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

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.

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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%.

Colorectal Cancer Screening Statewide Trend - Minnesota NEWS FLASH: 2014 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…

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

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

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

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

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

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© 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

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

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.

© 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.

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.

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

Optimal Diabetes Care Results by Race

By Ethnicity

Results Vary by Region of the State Optimal Diabetes Care Measure

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.

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

Adolescent Overweight Counseling Rate by Ethnicity MNCM all rights reserved

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

% 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

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

Heart Disease Deaths per 100,000 MNCM all rights reserved Kaiser Family Foundation -2014 Data

Heart Disease Deaths per 100,000 MNCM all rights reserved Kaiser Family Foundation -2014 Data

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

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