As MN Community Measurement evolved from a project to an independent, non-profit organization in 2005 and expanded our measurement work, our pioneering approach to collecting the data from medical groups and clinics began to take shape.
By 2006, many medical groups were using MNCM specifications to collect data from their electronic medical records on diabetes and vascular care for their own internal improvement efforts. At the time, MNCM was utilizing claims data from health plans for its provider performance reporting. However, data from medical records is more timely, reflects the care for all patients (including those who are uninsured), and is able to be reported by clinic site. On the urging of medical groups, MNCM agreed to test the use of medical record data for measurement.
Depression is more than feeling sad or “blue.” When sad feelings are intense, last for more than a few days, and/or interfere with daily activities, its depression – a very treatable medical condition.
More than half of those who experience a single episode of depression will continue to have episodes that occur as frequently as once or even twice a year. Most people who seek treatment make progress toward feeling better, which means they’re responding well to treatment. Without treatment, the frequency of depressive illness as well as the severity of symptoms tends to increase over time.
Depression is a major cause of disability, absenteeism, absenteeism and productivity loss among working-age adults and is estimated to cause 200 million lost workdays each year at a cost to employers of $17 to $44 billion. Untreated depression can also result in suicide.
Increasing Quality Care for Depression
Providing high-quality depression care is critical to the health and economy of Minnesota, which is why MN Community Measurement focused on it just a few years into our existence. Measurement and public reporting of quality results improves patient care and outcomes.
Minnesota has long been a national leader in health and health care measurement and improvement – an achievement that has been driven by our community. And we continue to seek impactful and collaborative ways to improve the health of all Minnesotans.
MN Community Measurement (MNCM) has had a significant impact on the health of Minnesotans by measuring and publicly reporting health care information over the past decade. An important element in that success is our long-term partnership with the Minnesota Department of Health (MDH).
The amount spent on health care in Minnesota and nationally is growing; but that information is not new. Health care experts, economists, policymakers and providers are currently, and have in the past, attempted a variety of methods to cut costs.
Some, including many in Minnesota, have been effective in curbing costs for particular types of care or in particular markets. However, we have been unable to truly assess whether those efforts add up to the societal impact we need them to because we have not been able to truly measure the cost of health care in Minnesota or the United States.
Without reliable, comparable and validated information, providers, health plans, employers, patients and policymakers cannot make informed decisions about how to reduce the cost of health care. Clinics are not aware of what one another charges for services or are being paid by health plans. Thus, they don’t really know where their practice stands on cost compared to others. Few providers have had the tools necessary to make adjustments within their practices to positively impact the overall cost of care.
Patients are also beginning to demand cost information. In 2014, 80 percent of workers in employer-sponsored health insurance plans had deductibles — up from 63 percent just five years earlier. As the burden of cost has shifted more onto consumers, their appetite for health care cost information has also increased.
MN Community Measurement was delighted to share this message from Minnesota’s Senator Al Franken at our 2015 Annual Seminar and 10th Anniversary Celebration on Thursday, September 24th. Senator Franken underscores the importance of our community’s work to collect, analyze and report data on the quality, cost and experience of care in our state.
“You’ve been on the forefront of collecting and analyzing data in order to strengthen public policy and health outcomes for Minnesotans,” said Senator Franken. “It’s this kind of forward thinking that has made Minnesota a national leader.”
MN Community Measurement is pleased to announce the winners of the Leadership in Health Care Innovation and Minnesota Health Care Transparency Champion awards. The awards are presented in honor of MNCM’s 10th Anniversary and recognize organizations and individuals for leadership in health care transparency and use of provider performance data to improve health and health care in Minnesota. The awards will be presented to recipients at MNCM’s 10th Anniversary Celebration next Thursday, September 24.
MNCM would like to thank all of the organizations that submitted nominations for the Leadership in Health Care Innovation Award, as well as the Board of Directors members who participated in the difficult process of selecting the winners.
Patients have the best health outcomes when health care providers partner with them, their family members and caregivers.
Research shows patients who have the knowledge, skills and confidence to advocate for their health care also have the best patient experiences. Additionally, patients who have positive relationships and good experiences are more likely to return for follow up tests, take medications they’re prescribed and stay healthy.
