MNCM News

"The two words ‘information’ and ‘communication’ are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through." -- Sydney J. Harris

A Decade of Transparency in Health Care

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NOTE: This is the second article in a year-long series highlighting the notable achievements and milestones of MN Community Measurement in celebration of our 10th anniversary. Read more about our history in Our Story.

Transparency has become a hot topic in the health care industry over the past few years, with information on quality, safety and cost findings now available for care settings from hospitals to clinics to long-term care institutions. Minnesota has been a leader in public reporting of health care performance information since the precipice of this movement.

This move toward transparency resulted from policymakers, health plans, employers and patients demanding more visibility into the health care system as health care costs continued to rise while overall health in the United States remained the same. According to the Henry J. Kaiser Family Foundation, the United States spent $2.6 trillion on health care in 2010. The share of economic activity (gross domestic product) devoted to health care increased from 7.2% in 1970 to 17.9% in 2009 and 2010. These increases outpace wages and spending on other goods and services, all of which impacts households, businesses and government. At the same time, the United States ranks last in health outcomes compared to 10 other industrialized countries, according to The Commonwealth Fund. In particularly, the U.S. ranks last or near last on dimensions of access, efficiency and equity of care.

Minnesota has one of the best health care systems in the United States, and was an early pioneer in health care transparency. In the late 1990s, Minnesota health care leaders suspected there was considerable variation in the quality of care in the state. Unfortunately, there was no standardized way to measure care and so it was difficult to compare information across care systems. Additionally, considerable administrative cost was being incurred by medical groups as a result of duplicative measurement processes. The foresight of visionaries in the community and a strong partnership between health plans and medical groups resulted in the birth of MN Community Measurement (MNCM), solidifying our community’s investment in health care transparency and improvement.

Transparency and public reporting of health care cost, quality and patient experience information is essential to improving quality and lowering cost. It helps patients make more informed choices about their care, while allowing providers to benchmark their performance against others, highlight differences in quality and spark improvements.

Even in its infancy, Minnesota drove the transparency conversation

MNCM has driven the local and national conversations during this movement toward increased health care transparency. In March 2006 – just over a year after MNCM became a non-profit organization – MNCM was one of six regional health care improvement organizations selected to participate in the Centers for Medicare and Medicaid Services (CMS) Better Quality Information to Improve Care for Medicare Beneficiaries (BQI) project. The project’s goal was to assess the benefits and challenges of combining Medicare data with regional quality data to derive and report performance results. This first foray into national health care transparency work put MNCM on the map – and got noticed by more than a few policymakers.

Two of those policymakers were then-President George W. Bush and Health and Human Services Secretary Michael Leavitt. When they came to Minnesota six months later to sign an executive order requiring federal agencies to compile and share information about health care cost and quality of health, MNCM President Jim Chase was invited to participate in a panel on innovations in health care transparency alongside four other Minnesota health care leaders.Jim and Bush

“I think what’s exciting is that we’re actually seeing some changes now,” Chase said at the time. “Being able to measure [health care], we’re seeing the results change. And it’s very encouraging for the providers because that’s what they are in this for – to find better ways to treat their patients.”

Becoming a trusted source for data and reporting

Measurement is a critical component to providing high-quality, affordable care to patients. If you don’t measure it, you don’t know what or how to improve. An equally critical component is making the information transparent and actionable for patients, providers, medical groups and other stakeholders. To accomplish this, MNCM publicly reports information on cost, quality and patient experience through multiple annual reports and on our consumer-focused website, MNHealthScores.org.

Our inaugural Health Care Quality Report, which features comparative and historical trend performance data on medical groups and clinics, was released publicly in 2004 and has been each subsequent year since. Two years later, we began producing the Health Care Disparities Report in collaboration with the Minnesota Department of Human Services. This annual report presents statewide, clinic and medical group performance rates for patients in Minnesota Health Care Programs on 13 quality measures, as well as identifies differences between MCHP patients in varying racial and ethnic groups. In January 2015, we released our inaugural Health Equity of Care Report featuring health outcomes in five key areas segmented by race, Hispanic ethnicity, preferred language and country of origin. This annual report provides information at statewide and regional levels and provides the first comprehensive view of racial and ethnic health disparities in Minnesota.

