The role of measurement in overcoming health disparities, with insight from MN Community Measurement (MNCM), was the featured topic during the November 6, 2017 edition of Community Health Dialogues, a radio program on KMOJ FM.
Julie Sonier, President of MNCM, was joined by Gaye Adams Massey Co-Chair of the MNCM Health Equity Advisory Council (HEAC) and Anne Snowden Director of Performance Measurement & Reporting at MNCM.
Want to hear the Community Health Dialogues program again? Click here to listen to the entire conversation.
The weekly radio program is hosted by Clarence Jones. Jones participated at the MNCM Annual Seminar 2017 and spoke about the Clippers ‘N Curls program to reduce incidents of heart attack and stroke in the African American population. Jones invited MNCM to continue the panel discussion, titled In Pursuit of Health Equity, from the seminar, onto the air waves and directly with KMOJ listeners.
“There are so many things that impact good health,” said Adams Massey. She shared her insight as both the co-chair of the HEAC and also as CEO of the YWCA of Saint Paul.
The discussion touched on the importance of collecting health data in efforts to reduce health disparities. Definitions of health equity were shared, as well as the methods used to collect quality measurement data and the usefulness of this information in helping providers and patients to overcome barriers.
“This data is about getting Minnesota healthier,” said Sonier. MNCM works to not only collect the data, added Sonier, but also to disseminate it so that the public and health care professionals can better understand the result and take action based on the results.
The three panelists invited listeners to think of health broadly, more than doctors and nurses. The data, they added, is a tool to help come up with solutions to health disparities.
Sonier ended the program with an invitation for KMOJ listeners to visit MNHealthScores.org and to think of other ways that MNCM could work with community groups to reduce health disparities though quality measurement data.
In addition to the weekly radio program, Jones is outreach director of Southside Community Health Services and Q Health Connections which works with community partners to offer free, weekly blood pressure screenings.
In August 2016, MNCM’s Measurement and Reporting Committee approved recommendations that further align the Childhood Immunization Status HEDIS measure with CMS’s Merit-Based Incentive Payment System (MIPS) requirements.
In the 2017 report year, MNCM will report the Childhood Immunization Status Combo 10 measure. The Childhood Immunization Status measure evaluates children’s vaccination status, as of their second birthday. Evidence and national consensus support the recommendation for children to receive all vaccines encompassed in the HEDIS Childhood Immunization Combo 10 measure. Currently, MNCM reports results for the Childhood Immunization Status Combo 3 measure. Three additional vaccines are included in Combo 10: Hepatitis A, Rotavirus, and influenza, all of which are included in state and national preventive care guidelines, both from ICSI and the USPSTF.
In the 2018 report year, MNCM will report the Immunizations for Adolescents Combo 2 measure. The Immunization for Adolescents measure evaluates adolescents’ vaccination status, as of their thirteen birthday. Evidence and national consensus support the recommendation for adolescents to receive all vaccines encompassed in the HEDIS Immunization for Adolescents Combo 2 measure. Currently, MNCM reports the Immunization for Adolescents Combo 1 measure. In the 2017 report year, the National Committee for Quality Assurance (NCQA) will introduce Combo 2 for this measure – an update that will include the HPV vaccine for males and females. In the 2018 report year, NCQA has updated their specifications for this measure to reflect the most recent guidelines for HPV vaccine, namely, children aged 11-12 receiving two doses, instead of the previously recommended three doses. The addition of the HPV vaccine is supported by state and national preventive care guidelines. With recent changes in recommendations by the US Preventive Services Task Forces (USPSTF) and NCQA’s recent update of the measure, reporting this measure as a Combo 2 allows MNCM to be completely aligned with national and local guidelines.
In June 2017, MNCM’s Measurement and Reporting Committee (MARC) recommended the retirement of two quality measures starting in the 2018 report year:
- Pediatric Preventive Care Overweight Counseling – This is a process measure that is now topped out with a statewide rate of 90%.
- Maternity Care Cesarean Section Rate – Although Cesarean section rates have increased significantly over the past 20 years and may be medically necessary in many situations, an appropriate target rate is unknown. The statewide Cesarean section rate of 22% (lower is better) is 3.5 percentage points below the national rate of 25.7% and the statewide rate has been flat for more than three years.
As part of ongoing efforts to communicate health care performance results in a timely and user-friendly way, MNCM has created “snapshots” from the 2017 Cycle A and Cycle B measure reporting periods.