MN Community Measurement began measuring and moving toward public reporting of patient experience of care in 2007. Patient experience of care is a broad term that refers to everything that happens to patients from the moment they walk into the provider’s office until the end of the appointment. It also includes all phone calls and/or other contact a patient has with the provider’s office before or after appointments.
The measurement of patient experience differs from many other clinical measures in one critical way: data is collected directly from patients regarding their clinic experience.
Patient and family engagement is increasingly acknowledged as a key component of a comprehensive strategy to achieve a high, quality, affordable health system, according to the National Quality Forum (NQF). Emerging evidence affirms that patients who are engaged in their care experience better outcomes and choose less costly, but equally effective, interventions.
However, historically, patients themselves have been a largely untapped resource in assessing the quality of health care. Patients are an extremely valuable and, arguably, the authoritative source of information on outcomes beyond experience with care.
A systematic and validated way to hear from patients is to solicit information on patient reported outcomes (PROs). PROs are the changes in an individual’s physical and/or mental health status, including their ability to perform normal household functions and job duties, resulting from medical treatments or procedures. For example, what is the quality of life or pain level for a patient who recently recovered from total knee replacement? PROs are typically measured using a standardized patient survey instrument, which exist for asthma, depression, back pain and a variety of other conditions and procedures.
Physicians are faced with an unprecedented number of quality measures required by different entities in today’s health care system. Payment is pivoting away from traditional reimbursement models and moving toward value-based reimbursement, where value factors in both quality and cost. Patients are slowly moving from being passive receivers of health care to informed consumers with expectations of transparency. And payers and employer groups are demanding more accountability for how their dollars are spent on care. In this changing environment, health care quality measurement must also evolve.
The National Quality Forum (NQF), a non-profit organization in Washington, DC, plays an important role in standardizing health care quality measurement across the country and recommending measures for use in Medicare value-based purchasing and meaningful use programs. MNCM’s President, Jim Chase, has served on the NQF Board of Directors since January 2014, where he’s been able to share MNCM’s practical experience in both measure development and data collection.
Minnesota tops the nation in many health care surveys, so it’s no surprise that we’re well positioned to take advantage of – and even drive – national and local activities in quality measurement and value-based purchasing. We are actively working to align local and national measurement work through high-value measurement that drives real improvement in cost, quality and patient experience of care.
“There are many exciting opportunities and partnerships that remind us that while Minnesota is at the forefront of health care measurement and improvement, we must also continue to push ourselves so our community and nation ultimately achieves the goal of delivering the highest quality care with the best patient experience for the most efficient cost,” said Jim Chase, MNCM President.
Minnesota is one of the healthiest states in the nation. On a variety of indicators, from insurance status to life expectancy to the overall quality of health care, Minnesota ranks at or near the top among all states. But Minnesota also has some of the largest inequities in health status and incidence of chronic disease between populations. According to the Institute of Medicine, communities of color are less likely to receive preventive care; more likely to suffer from serious illnesses and have less desirable health outcomes; and less likely to receive clinically-necessary procedures and services.
These inequities are both morally unacceptable and pose a threat to the health and economic stability of all Minnesotans. But a significant obstacle to eliminating health disparities has been the relative lack and inconsistent collection of data, both locally and nationally. In order to effectively address inequities in health care on a large scale, we need consistent, actionable data that provides a window into where disparities exist, their underlying causes and how to address them.
Throughout our ten-year history, MN Community Measurement (MNCM) has worked hard to provide that window through the collection of race, Hispanic ethnicity, preferred language, and country of origin data; and publication of reports that evaluate disparities based on those demographics as well as socioeconomic status.
Aligning Forces for Quality (AF4Q) has been the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities, and provide models for national reform. Minnesota became a focus of AF4Q in 2006; this month, after eight years of funding and milestones, the effort comes to an end.
AF4Q asked the people who get care, give care and pay for care to work together toward common, fundamental objectives to lead to better care. The 16 geographically, demographically and economically diverse communities that have participated in AF4Q cover 12.5 percent of the U.S. population collectively.
