1. © MN Community Measurement. All rights reserved.. Lessons from the School of Hard Knocks September 10, 2012

2. MNCM all rights reserved 2008 MN Community Measurement Accelerating the Improvement of Health Through Public Reporting The trusted source of information across the spectrum of care and the IOM six aims Used by providers to improve care and by patients to make better decisions Our community works together on measurement

3. MNCM Health Care Quality Report Reports on 18 clinical quality measures, Health Information Technology, patient experience, cost of care, and hospital measures Reports on 315 medical groups and 672 sites of care Data from health plans, hospitals and medical groups

5. Measurement Challenges Orthopedic Surgery –Total Knee Replacement –Back surgery Provider Peer Grouping (Cost and Quality Measure)

6. Our First Specialty Measure Went Well Colonoscopy Quality Physician Champion Recognized gap in outcome Groups working on improvement Wide agreement on measure even with questions on data collection and reporting MNCM all rights reserved

7. Dartmouth Atlas Knee Replacement Rates MNCM all rights reserved

8. Orthopedics Measures Total Knee Replacement Went well Champion led Limited participation Acceptable data source Led to innovative patient status measure Spine Surgery Not so well No clinician agreement Proposed measure to narrow Many meetings/Many referrals But gained consensus MNCM all rights reserved

10. Concerns with the TKR Measure Too broad No risk adjustment Patient factors Patient reported data Low participation Who gets to decide Conflicts of interest MNCM all rights reserved

11. Five Stages of Measurement Can’t measure quality The measure must be wrong My patients are sicker Others are responsible Acceptance – actions that lead to improvement MNCM all rights reserved

12. What We Have Learned Agree on purpose with new participants Tie measures to improvement –Is it actionable? Communicate Decision Process –Multi-Stakeholder –Input or approval –Consensus on what can accept –Only vote on final

13. Provider Peer Grouping 2008 Health Reform Law – Total Cost of Care plus quality for medical groups and hospitals State-led multi-stakeholder process Initial results rejected by providers Legislature delayed implementation in 2012 MNCM all rights reserved

14. What We Learned (Part II) Start small and pilot test Focus on users not experts Verifiable data Tie to improvement MNCM all rights reserved

15. Next Steps on Cost of Care Support PPG, but develop other options Reduce scope, test on commercial groups Build on/align existing measures Narrow initial use – public reporting on variation – but remain flexible MNCM all rights reserved

16. Questions or Comments Jim Chase President, MN Community Measurement 612-454-4812 chase@mncm.org www.MNHealthScores.org © MN Community Measurement. All rights reserved.