New information published by MN Community Measurement (MNCM) allows consumers to compare the cost of care at medical groups across the state. The total cost of medical care in Minnesota increased 5.6 percent from 2014 to 2015 for commercially-insured patients, according to the latest data released by MNCM. View complete results for 2014 and 2015 in the 2016 Cost & Utilization Report
“This increase is more than the previous year and greater than the average increase in people’s income in Minnesota,” said Jim Chase, MNCM President.
The MNCM data shows an increase for commercially-insured patients per month from $449 in 2014 to $474 in 2015. The increase was 3.2 percent between 2013 and 2014.
This is the third release of overall total cost of care (TCOC) information by MNCM. The first TCOC report occurred in 2014 and reported a TCOC in 2013 of $435 per commercially-insured patient per month. The data is available at MNCM’s public reporting website MNHealthScores.org.
“This data not only informs consumers,” said Chase, “the availability of these results provide useful information for our community about what is driving cost increases by medical group and by region.”
February 10, 2016 – It’s well known that significant disparities exist in health care outcomes in Minnesota; however, first time analysis indicates significant disparities exist across patient experiences of care as well, according to the 2015 Health Equity of Care Report.
The second-year report, which was released today by MN Community Measurement (MNCM), deepens our understanding of health care disparities in Minnesota with the addition of two major features: four patient experience measures segmented by race and Hispanic ethnicity; and comparable medical group reporting of the five quality measures included in last year’s report.
The report’s major findings include:
- Significant inequities in health care outcomes based on race, Hispanic ethnicity, preferred language and country of origin persist throughout Minnesota.
- Disparities are particularly distinct among patients who are American Indian or Alaskan Native; Black or African American; Hispanic; and/or were born in or prefer to speak the native languages of Laos, Somalia and Mexico.
- Generally, racial and ethnic groups with better health outcomes rated their care experiences better as well. However, Asian patients generally had high quality outcomes but rated their experiences of care the lowest of any racial group.
- Patients in Greater Minnesota overall had poorer health care outcomes than Metro-area patients.
- Large, Metro-area medical groups tended to have higher quality outcomes across the majority of race, Hispanic ethnicity, preferred language and country of origin patient categories than medical groups in Greater Minnesota or of smaller size.
“Successfully addressing health inequities on a large scale requires consistent, actionable data that offers a window into the disparities,” said Jim Chase, MNCM President. “This report shows there are places in our community that are achieving better health care outcomes for all patients and we need to learn from providers who are having success.”
The Health Equity of Care Report offers a glimpse into disparities experienced by communities of color, immigrant communities and rural residents of Minnesota. It contains information collected from patients seen for appointments at medical groups throughout Minnesota, and evaluates health care quality in five areas and patient experience of care in four areas.
The results for five health care quality measures were segmented by race, Hispanic ethnicity, preferred language and country of origin. These are reported at statewide, regional and medical group levels. The measures are: Colorectal Cancer Screening; Optimal Asthma Control – Adults; Optimal Asthma Control – Children; Optimal Diabetes Care; and Optimal Vascular Care.
The results of four Patient Experience of Care domains were segmented by race and Hispanic ethnicity, and are reported at statewide and regional levels. The domains are: Access to Care; Helpful and Courteous Staff; Provider Communication; and Provider Rating.
“This information helps identify what health care disparities exist in Minnesota,” Chase said, “however; it does not explain why they exist, which is why sharing it with our community is critical to truly addressing inequities.”
For the first time, the Health Equity of Care Report includes clinical quality measure results segmented by race, Hispanic ethnicity, preferred language and country of origin reported by medical group.
Allina Health Clinics and Allina Specialties; HealthPartners Clinics; Park Nicollet Health Services; and Fairview Health Services generally had the highest rates across multiple quality measures and patient populations.
Reporting this information at the medical group level is a significant milestone because it brings the results to the level where accountability for patient outcomes lies in the health care system. Provider groups compare themselves to their peers and then evaluate the barriers faced by specific patient populations when seeking care at their practice. The report contains perspectives on health equity from six different organizations on how they are using this information to get better outcomes for patients.
We caution against jumping to conclusions about specific medical groups based on the information in this report. Rather, we encourage its use by medical groups and community organizations to work collectively to address the disparities that are identified.
Other report findings include:
- White and Asian patients generally had the highest rates of optimal care, while American Indian or Alaskan Native and Black or African American patients generally had the lowest rates. This is consistent with the findings of our 2014 report.
- Hispanics tended to have lower health care outcomes than non-Hispanics; however, this was not consistent across all regions. In particular, Hispanic patients had higher rates than non-Hispanics in some regions for Optimal Vascular Care and Optimal Asthma Control – Children.
- Patients born in Laos, Somalia and Mexico and/or who preferred speaking Hmong, Somali and Spanish generally had the poorest health outcomes compared to other country of origin and preferred language groups.
