1. Minnesota Senate HHS Finance and Policy Committee
Jim Chase
February 14, 2017

2. MN Community Measurement
Accelerating the Improvement of Health Through Public Reporting
The trusted source of information across the spectrum of care supporting the Triple Aim of the Health Care System
Used by providers and patients to improve care
Our community works together on measurement
MNCM all rights reserved
History of How MNCM got started.
Important role of multi-stakeholder.

3. MNCM all rights reserved

4. Aspirin for Secondary Prevention
MNCM all rights reserved
“In 2007 to 2008, antiplatelet medications were prescribed at only 46.9% of visits for patients with ischemic vascular disease”
Prarek, et. al. New England Journal of Medicine, January 17, 2013
Aspirin use in component of the Optimal Vascular Care and Optimal Diabetes Care measures in Minnesota is now over 95%.

5. Colorectal Cancer Screening Statewide Trend - Minnesota
NEWS FLASH: Results: 70%
The green bars indicate years when this measure was reported as a HEDIS measure. HEDIS measures are pulled directly from claims data. The orange bars indicate years when this measure was reported as a Direct Data Submission (DDS) measure. DDS measures use data submitted from clinics’ medical records via the MNCM Data Portal. The statewide rate has been increasing by one percentage point each year from 2010 and on.
It should be noted that the trend appears to be flat when comparing the 2009 statewide rate to the 2010 rate. That year the measure specifications changed, reducing the upper age limit from 80 to 75; causing a decrease in the number of eligibles for this measure. Having included the additional ages, 76-80, the trend may have continued to increase, but there is an inability to appropriately show a trend for this measure because of the specification changes.
Number of eligibles for 2013: 1,079,937
Number of eligibles for 2012: 1,049,321
Number of eligibles for 2011 (start of DDS measure): 1,007,960
Number of eligibles for 2010: 244,771
Number of eligibles for 2009: 351,135
Statewide rates:
2006 = 58%
2007 = 60%
2008 = 63%
2009 = 66%
2010 = 66%
2011 = 67%
2012 = 68%
2013 = 69%
Additional 11,100 screenings in 2014 means 2,700 life-years saved…

6. Clinic Performance Variation Colorectal Cancer Screening Rates - 2013
MNCM all rights reserved
07/01/2012 to 06/30/2013 Dates of Service
643 Clinics Reporting – 1,080,000 Patients

7. Optimal Diabetes Care
Just 4% of patients with diabetes were optimally managed according to the first report to medical groups. In 2014, that number was up to 39%.
* Underwent a measure specification change in 2015

8. Why Minnesota is Leading
Wide use of measures for improvement
Multi-stakeholder process
Alignment across the community
Use of clinical data and patient-reported outcomes in measures
National endorsement of measures
Robust set of measures: patient experience and cost of care – and equity
Public Reporting

9. Depression Measures
Started with medical groups efforts to improve outcomes
Uses patient reported outcome – are they better after 6 or 12 months
Adopted by Medicare in 2013
Adopted by National Committee on Quality Assurance for use by health plans nationally
MNCM all rights reserved

10. Statewide Quality Reporting and Measurement System
Established in 2008 legislation
Commissioner of Health can mandate reporting of clinical data for provider performance measures through rule making
MNCM is the current contractor
Recommend measures
Collect and report results
Requires risk adjustment and segmentation of results
MNCM all rights reserved

11. MNCM all rights reserved

12. © MN Community Measurement All Rights Reserved.
Public Reporting
© MN Community Measurement All Rights Reserved.
Public reporting display on MNHealthScores.org – Cost and quality side-by-side

13. Minnesota’s Measurement Innovations
Measures of Clinical Outcome
Patient Experience of Care
Patient Reported Outcomes
Total Cost of Care
Equity of Care
MNCM all rights reserved