Minneapolis was chosen (and later expanded to Minnesota) as one of the four initial pilots in 2006. Minnesota has been a pioneer in the field of quality improvement and performance measurement. Since the early 1990s, we have focused on getting doctors, hospitals, insurers and others to measure the quality of care delivered in the state. With MN Community Measurement as the Minnesota AF4Q Alliance’s lead agency, and guided by a broad stakeholder group, Minnesota has been an ideal partner for AF4Q.
MNCM’s track record of bringing together those who give care, get care and pay for care made us an ideal organization to lead the Minnesota Alliance. Through AF4Q, we have served as a national model for quality measurement. Today, we bringing providers together to measure and assess everything from how doctors treat simple infections to how hospitals, physicians and other health care providers manage costly, chronic conditions such as diabetes and heart disease, as well as how well they communicate with patients.
Laying the foundation to improve the health of our community
AF4Q kicked off during a period of uncertainty, when quality measurement and improvement programs were largely still in their infancy. The community was asking Could we get buy-in? Who would fund measurement and improvement? How could we have meaningful impact that we so deeply sought?.
In this environment, AF4Q offered the structure from which Minnesota prospered. Each organization lent their expertise and leadership, oftentimes collaboratively, to:
Launch and report on the nation’s first comprehensive statewide patient experience of care survey for clinics;
Many of these initiatives had been trying to get off the ground; however, they required collaboration and alignment across organizations to succeed. Progress is not always straight and linear – it’s often messy. Despite this, the Minnesota AF4Q Alliance accomplished a substantial amount due to our highly-committed community organizations, medical groups and health plans that were all singularly focused on improving outcomes for patients.
“Credit goes to our community. There are some unique things about Minnesota that helped us be successful. Not that it can’t be done elsewhere – but the fact that we have a mix of larger and smaller medical groups that are committed, and the non-profit feel of the health care community, there’s good to be accomplished when we come together and share information,” according to MNCM President Jim Chase.
Working together to get it done
The AF4Q community pulled together quickly to tackle its first two priorities in Cycle One: consumer engagement and ambulatory care quality. With the goal of helping consumers more fully participate in their care by engaging with their health care providers, the Minnesota Consumer Engagement Work Group was formed to analyze best practices, conduct focus groups and publish the results and key learnings. During this time, Minnesota also began to develop new and more robust measures for physician and ambulatory quality reporting, with more than 180 health care professionals attending educational forums focusing on physician involvement in quality reporting. The voluntary patient experience measurement work also began, with nine medical groups, representing 123 clinics, participating in the first patient experience survey.
While, the work begun in Cycle One continued, new activities kicked off in Cycle Two that focused on reducing health disparities, and improving quality and safety. MNCM began collecting race, Hispanic ethnicity, preferred language and country of origin data directly from medical groups. Continuing to advance consumer engagement, new programs, measures and consumer tools were developed for depression, asthma, colorectal cancer screenings and diabetes. The D5 campaign also began to show decisive results as providers used the easy-to-understand concept to help patients recognize the importance of managing all five key health components to keep their diabetes in control.
With strengthened partnerships, new tools and increased trust with providers and consumers, the Minnesota AF4Q Alliance turned its focus to payment reform and the cost of health care in Cycle Three. MNCM developed the methodology specifications to implement a Total Cost of Care (TCOC) measure in 2012 by securing agreement from medical groups, health plans, economists and other stake holders on patient assignment, risk adjustment and methods of calculation. The RARE Campaign to engage hospitals and providers across the continuum of care was also launched by the Institute for Clinical Systems Improvement (ICSI), the Minnesota Hospital Association (MHA) and Stratis Health, with the goal of preventing 4,000 avoidable hospital readmissions statewide. Results of the first state-mandated survey on Patient Experience of Care were also released, with over 700 clinics participating and more than 230,000 patients completing the survey.
Moving into the final cycle, the Minnesota AF4Q Alliance continued to build on the milestones accomplished in previous cycles and completed several critical long-term projects – all with the emphasis on sustaining the momentum after AF4Q’s conclusion. MNCM released the nation’s first-ever report on TCOC in late 2014, which allowed consumers to compare the cost of care at medical groups across the state for the first time. And after years of overcoming challenges and encourage collection by medical groups, MNCM released a landmark Health Equity of Care Report in early 2015 with health outcomes for diabetes, vascular, and asthma care as well as colorectal cancer screening stratified by race, Hispanic ethnicity, preferred language and county of origin.