These snapshots include Optimal Diabetes Care, Optimal Vascular Care and Depression Care from Cycle A and Adolescent Mental Health and/or Depression Screening and Overweight Counseling from Cycle B that will be published in the Health Care Quality Report, which is anticipated to be released in January 2018.
This information can be used to aid decision making associated with quality improvement efforts.
In 2017 (2016 Dates of Service), the statewide rate for Optimal Diabetes Care is 45 percent and 62 percent for Optimal Vascular Care. The statewide rate for Depression Remission at Six Months is 8 percent. Overweight Counseling is 90 percent and 73 percent for Adolescent Mental Health and/or Depression Screening. Clinic and medical group level results are publicly reported on our consumer website, MNHealthScores.org. The site provides this information in convenient, sortable tables to view, download and/or print.
MNCM appreciates the significant contributions of clinics, medical groups, health plans, hospitals and other professional organizations that provide data to MN Community Measurement. Achieving our mission to accelerate the improvement of health by publicly reporting health care information relies on this collaborative, multi-stakeholder effort. MNCM strives to continue to be the trusted source for performance measurement, data sharing and public reporting locally and nationally.
2017 Patient Experience Survey Results Released
In the nation’s largest and most comprehensive view of patient experience, 81 percent of Minnesota patients gave their health care provider a top rating of 9 or 10 on a 10-point scale. Two-thirds (66 percent) of patients said they experienced a top level of access to care, defined as patients who say they were able to get appointments, health care and information when they needed it.
“This information is collected directly from patients and based on their own experiences,” said Julie Sonier, President of MN Community Measurement.
Survey results for 767 clinics, separated into five categories, are included in the 2017 Patient Experience of Care Survey published by MN Community Measurement (MNCM). These clinic level survey results are available for the public online at MNHealthScores.org.
“Sharing these results can help patients make quality decisions about their health care and help clinics and medical groups learn what they can do to improve the results,” added Sonier.
The survey measures patient experience in five categories, in terms of whether patients were:
- getting care when needed (“Access to Care”)
- receiving coordinated care defined by asking patients how often providers knew their medical history, followed up to give results of tests and asked about prescription medications being taken (“Care Coordination”)
- satisfied with their provider (“Provider Rating”)
- experiencing courteous and helpful office staff (“Office Staff”)
- being listened to and receiving understandable information and instructions (“Provider Communication”)
“Since MNCM unveiled the state’s first patient experience results in 2013, many clinics have used this information to focus on improving experiences for their patients,” said Sonier. “These results are also used to recognize outstanding service and health care satisfaction for clinics and medical groups.”
Though patients are generally reporting positive experience, the latest survey does show significant differences between clinics. Here are some highlights from the survey:
- 66 percent of respondents said they had top-level Access to Care. Individual clinics have results ranging from 33 to 91 percent.
- 73 percent of respondents gave their clinic the most positive rating possible when asked about Care Coordination. Across individual clinics, the low score was 49 percent and the high score was 87 percent.
- 81 percent of respondents gave their provider a top rating of 9 or 10 on a 10-point Provider Rating scale. Individual clinics ranged from 46 to 94 percent of providers receiving a top rating.
- 83 percent of respondents gave the office staff at their clinics top marks for being respectful and helpful. A 35 percentage difference is noted between the highest and lowest rated clinics.
- 86 percent of respondents described communication from their providers as top-level. Across individual clinics, the low score was 59 percent and the high score was 96 percent.
One clinic, Surgical Consultants in Edina, MN ranked in the top 15 performers across 4 of 5 survey categories. Three clinics, Gunderson Health System in La Crescent, MN, Minnesota Oncology in Fridley, MN and Essentia Health Pillager Clinic in Pillager, MN ranked in the top 15 performers across 3 of 5 survey categories. For additional information on top performers, click here.
Results by Region
A regional analysis, based on the patient’s zip code, shows that among the five categories, patients in Northeast Minnesota rated all five categories significantly above the statewide average. Conversely, patients in Minneapolis rated all five categories significantly below the statewide average. Patients in the Twin Cities area are less satisfied with Care Coordination as this category was rated significantly below the statewide average for patients in Minneapolis, St. Paul, West Metro and East Metro.
Further analysis of the five categories within the 2017 Patient Experience of Care Survey examining race, ethnicity and region will be published in the forthcoming Health Equity of Care Report scheduled to be released by MNCM in December 2017.
About the Survey
Results are from the more than 180,000 patient-completed surveys on patient experience of care, known as the Clinician & Group Surveys Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS® 3.0) survey. This is the third time that MNCM has conducted the Patient Experience of Care Survey. Twenty-nine percent of the patients surveyed responded, which is a similar response rate compared to previous years. Although the survey was completed previously in 2013 and 2015, trending and direct comparisons to previous year results are not recommended due to modifications to the questionnaire.