14. What is Total Cost Of Care
Measure of All Risk Adjusted Costs for All Patients compared to Overall State Average
Patients are attributed to one and only one medical group
Primary Care activity
All of the patient’s costs are assigned to that group
Insurance payment + patient responsibility
Adjusted for patient risk and outlier costs removed
Medical group level reporting
MN Community Measurement – All Rights Reserved
A Total Cost of Care measure takes all of the patient’s costs and assigns the cost to a single medical group. The costs are adjusted for the patient’s risk and outlier costs are removed in order to create a level playing field
The measure is not designed to be used at a patient level, this works as an average, in fact there is a requirement of at least 600 patients per medical group
We are starting with commercial patients from four health plans: Blue Cross of MN, HealthPartners, Medical Health Plans and PreferredOne, that large volume of patients makes the 600 patient requirement achievable to many medical groups who, at a individual health plan, would not be reportable.
I want to point out that cost is defined as insurance payment plus patient responsibility.

15. © MN Community Measurement All Rights Reserved.
Total Cost of Care
© MN Community Measurement All Rights Reserved.
Based on 1.5 million commercially-insured patients and $8 billion in costs.

16. Health Equity of Care Report
Released in January 2015
First of its kind report
Health outcomes on diabetes, vascular care, asthma (adult and child), colorectal cancer screening
Stratified by race, Hispanic ethnicity, preferred language and country of origin
Statewide and regional results
Community-based effort began in 2008
2009: Released standard data elements, best practices
2010-Current: Supported, audited medical groups to ensure use of best practices
2012: Overcame electronic health record challenges
2014: Surpassed threshold for public reporting
© MN Community Measurement All Rights Reserved.

17. MNCM all rights reserved

18. CRC Screening Disparity Patients enrolled in MN Health Care Programs
* Lowered upper age limit from 80 to 75.
Other Purchasers = Commercial & Medicare Managed Care

19. Optimal Diabetes Care Results by Race

20. By Ethnicity

21. Results Vary by Region of the State
Optimal Diabetes Care Measure

22. Health Equity of Care Report
Findings
Significant health inequities exist in Minnesota
Variation in results by medical group and clinic
Improvement is slow and comes in leaps
Not all population results are the same
White, Asian patients had highest health outcomes; Black, American Indian patients had lowest
Hispanics had worse health outcomes statewide, but results varied by regions
Differences between immigrant groups
Vietnamese immigrants had higher outcomes than English-speaking, U.S.-born patients
Hmong and Somali patients had some of the poorest health outcomes across measures, populations
© MN Community Measurement All Rights Reserved.

23. MNCM Overweight Measure 2015 Results 101 medical groups reporting
2015 Dates of Service

24. Adolescent Overweight Counseling Rate by Ethnicity
MNCM all rights reserved

25. What are Providers Doing to Improve Results?
Regularly review results with care team
Use electronic medical record to enable results
Engage entire staff in improvement
Test small scale improvements – patient population approach
Share measures with patients
MNCM all rights reserved

26. % BC screening (all pts)
Reducing Disparities
Integration of disparities reduction goals in accountability mechanisms
Data available by clinic
90 day work plans to cascade awareness, goals and accountability
Part of management incentive program
Added to physician compensation program
Location
# white
# of color
Point difference
% BC screening (all pts)
Clinic 1
278 48
-0.1
87.2%
Clinic 2
244
142
1.7
83.8%
Clinic 3
258
132
6.8
80.4%
Monthly review: Preview results at care meetings, institute
interventions, remind clinicians of goals, share best practice

27. Reducing Disparities
New reporting allows us to breakdown traditional quality measures by race and payer
Transparency
Care teams surprised by their gaps “But I treat everyone the same”
Underscores the potential need for different approaches for different populations to achieve similar outcomes

28. Heart Disease Deaths per 100,000
MNCM all rights reserved
Kaiser Family Foundation Data

29. Heart Disease Deaths per 100,000
MNCM all rights reserved
Kaiser Family Foundation Data

30. Key Issues Measurement matters Alignment with Medicare
Reduce the burden of measurement
Patient factors and risk adjustment
MNCM all rights reserved

31. Questions or Comments? Jim Chase President, MN Community Measurement
Connect with us!
MNCM.org MNHealthScores.org
@mnhealthscores
facebook.com/mnhealthscores
MNCM all rights reserved