Develop a strategy and program for an Independent Practice Association (IPA) composed of pediatric healthcare providers such as UCSF Benioff Children’s Hospital Oakland and Stanford Children’s Hospital. The focus is to align with the California Governor’s priority of delivering high-quality preventive care for children and meet the Department of Health and Children’s Services mandates.

The IPA adopted the Healthcare Effectiveness Data and Information Set (HEDIS) as a comprehensive tool for performance evaluation, financial agreements, regulatory compliance, and improving the overall patient experience. HEDIS is also an integral to Pay for Performance (P4P) initiatives, offering financial rewards to providers who achieve performance targets and qualify for incentive programs within the network.

Saoirse Consulting in collaboration with the IPA implemented a comprehensive strategy to enhance performance and address care gaps identified by HEDIS. This multifaceted approach included:

• Customized Software Development:
  To evaluate and analyze HEDIS measures and generate real-time actionable data, allowing for immediate insights into patients’ care gaps.
• Dynamic Reporting System:
  Established a reporting system for HEDIS measures, presenting trended data over time across sites, providers, and individual patients. Reports are disseminated to providers, categorized by clinical performance, and undergo monthly review sessions with practice stakeholders.
• Patient Outreach:
  Developed outreach strategies to proactively engage providers and their patients on gaps in care to enable timely and targeted communication to encourage patients to schedule necessary appointments.
• Educational Initiatives:
  Created educational programs on HEDIS and best practices. Quarterly presentations and monthly outreach sessions with provider groups are conducted to keep healthcare professionals informed and aligned with the latest standards.
• Collaboration with Health Plans:
  Established partnerships with health plans to participate in quality incentive programs. This collaboration enhanced access to care and elevated the quality of services provided to members, fostering an environment of continuous improvement.

This comprehensive strategy focused on delivering high-quality care, proactively addressed and closed gaps in healthcare performance and enhanced the support among providers to achieve and outperform HEDIS measures.

The IPA achieved significant performance enhancements, surpassing the established thresholds across various HEDIS measures, notably excelling in well-child visits. This improved performance secured additional supplemental funding for the IPA and increased engagement with providers on how to leverage HEDIS to continue to deliver high-quality preventive care to children. Saoirse Consulting has developed with the IPA a strategic outreach plan that establishes the groundwork for initiatives extending into 2024.