The data are collected as part of Minnesota’s Statewide Quality Reporting and Measurement System. The Minnesota Department of Health partners with MNCM to collect the data, and MNCM reports results on MNHealthScores.org. Individual clinics are also given access to more detailed analysis on their survey results to see where they are performing well, and identify areas for improvement. A small number of clinics in border communities in Iowa, North Dakota and Wisconsin that see Minnesota patients also chose to voluntarily submit results to MNCM.
MN Community Measurement is a non-profit organization dedicated to improving health by publicly reporting health care information. A trusted source of health care data and public reporting on quality, cost and patient experience since 2003, MNCM works with medical groups, health plans, employers, consumers and state agencies to spur quality improvement, reduce health care costs and maximize value. Learn more at MNCM.org.
MNCM has been named a Qualified Clinical Data Registry (QCDR) by CMS for the upcoming Merit-based Incentive Payment System (MIPS) under the Quality Payment Program (QPP). A QCDR is a CMS-approved entity that collects clinical data on behalf of clinicians for data submission.
MNCM is now able to assist clinician group practices in meeting MIPS (formerly PQRS) requirements for the 2017 reporting year. The MNCM QCDR service will seamlessly submit quality measures and improvement activities to CMS.
The proven MNCM Direct Data Submission (DDS) reporting platform is familiar to many and is currently used by clinics and medical groups for state reporting. The MNCM QCDR is an enhancement of the DDS to help you comply with federal MIPS and MACRA requirements.
Simplify your reporting needs with MNCM. For details on timing, list of approved measures and more, click here.
MN Community Measurement has announced that Shantanu Agrawal, MD, President and CEO of the National Quality Forum will be a featured keynote speaker at the MNCM Annual Seminar on Sept 13, 2017.
Registration is open through September 1. Early bird pricing for attendance us in effect until July 14. The full event agenda is found at seminar2017.mncm.org and online registration can be accessed at this LINK.
Shantanu Agrawal, MD, MPhil, is president and CEO of the National Quality Forum (NQF). A board certified emergency medicine physician who has worked in both academic and community settings, Dr. Agrawal is the former deputy administrator for the Centers for Medicare & Medicaid Services (CMS) and director of one of its largest centers, the Center for Program Integrity (CPI).
At CMS, Dr. Agrawal led an effort to improve the physician experience with Medicare by working to minimize the administrative tasks with which doctors contend. He also was one of the main architects of CMS’s strategy and action plan to address the national opioid misuse epidemic. His main focus at CPI was improving healthcare value by lowering the cost of care through the detection and prevention of waste, abuse, and fraud in the Medicare and Medicaid programs. From 2012 through 2014, CPI’s prevention efforts saved Medicare and Medicaid $42 million.
Dr. Agrawal previously served as CPI’s chief medical officer and was instrumental in launching new initiatives in data transparency and analytics, utilization management, assessment of novel payment models, and stewarding a major public-private partnership between CMS and private payers, the Health Care Fraud Prevention Partnership.
Dr. Agrawal has testified numerous times before Congress and is a frequent national speaker on healthcare and cost. He is a well-published author with articles in Journal of the American Medical Association, New England Journal of Medicine, Annals of Emergency Medicine, among others.
Prior to joining CMS, Dr. Agrawal was a management consultant at McKinsey & Company, serving the senior management of hospitals, health systems, and biotech and pharmaceutical companies on projects to improve the quality and efficiency of healthcare delivery. He also worked for a full-risk, capitated delivery system as its leader for clinical innovation and efficiency.
Dr. Agrawal completed his undergraduate education at Brown University, medical education at Weill Medical College of Cornell University and clinical training at the Hospital of the University of Pennsylvania. He has a master’s degree in social and political sciences from Cambridge University.
MN Community Measurement (MNCM) today announced that Julie Sonier has been named President of MNCM. Sonier is only the second person to lead MNCM and will succeed current MNCM President Jim Chase who announced in October 2016 that he would step down in 2017.
“Julie Sonier is very familiar with our work, having served on the Board, and she comes to MN Community Measurement with a wealth of strong relationships and immense respect within the community,” said MNCM Board Chair Tim Hernandez, MD. “Julie will lead MN Community Measurement into its next decade and bring new vitality to our efforts to accelerate the improvement of health at an important time of change in our health care system. We are excited about having Julie join us, and at the same time we will miss Jim.”
