD exacerbation (pdf)
• COPD care - use of spirometry testing (pdf)

Musculoskeleton Conditions

• Disease modifying anti-rheumatic drug therapy (DMARD) for rheumatoid arthritis (pdf)

Blue Shield of California announced that the health plan will launch its physician quality recognition program June 1, 2010. Network physician listings will include physician quality designations for a set of 8 CPPI quality measures. A set of physicians, who have sufficient patient samples to be reliably scored, have been designated as higher quality performing physicians for select preventive screening and chronic care measures. Blue Shield members can view this new information in the plan's online physician directory. See the Blue Shield announcement here.

Physicians in the Blue Shield network who would like to request a duplicate of the Physician Performance Report that you received last summer may request a copy here.

CCHRI Senior Manager
Julie France, PBGH
jfrance@pbgh.org