MN Community Measurement is the result of a pioneering project to collect comparable data across health systems and report it publicly. What began as an idea in 2000 has grown into the trusted source for credible performance data on quality, cost and patient experience in Minnesota, neighboring communities and nationally.
MNCM’s consensus-based, multi-stakeholder process has helped to bring the right people to the table at each step, allowing us to build a robust, extensive set of measures, many of which are nationally endorsed by the National Quality Forum (NQF). Additionally, multiple state, national and pay-for-performance programs have adopted MNCM-developed measures as part of their reporting initiatives. Local medical groups are able to easily participate in multiple programs by submitting their data through our secure, direct data submission portal.
We fulfill our vision of public reporting both through our annual Health Care Quality and Disparities reports, as well as through our consumer-focused, public reporting website, MNHealthscores.org. The site allows patients to find the measures that matter to them, compare performance across clinics and find providers close to home.
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 — in Minnesota, and beyond.
Our annual report offers a snapshot of the impact MNCM has on health care in our community and provides an overview of recent accomplishments, activities and plans. As the landscape of American health care continues to shift, our work is fundamental to understanding how those changes improve health care in our state and across the country.
2015 Annual Report
“Between the health care that we now have and the health care that we could have lies not just a gap, but a chasm.”
The Need for MNCM
Health care quality varies considerably throughout the United States. Collecting and sharing information can illuminate differences in quality and spark improvements.
Despite having one of the best health care systems in the nation, Minnesota health care leaders suspected there was a great deal of variation in quality in the late 1990s. Unfortunately, they struggled to determine if that was, in fact, true; the way the quality of care was measured also varied, making it very difficult to compare information across clinics and medical groups. Moreover, considerable administrative cost was being incurred by medical groups, health plans and others due to duplicative measurement processes. Thanks to the foresight of visionaries in the community, and a strong partnership among health plans, Minnesota now has standardized measures and public reporting to understand the variation in health care quality in Minnesota.
The idea of MN Community Measurement was born in 2000. Minnesota’s health plans were already working together to sponsor the Institute for Clinical Systems Improvement (ICSI) for quality improvement initiatives. The medical directors of these health plans believed health plans should also work together to create a single, combined report that compared patient care and outcomes statewide – which would allow quality comparisons for the first time. From this a revolutionary idea was born: publicly report the results to make them transparent.
Dr. Gail Amundson, then the medical director for HealthPartners, worked for more than a year with her peers at Medica and Blue Cross Blue Shield of Minnesota, Drs. Charlie Fazio and Steve Richards. Together they created a process to combine data from each health plan and report the results on diabetes care by medical group. Other health plans and medical group leaders soon agreed to join this effort. In 2002, the Minnesota Council of Health Plans launched the Minnesota Community Measurement Project to put the idea into action.
Progress came quickly. Just one year later, the project produced its first performance report on Optimal Diabetes Care, which used a pioneering approach to reporting the five key components of diabetes care in one “all-or-none” composite measure. Forty-nine medical groups were reported. Medical groups could see how their performance compared with the other 48 groups, although the other groups weren’t listed by name. That inaugural report made it possible for medical groups to see where they stood and to focus their quality improvement work. In other words, it leveled the playing field.
When the Minnesota Community Measurement Project issued its second comparative report in late 2003, an additional seven measures on chronic and preventive care were added.
The plan had always been to share the data publicly, to increase accountability and improve care. In 2004, MNCM did just that by publishing the third report with the performance identified for each medical group and shared the results on a public website and with the media.
In 2005, Minnesota health plans and the Minnesota Medical Association formed a non-profit 501(c)(3), MN Community Measurement (MNCM), to guide the continuing work. MNCM’s Board of Directors would include physicians, hospitals, health plans, consumers, employers and professional associations. The organization built a reputation as the trusted source for health care performance data by making sure viewpoints of a wide variety of stakeholders were involved in developing measures and making decisions about areas of focus.
As MNCM continued to expand its areas of measurement, the medical community responded: by 2006, 90 medical groups were voluntarily submitting data, including the specialty areas of endocrinology, obstetrics and gynecology, and urgent/convenience care. The data proved to be so robust and credible that health plans and Buyers Health Care Action Group (now the Minnesota Health Action Group) began using the Optimal Diabetes Care measure in their pay-for-performance programs. Medical groups were able to show how well they performed in comparison with their peers; those with the highest quality care earned rewards.
By this time, many medical groups were using MNCM specifications to collect data from their medical records on diabetes and vascular care for their own internal improvement efforts. Data from medical records had the advantage of being more timely, reflecting the care for all patients (including those who were uninsured), and being reported by clinic site. Clinic-level reporting showed variation even among practices within the same medical group. On the urging of medical groups, MNCM agreed to test the use of medical record data for measurement; soon after, the direct data submission process and the MNCM Data Portal were born. The MNCM Data Portal is a secure online portal that streamlines the process through which medical groups submit and use data.