In 2009, MNCM launched is consumer-focused public reporting website, MNHealthScores.org, to make the information more understandable, comparable and actionable for consumers. When it was first launched, we reported on only 33 measures for clinics and medical groups; today, we report on more than 70 measures for clinics, medical groups and hospitals. As a result of this significant growth and diversification of MNCM’s publicly-reported information, as well as the growing number of health care consumers who use the site to make more informed care choices, MNHealthScores got a major facelift last year.

Along the way we’ve expanded from reporting exclusively health care quality measures to rounding out the Triple Aim by releasing the nation’s first statewide Patient Experience of Care information in 2013 and the nation’s first Total Cost of Care results in 2014. These add new and important dimensions that are critical to patients, employers and other stakeholders as they make care and coverage decisions. They also further illustrate the variation in cost and care between medical groups and highlight areas for improvement.

Transforming health across the nation

As MNCM established the transparency landscape in Minnesota, our milestones continued to push the national conversation forward. Beginning in 2008, the Robert Wood Johnson Foundation (RWJF) selected Minnesota as one of 16 sites for its groundbreaking Aligning Forces for Quality initiative. This seven-year effort, which concludes in April, has made care more patient-centered, more cost efficient, and higher quality by championing measurement and improvement projects.

Our work in Minnesota has been acknowledged nationally: seven measures developed by MNCM have been endorsed by the National Quality Forum, considered the gold standard for health care measurement in the United States. And CMS and multiple pay-for-performance programs have adopted MNCM measures for use in their programs.

We’re proud of our role in supporting Minnesota’s health care community to become one of the best in the nation. In addition to maintaining that exceptional level locally, we seek to push the envelope nationally so more patients in more states can experience high-quality, affordable care just like many Minnesotans.

Last year, MNCM was once again selected by RWJF to lead a cutting-edge project: the Doctor Project, a new initiative involving 10 communities across the county that will result in a series of consumer-friendly reports measuring how well physicians in each community deliver high-quality health care. In 2012, Consumer Reports partnered with MNCM to publish a special supplement for their Minnesota subscribers focused on high-quality diabetes and cardiovascular care. MNCM is once again partnering with Consumer Reports through The Doctor Project. The data from all 10 communities will be published by Consumer Reports in early 2016.

Similarly, the Center for Healthcare Transparency awarded MNCM a planning grant last fall as one of 14 regional health care improvement organizations working collaborative to lay the groundwork to make meaningful information on health care cost and quality available by 2020. And we’ve partnered with four other organizations through the Network for Regional Healthcare Improvement nationally to measure and compare health care costs across regions.

Each of these efforts will move the needle nationally on health care cost and quality. Just as medical groups in Minnesota have shared best practices with one another to raise the overall quality of health care, these efforts will soon allow us to compare cost and quality information across regions to learn what’s working nationally.

Our future role as a pioneer in health care transparency

Accelerating the improvement of health through measurement and public reporting requires foresight; as a result, MNCM is constantly looking ahead. We are focused on the next major efforts to drive improvement in health care – providing validated, actionable information on the cost of care, patient quality of life after certain procedures, and quality of more specialty services. To that end, we will move further into specialty care measurement in 2015, with the first public reporting of spine surgery and total knee replacement outcome measures expected. We will continue to focus on meaningful and impactful measures where gaps currently exist, including the pediatric preventive care measures that we will publicly report for the first time later this year and the cancer care measure development we will kick off shortly. And we will begin looking at measurement in other care settings, such as our low back pain measure that has been approved for pilot testing in chiropractic care settings.

We must also not lose sight of the important gains we’ve made. We will continue to collect and report our many quality performance measures, as well as release the second year of Total Cost of Care and Patient Experience of Care results. We remain committed to creating high-quality, broadly acceptable measures that lend themselves to alignment with state and national initiatives to improve the quality and experience of care, while making it more affordable.

MNCM was a pioneer in collaborative health care reporting at a critical time for health care in Minnesota. We are proud of our ongoing, central role in improving health and maximizing value both in Minnesota and beyond.

“We know our role will continue to be vital as we face the growing challenge to transform our health care system to support better health and provide better care at a lower cost,” Chase said, “We are grateful for the commitment and support of our health care community to help us accomplish this.”