Sonier is scheduled to begin May 1. Chase will continue to serve MNCM through April 28.
“I look forward to this opportunity to deliver and demonstrate value to our partners and the community,” said Sonier. “MN Community Measurement is one of the best examples nationally of the power of collaboration among stakeholders from across the health care spectrum to achieve results that none could achieve alone.”
Sonier brings nearly 20 years of experience working to improve health care in Minnesota. She has in-depth knowledge of the health care financing and delivery systems, as well as the state and federal policy landscapes and their associated challenges and opportunities. She has a reputation as a knowledgeable, trustworthy, creative and thoughtful leader in Minnesota’s health policy community.
Prior to MNCM, Sonier served as Director of Minnesota’s State Employee Group Insurance Program, where she worked with labor unions, health plans, other employers, state agencies, state policymakers and others on initiatives to improve health and health care through the design of insurance benefits and value-based health care purchasing. She served as lead staff for Governor Tim Pawlenty’s Health Care Transformation Task Force in 2007-2008 which brought together stakeholders from across the health policy community in Minnesota to develop nation-leading initiatives aimed at improving health care cost, quality and access. She has served as Deputy Director of the State Health Access Data Assistance Center at the University of Minnesota and as State Health Economist/Health Economics Program Director for the Minnesota Department of Health. Sonier has a MPA in economics and public policy from the Woodrow Wilson School of Public and International Affairs at Princeton University in Princeton, NJ and a BA in economics from Amherst College in Amherst, MA.
MNCM started as a pilot project in 2003 to share diabetes care outcomes at medical groups across the state. In 2004, MNCM released its first public quality report. The report provided information about care in areas such as asthma, diabetes, breast and cervical cancer and well child visits. In 2006, MNCM became the first in the nation to use electronic medical records to collect health care quality measures from clinics across the state.
“MN Community Measurement is in a strong and respected position because of the leadership of Jim Chase for more than a decade,” said Dr. Hernandez.
During his tenure at MNCM Chase has led numerous initiatives, including development of more than 70 measures used by health plans, medical groups, consumer organizations and policy makers across the state. MNCM collects information on quality and patient experience from more than 1,500 clinics, 500 medical groups and 135 hospitals and reports on health care quality, cost, health equity, and health care disparities through its public reporting website MNHealthScores.org. MNCM has led the country in use of patient reported outcome measures. The National Quality Forum, considered the gold standard for health care measurement in the United States, has endorsed nine MNCM measures for conditions including knee replacement, spine surgery and care for diabetes, depression, asthma and heart and arteries.
“MN Community Measurement has a solid foundation to continue to lead towards better value in health care especially as organizations move towards greater transparency around quality and cost,” said Dr. Hernandez.
About Us: MN Community Measurement is a non-profit organization dedicated to improving health by publicly reporting health care information. A trusted source of health care data and public reporting on quality, cost and patient experience since 2003, MNCM works with medical groups, health plans, employers, consumers and state agencies to spur quality improvement, reduce health care costs and maximize value. Learn more at MNCM.org.
On January 3, 2017, MinnPost published an article titled, “Minnesota health and medical experts cite greatest concerns — and hopes — for 2017.” In the article, several health and medical experts including Jim Chase, MN Community Measurement President, were asked to answer the following question: With a new administration taking over the White House, what is your greatest concern for your particular corner of the health/medical field in the coming year? What is your greatest hope?
“2017 will be a time of great opportunity to improve our health system. We can adopt a more efficient enrollment and purchasing system for people with high risks and those who need subsidies. We can expand payment methods that focus on patient outcomes and encourage less waste on treatments with marginal benefits. We can agree on better performance metrics across payers so we reduce the administrative burden on doctors while expanding transparency about their results. We can do more to reduce health disparities by race and income by providing more information that helps address both the social and care difference that cause these disparities. The greatest risk is people waiting to see what happens in Washington and not taking the actions we know have worked to give Minnesotans better care: focusing on patient and community needs, testing new processes and partnerships to improve outcomes, and sharing information on results.” — Jim Chase, president of Minnesota Community Measurement
The full MinnPost article can be read at this link.
[As seen in the Mankato Free Press] By Brian Arola, firstname.lastname@example.org, Oct 12, 2016
MANKATO — Medical care costs for insured patients in Minnesota rose by more than 5 percent last year, according to new data analysis.
The 5.6 increase in medical costs statewide is the biggest since the MN Community Measurement nonprofit started releasing cost of care data for medical groups two years ago.
