1. QCare: Minnesota’s Quality Care and Rewarding Excellence Initiative August 2, 2007 Scott Leitz, Assistant Commissioner Minnesota Department of Health

2. What is QCare?  QCare: Quality Care and Rewarding Excellence  An initiative to build on and leverage community standards and initiatives in Minnesota to achieve a rapid improvement in the health outcomes  Sets goals and standards for health care performance and quality outcomes  Identify, reward superior quality health care

4. QCare rationale  …between the health care that we have now and the health care that we could have lies not just a gap, but a chasm. –Crossing the Quality Chasm: A New Health Care System for the 21 st Century  Wide and persistent differences in quality of care

5. Percentage of Adults Receiving Recommended Care, U.S. Source: McGlynn, New England Journal of Medicine.

6. Percent of Minnesotans with diabetes receiving optimal care Source: Minnesota Community Measurement.

7. Overall Goals  QCare Goals: –Dramatically improve health care quality by 2010 –Save lives and improve health –Achieve cost savings as health care quality and delivery improves Back of envelope cost savings analysis

8. QCare development  QCare Council –Developed as part of NGA policy academy –10 member team: Providers overall guidance and governance for QCare State agencies (Health, Medicaid, State Employee Insurance) Private sector –Hospital, health plan, physician, employer leaders Key Legislators  Framework and preliminary goals

9. QCare in a Nutshell  Agree on best care  Measure outcomes commonly  Report transparently  Establish stretch goals for improvement  Align rewards and incentives to support improvement  Provide supports to providers, employers in achieving goals

10. Build on Existing Iniatives: “Align the boxes”  Institute for Clinical Systems Improvement (ICSI) –Guideline development  Minnesota Community Measurement –Measurement of performance at clinic level  CMS and MN Hospital Association reporting for hospitals; adverse health event reporting  Leadership in both the public and private sector  Smart Buy Alliance –State government purchasers, BHCAG, Chamber of Commerce, unions  www.minnesotahealthinfo.org www.minnesotahealthinfo.org  Others

11. Q-Care Rapid Transformation  Significantly improve in key areas –Preventive care –Diabetes –Cardiovascular –Hospital-based care

12. QCare Governor’s Executive Order  In July, 2006, Governor Pawlenty issued an executive order  …The Commissioner[s] of Human Services and …Employee Relations are directed to adopt and apply the QCare standards and align payments and incentives for all state purchased health care  To the extent permitted by law, apply QCare standards to all state purchased health care  Contracts with health plans and providers must include incentives and requirements for reporting costs and quality, and for meeting targets and goals, improvements in key areas, and greater accountability

13. QCare Goals Diabetes MeasureBaseline2010 QCare Optimal care – 5 Targets achieved (for A1c blood sugar level, LDL, blood pressure, daily aspirin use, no tobacco use) 6%80%

14. QCare Goals Cardiovascular MeasureBaseline2010 QCare Optimal care – 5 Targets achieved [LDL (generally and for persons with diabetes), blood pressure, daily aspirin use, no tobacco use] 38%90%

15. QCare Goals Hospital Care MeasureBaseline2010 QCare Heart Attack Care91.6%100% Heart Failure Care84.7%100% Pneumonia Care67.7%100% Leapfrog reporting 42%100% Adverse events10550

16. QCare Goals Preventive Care MeasureBaseline2010 QCare Child Immunizations68% 90% Adolescent Immunizations39% Well Child Visits59% Breast Cancer Screening74% Cervical Cancer Screening78% Chlamydia Screening Women 32%

17. Implementation and Next Steps  State Public Programs –Medicaid: Preventive Care Incentives (Health plans and patients) –Bridges to Excellence: diabetes and heart State employee insurance, Medicaid  Smart Buy Alliance –BTE participation  Supports –E-Health, Administrative uniformity  Expanding Measures –Asthma, Depression  Additional Partnerships

18. Challenges and Lessons Learned  Still lots of boxes  Public/private partnerships remain a challenge  “Stretch goals” are not always well-received  Not a lot of agreement or consensus on how to provide supports  Even with the best attempts at coordination and alignment, groups will still go off on their own

19. Contact Information  Scott Leitz  Assistant Commissioner  Minnesota Department of Health  651-201-3565  scott.leitz@state.mn.us