Leadership in Action Minnesota Bridges to Excellence

2 Bringing Good Ideas to Minnesota through Collaboration  Multi-stakeholder community convening in 2005 –Learn about National Bridges to Excellence program Implemented by GE and Ford Financial rewards for providers that improve quality in diabetes and coronary care Individual doctors must receive NCQA certification  Early adopter purchasers – Champions of Change  Carlson Companies  General Electric  Honeywell  3M  Medtronic  State of MN Employer Group  Wells Fargo

3 Minnesota Bridges to Excellence - Leverage Community Partnerships and Best Practices  Institute for Clinical System Improvement (ICSI): develops guidelines and drives physician consensus  Minnesota Community Measurement (MCMN): measure development, data aggregation, quality review, performance rates, public reporting for increased transparency  Health Plans: aligned measure specifications used by all payers for rewards  Guiding Coalition formed: –Employers, providers, health plans, MMA, ICSI, MNCM, Stratis Health –Ensure collaboration, consensus and success of program

4 Supporting High Quality Outcomes  Program Goals: –Improve the quality of care for patients –Raise the level of purchaser and consumer awareness about the variation in the quality –Spark provider competition based on quality outcomes  Action Group –Manages and administers Performance Criteria Clinic eligibility and reward calculation Ongoing program development/enhancement Community Dialogues Provider Webcasts  Celebrate Excellence: Annual Recognition Reception

5 MNBTE – Chronic Conditions Optimal Diabetes CareOptimal Vascular Care (added in 2007) Depression Care (added in 2009) HgBA1c < 8LDL < 100Remission: LDL < 100Aspirin DailyInitial PHQ-9** of >9; follow-up PHQ-9 in 6 months < 5 Aspirin Daily*Non SmokerOr Non SmokerBlood Pressure < 140/90Response: (added in 2012) Blood Pressure <140/90Initial PHQ-9** of >9; follow-up PHQ-9 in 6 months 50% better * Only if risk of cardiovascular disease is present – then all adults age ** PHQ-9 depression assessment questionnaire

6 Innovations  2007 –Require Direct Data Submission to MNCM to reward at clinic-level based on clinical data –DHS Managed Medicaid joins program –Work with health plans to ensure alignment of measure specifications  2008 – 2009 –More purchasers join – 14 Champions of Change Resource Training & Solutions, Southwest/West Service Cooperative, Target, US Bank, University of Minnesota –MNBTE serves as model for State of Minnesota Quality Incentive Payment System (QIPS)  2009 –Early adopter of depression care rewards using ICSI- developed remission measure for DIAMOND program

7 And More Innovations  2010 –Add improvement rewards (ODC/OVC), encouraging all clinics to improve outcomes –QIPS becomes operational for State Employee Group and DHS Action Group manages – ensures private/public market alignment  2011 –Depression care improvement rewards added –Launched study to determine next opportunities Supply sensitive care and overuse identified  2012 –Learning collaborative established: Phase I – Low back pain and spine surgery –Value Statement developed outlining purchaser expectations. –Health plans, care systems and innovators meet with Champions to discuss new programs, care redesign and other efforts to improve outcomes and efficiency.

8 MNBTE – Historical Picture DiabetesVascular DiseaseDepression 2006Minimum: 10% 9 Medical Groups 2007Minimum: 20% 37 clinics – achievement Minimum: 50% (CAD-2007) 64 clinics – achievement 2008Minimum: 25% 62 clinics – achievement Minimum: 40% (Vascular) 76 clinics – achievement 2009Minimum: 35% 17 clinics – achievement Minimum: 50% 36 clinics – achievement Minimum: 5% 17 clinics 2010Minimum: 41% 44 clinics – achievement 20 clinics – improvement Minimum: 55% 45 clinics – achievement 45 clinics – improvement Minimum: 10% 10 clinics - achievement 2011Minimum: 48% 94 clinics – achievement 82 clinics – improvement Minimum: 55% 48 clinics – achievement * 41 clinics – improvement * Minimum: 10% 27 clinics – achievement 3 clinics – improvement 2012Minimum: 51% 45 clinics – achievement 104 clinics – improvement Minimum: 58% 102 clinics – achievement 98 clinics – improvement Minimum Remission: 13% Minimum Response: 18% Xx clinics remission Xx clinics response Champions of Change: $2,500,000 in financial Incentives * QIPS rewards additional 300+ clinics – lower minimum threshold

9 Today we recognize the Champions of Change for their leadership in rewarding providers for improved health outcomes for all Minnesotans

10 Thank You!