Case Study 4: Rochester Individual Practice Association

Founded in 1977, Rochester Individual Practice Association (RIPA) is a large nonprofit physician organization in Rochester, New York, that contracts with managed care companies to provide professional medical services. RIPA membership includes group practices and individual clinicians representing approximately 3,000 practitioners, consisting of 900 primary care providers and encompassing more than 20 specialties. Currently, RIPA contracts with Excellus Blue Cross Blue Shield and serves 300,000 Blue Choice enrollees for acute and chronic conditions.

In 2002, RIPA created an individual physician profiling program, the Value of Care Plan, which reports performance at the individual provider level three times a year. Data are collected in three areas of measurement and weighted as follows: patient satisfaction (20 percent); quality of care, comparing practice patterns with recommended care (40 percent); and efficiency (40 percent). Measures are collected using administrative data, and validation testing has shown them to be 92–95 percent accurate. Measures are based on communitywide guidelines established by the Rochester Health Commission, a nonprofit community-based organization representing all insurers, physician organizations, large employers, and hospital systems in Rochester.

As a part of RIPA’s profiling system, registry data are available for family medicine, practitioners, obstetricians, and cardiologists with patients who have coronary artery disease, diabetes mellitus, and asthma, as well as those eligible for mammography. Each provider receives the following registry data: rate of patient adherence to expected care, costs of patient care, comparative data against the specialty average, and a target rate set by communitywide guidelines.

Technical support for RIPA, encompassing information technology and data analysis, is provided by Excellus Health Plans. RIPA and Excellus medical directors evaluate and propose measures, analyze variation patterns, and educate and meet with practitioners. Provider buy-in was obtained through the program’s explicit goal of reducing underuse, misuse, and overuse, moving toward a more balanced, data-driven incentive system.

The estimated annual cost to RIPA and Excellus for supporting the profiling program is approximately $1.2 million which includes staff costs. Additional expenses are accrued for time spent correcting the patient-specific data and for developing and implementing improvement programs. The overall cost is $0.33 PMPM.

RIPA demonstrates improvement in a practitioner’s performance that ultimately benefits the entire practice. For example, an opthalmologist requested data to improve his efficiency index. The efficiency index measure is the ratio of actual episode costs to the specialty average episode costs for

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