During this period, MNCM’s reputation continued to grow. In August 2006, President George Bush and U.S. Health and Human Services Secretary Michael Leavitt came to Minnesota to sign an executive order requiring federal agencies to compile information about the cost and quality of health care, and share this information with consumers. President Bush invited MNCM President Jim Chase to participate in a panel at this event with four other Minnesota health care leaders to discuss innovations in health care transparency.
MNCM led the nation with its 2007 Health Care Disparities Report, which was created in partnership with the Minnesota Department of Human Services. The report compared primary care performance data results for patients insured by Minnesota Health Care Programs (such as Medicaid) to patients with commercial insurance on eight measures. The Disparities Report showed gaps differences in quality at the same clinic and medical group based on the patient’s income level by using enrollment in state Medicaid programs as a proxy for socioeconomic status. It also let health care providers at all levels (clinics, medical groups and health systems) see health care performance data by insurance type, socioeconomic status and, more recently, race and ethnicity. The report’s detailed data could be used to help reduce health care disparities – an important tool in a state where gaps in care by race and ethnicity persist.
Almost all Minnesota providers rose to the challenge of collecting and submitting data by choice. By 2008, 85 percent of Minnesota’s primary care providers chose to provide data. That year the State of Minnesota passed a health reform law requiring providers to submit data, bringing the last groups to the table. Minnesota is a national leader in its commitment to public reporting of health care data. MNCM works closely with the Minnesota Department of Health to develop measures and to collect and report clinical data through the State Quality Reporting and Measurement System.
Ready for the Future
MNCM’s accomplishments are widely recognized. NQF has endorsed seven measures developed by MNCM, beginning with measures for depression and diabetes care in 2010. NQF-endorsed measures are considered the gold standard of American health care measurement. The following year, the first MNCM measure was adopted into the Centers for Medicare and Medicaid Services’ Physician Quality Reporting System (PQRS) for use nationally. Since then, multiple additional MNCM measures have been accepted into PQRS as well as other Medicare value-based purchasing initiatives. Due to this experience aligning local and national initiatives, MNCM also began to assist other organizations with measurement development and endorsement services.
Making data public was a big step; helping make sense of it for people to use in their daily lives was and remains a challenge. MNCM launched MNHealthScores.org in 2009, with features to help people find the health topics that matter most to them, compare performance across clinics and find providers close to home. At that point, the number of measures publicly reported had grown to 33. Soon after, the Minnesota Hospital Association joined MNCM as a member and shared their data on hospital performance, which was added to MNHealthScores. The site also includes Minnesota hospital measures from the Agency for Healthcare Research and Quality (AHRQ).
By 2013, MNCM had grown to report cost, quality, patient experience and health technology information on clinics, medical groups and hospitals throughout Minnesota and neighboring communities. Our expanding breadth of measures meant our site needed more flexible display options. Additionally, we wanted to take advantage of research that had been conducted in recent years on consumer use of health care data. After a year-long process that included significant stakeholder involvement and consumer input, a redesigned MNHealthScores.org was launched in Fall 2015. The redesigned site exemplifies best practices gleaned from more than a decade of academic research on consumer interpretation of health care cost and quality data displays. We introduced the HealthScore, an easy-to-understand icon and label that puts the result for each clinic, medical group or hospital for each measure into clear groupings. This provides consumers with important context to understand what constitutes a “good” rate.
Our public reporting efforts have been recognized as nation-leading by the Health Care Incentives Improvement Institute and Catalyst for Payment Reform, among others. Those efforts are also why Consumer Reports partnered with MNCM to publish a special supplement rating diabetes and cardiovascular care in October 2012, and is doing so again in early 2016.
In recent years, we’ve also blazed the trail in the development of new and innovative patient-reported outcome measures, and in the release of groundbreaking new reports and data sets. These include the inaugural release of our Total Cost of Care measure in late 2014, which provided comparable cost information across 115 medical groups; and our Health Equity of Care Report, which segmented the results of five clinical quality measures by race, Hispanic ethnicity, language and country of origin. Both were firsts for Minnesota and the nation.
MNCM pioneered collaborative health care reporting at a critical time for health care in Minnesota. We are proud of our pivotal and ongoing role in improving health and maximizing value in Minnesota, and beyond.
Celebrating Ten Years of Accelerating Improvement
We highlighted MNCM’s history in a year-long series of articles in 2015 as part of our 10th anniversary celebration.
- December: Pioneering Data Collection from Medical Groups
- November: Driving Improvement in Depression Care
- October: Partnering with Others to Improve Care Statewide
- September: Helping Minnesota Drive toward More Affordable Health Care
- August: Measuring the Experience of Patients Like You
- July: Impacting Care through Patient Reported Outcomes
- June: Improving Health Care Quality through Measure Development, Evolution and Alignment
- May: Advancing Health Equity through Measurement
- April: After Eight Years, AF4Q Comes to a Close
- March: Supporting Patients as Advocates for their Care
- February: A Decade of Transparency in Health Care
- January: Driving Change in Diabetes Care