Several important multi-year projects that focused on developing new methods to improve the quality of care and to engage consumers concluded during Cycle Four:
Bonnie Westra, a professor at the University of Minnesota, led a two-year project to develop content, tools and provide training on how to help consumers find and use quality health information online.
ICSI wrapped up work on three initiatives: TCOC community building, RARE Campaign and improving patient experience in ambulatory settings.
MHA concluded a sizeable project on hospital care transitions.
Stratis Health developed guidance and trainings to disseminate the results and learnings of care transitions and readmissions initiatives across the state.
During the final cycle, AF4Q also provided additional funding as mini-grants to support five Minnesota AF4Q Alliance partner initiatives that further developed sustainable networks, supported consumer engagement and facilitated strategic alignment. Those projects were:
Collective Action Planning – Included a community scan and report that detailed how community partners aligned mental health measures and activities.
Community Health Worker Integration in Asthma and Mental Health Care – Increased awareness and adoption of team-based strategies among pediatric asthma care and mental health providers.
Evaluation of Benefits and Burdens of Medical Group Performance Reporting – Strived to uncover the causes of data collection burden and document the benefits to providers who participate in health care measurement and reporting programs.
Measures Lab Testing – Developed as an online platform to efficiently test newly-developed quality measures before they’re submitted for endorsement; proposed for inclusion in federal programs; or implemented to support quality improvement efforts.
Multi-lingual Advanced Care Planning Resources – Created and translated patient education videos on completing and sharing advanced care planning into Somali, Hmong and Spanish.
Beyond Aligning Forces for Quality
Over the last eight years, AF4Q communities have built transformative partnerships, often where none existed before. Minnesota has been a key player in shaping AF4Q both through its work locally, as well as through its willingness to share learnings with other communities nationwide.
With the support of AF4Q, Minnesota has been able to springboard off our collective expertise and passion to make significant and meaningful change in our community. We are confident that Minnesota will continue to be a national leader in health, and health care measurement and improvement. Our partner organizations have a strong collaborative spirit and history of working together, as well as with other varied stakeholders, to achieve our collective goals. We will continue seeking impactful and collaborative ways to improve the health of all Minnesotans, both by guiding initiatives begun during AF4Q to their next breakthrough and by identifying new challenges faced by our community.
In honor of MN Community Measurement’s 10th anniversary, we are recognizing organizations in our community who help us achieve our mission by utilizing information provided by MNCM to improve health and health care.
The Leadership in Health Care Innovation Awards will recognize organizations that have developed and implemented solutions that improve health or health care. Any type of organization is eligible to enter. The innovation must utilize data collected and provided by MNCM or MNCM-developed measures, and it must have had demonstrated impact on health or health care.
Who Should Enter?
Organizations of any kind that have utilized data collected and provided by MNCM or performance measures developed by MNCM to inform innovations that have improved health or health care are eligible. Individuals are not eligible for this award. Any type of organization is eligible to enter, and organizations can be based in Minnesota or surrounding states as long as MNCM information was utilized.
For example, has your organization utilized MNCM data to more effectively educate providers about how to improve care? Has your medical group analyzed information obtained from MNCM to target health care disparities in your clinics? Have you used quality and cost performance information to drive a change in health care consumption amongst your employees? Or has your research team evaluated MNCM data as part of a project to improve care or access? These types of innovations and many more are eligible!
Why Should You Enter?
Winners will be featured in marketing activities, such as press releases, web content and event promotions. They will also receive an award to display at their organizational headquarters, as well as be featured at MNCM’s 10th Anniversary Dinner on September 24, 2015.
The submission process is straight-forward and only requires a two-page or less description how your organization has used MNCM data or measures to inform an innovation and the results of that innovation.
How Will Winners Be Chosen?
The organizations that best demonstrate leadership in using data to implement innovative solutions which result in improvements in health and/or health care will win. The award is focused more on how data is used to inform health innovations than on particular improvement targets. Multiple winners may be selected. They will be chosen from blinded entries evaluated by a multi-stakeholder panel.