The nonprofit measures costs by tallying insurance claims made by the more than 1.5 million patients enrolled in the four health plans available in Minnesota last year.
On top of being a larger increase than the 3.2 percent one highlighted in last year’s report, the uptick also far outpaces income increases for Minnesotans over the same time period.
Jim Chase, president of MN Community Measurement, said that’s a concern for families trying to keep up with medical costs.
“That’s worrisome when you think of how much pressure there is on families,” he said.
Higher costs in Greater Minnesota, where there are fewer options available to patients, are also a problem, he said.
The cost of care for insured patients at the medical groups included in the report ranged from $365 to $914 per month. Area medical facilities fell in the middle of the two marks. Mayo Clinic Health System in Mankato came in at $534 per month, a 2.9 percent increase from the previous year. Mayo facilities in St. James, Waseca and New Prague all came in lower per month — New Prague, at $461 per patient, being the lowest.
In a statement, Mayo Clinic Health System spokesman Micah Dorfner said measuring costs for care at destination centers such as Mayo Clinic can be complicated. While the clinic supports efforts to transparently measure costs for care, distinctions should be made in the data to reflect the difference between complex care and community care. As a health system, Dorfner said steps are being taken to mitigate costs.
“Mayo Clinic Health System continues to take significant steps to manage cost of care, including improving access, reducing costs and increasing transparency,” he said.
Mankato Clinic saw a larger increase in cost of care than the Mankato Mayo over the past year — 11.7 percent — but still had a lower overall cost at $490.
The increase from year to year could be explained by a variety of factors, said Randy Farrow, CEO of Mankato Clinic. Pharmacy costs, an unusual number of major medical procedures in a given year, or more visits associated with preventive care could all lead to higher costs for care, he said.
Of the factors the clinic can control, Farrow said it’s typical to have about a 2 to 3 percent increase in costs per year, mostly to make up for inflation and wage increases.
Pharmacy costs were one of the factors Farrow said the clinics don’t control — apart from their willingness to prescribe generic drugs — but they could still be attributed to the clinic in insurance claims. At a 9.3 percent increase, take-home pharmacy costs were the services with the largest increase from last year.
In an unintentional way, preventive care could also be a driver of increased costs. Farrow said if clinics are encouraging patients to be proactive with their health, it could lead to more visits to the clinic in a given year. More visits equal higher costs for care, although the short-term expense should be eclipsed by cost savings related to maintaining a healthier lifestyle in the following years.
Whatever the cause of the increases, Farrow said the transparent cost for care measures are good from both a patient and medical group perspective.
“It’s good to start having people see this data and be more transparent,” he said. “I think it’s going to make us all better and more competitive because we know price is an issue.”
The issue isn’t expected to go away next year either, Chase said. Premium hikes for individual insurance plans announced recently could foretell a similar increase in cost of care next year.
“I’m guessing we’ll see continued acceleration of health care costs, and that’s worrisome,” he said.
Follow Brian Arola @BrianArolaMFP.
Consumer Reports evaluates primary care physician groups on key performance measures
By Joel Keehn
March 29, 2016
Everyone needs a primary care doctor. That’s the person who knows you best, refers you to specialists, and follows up on care. But what do you look for when choosing a primary care doctor?
“For many people, the most important thing is that they like their doctor,” says John Santa, M.D., a medical consultant for Consumer Reports who has studied the qualities that make a good physician—and how to measure that—for more than two decades. “They want to feel that their doctor listens and understands them.”
Just as important, Santa says, is “whether your doctor is skilled at what he or she is paid to do—keep you healthy, help you recover from an illness or injury, or help you manage a chronic disease, like diabetes or high blood pressure.”
You might think it would be easy to find out how well physicians perform those essential functions. But it’s not, for several reasons.
To start, there’s the size of the doctor population: Almost a million practicing physicians are in the U.S. And roughly half are primary care doctors. Who is responsible for gathering information on them all?
At least as problematic: How is a doctor’s performance measured, anyway? After all, primary care doctors take on many tasks—from ordering cancer screening tests to treating infections, from managing chronic diseases such as heart disease to coordinating care with specialists. So which criteria exactly should they be judged on?
Once those questions get answered, how are physicians persuaded to share that information—or where can interested parties go to gather it? And how can the information be presented in a way that’s accepted by medical professionals as accurate and fair, and still be useful to patients?
Updated: 02/10/2016 7:21 PM
Created: 02/10/2016 6:41 PM
The health care experience for people of color in Minnesota is different from the experience of white Minnesotans.
This fact is backed up by data in the 2015 Health Equity of Care report just released by MN Community Measurement.