- Rates varied considerably across geographic areas of Minnesota. The East Metro region generally had higher rates across multiple measures and multiple patient populations than other regions. The Northwest and Southwest regions tended to have the lowest rates across measures and patient groups.
- Patients in Greater Minnesota overall had poorer health outcomes than patients in the 13-county Metro area; in particular, White patients in Greater Minnesota had lower rates than many other racial groups.
- The Southeast region generally had the highest Patient Experience of Care rates, while the Northwest region generally had the lowest.
MNCM released The Handbook on the Collection of Race/Ethnicity/Language Data in Medical Groups in 2008. This defined and standardized the information that should be collected from patients by clinics and medical groups, as well as set best practices for collection and reporting. Since then, Minnesota providers have steadily improved their collection and reporting of race, ethnicity, language and country of origin data.
In 2015, nearly all Minnesota providers submitted REL data to MNCM and three-quarters did so using best practices. Most providers that have not passed MNCM’s best practices audit are already collecting data from patients using best practices and are taking steps to address technical hurdles related to capturing and reporting the data in their electronic health records. Only data from medical groups who have successfully demonstrated to MNCM that they follow these best practices is included in the Health Equity of Care Report.
This report is unique because medical groups across the state collect and report the data in a standardized format, which allows MNCM to compare results across medical groups and regions.
“Our health care community is to be commended for its dogged pursuit of and support for the standard collection and reporting of REL data. We collect more data on health disparities than any other state, allowing us to target inequities more effectively,” Chase said.
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.
October 29, 2015 – The Minnesota Department of Health (MDH) and MN Community Measurement (MNCM) released first-time results from two new clinic measures that found most clinics are successfully providing lifestyle counseling to obese children, but less than half are screening adolescents for depression.
When clinicians did screen for depression, they found 9.7 percent – or 4,300 of 43,400 young people screened – had indications of a mental health condition, such as depression, anxiety or attention disorders.
The new data also indicates that 28.6 percent (98,000) of three to 17 year olds who had a well child exam last year were overweight or obese. Of those, 85 percent were counseled about nutrition and physical activity by their provider. This percentage of overweight and obese children in Minnesota clinics is slightly lower than the national rate of 31.8 percent, according to the CDC National Health and Nutrition Examination Survey, which used a different protocol than Minnesota’s effort but was conducted in clinics in 2011-2012 among children 2 to 19 years of age.
Click here to search the results
The total cost of medical care in Minnesota increased by 3 percent over the past year for commercially-insured patients, while the average price of the most common tests, procedures and services provided in clinics increased by 6 percent, according to a new report published by MN Community Measurement.
“Prices for clinic services are rising faster than the overall cost of care,” explained Jim Chase, MNCM President, “suggesting that medical groups are controlling the amount of care being provided or using less expensive services.”
The overall total cost of care (TCOC) per commercially-insured patient per month was $449 in 2014, a $14, or 3.2 percent, increase over the previous year.
Click here to see the detailed clinic results
Nearly 80 percent of Minnesota’s patients give their health care providers a top rating of 9 or 10 on a 10-point scale but only about 60 percent of patients said they experienced a top level of access to care.
The results of the 2015 Patient Experience of Care Survey were released today by the Minnesota Department of Health (MDH) and MN Community Measurement (MNCM). This is the second time that Minnesota has conducted the nation’s largest statewide patient experience survey. The survey included 200,500 patients at 765 clinics in Minnesota and neighboring communities who had appointments between September 1 and November 30, 2014. This year’s survey suggests patient opinion hasn’t changed much since the first survey in 2013.
“The survey indicates that patients are generally pleased with the care they receive but would like more convenience and timely access,” said Minnesota Commissioner of Health Dr. Ed Ehlinger. “Positive patient experience is a key element of high-quality medical care, and these survey findings help inform continued efforts to ensure that patients have access to care and the communication with providers they need to be healthy.”
Jim Chase, president of the Minneapolis-based Minnesota Community Measurement, has been elected Vice Chairman of the National Quality Forum (NQF) Board of Directors. The two-year term will begin in November. Chase joined the NQF Board in January 2014.
NQF is a non-profit, non-partisan, public service organization that reviews, endorses and recommends use of standardized health care performance measures. NQF also advises Medicare on measures to include in their value-based purchasing programs with physicians.
“It’s an honor to represent the Minnesota health care community at a national level,” Chase said. “Minnesota has expertise developing and using high value measures, particularly patient-reported outcome measures. As NQF looks at the challenging issues of developing and aligning high-value measures across the country, Minnesota’s expertise is extremely valuable.”
Chase has been the president of MN Community Measurement since 2004. He has a master’s degree in Health Administration from the University of Minnesota and served for eight years as Director of Health Purchasing at the Minnesota Department of Human Services. He has held roles at multiple health plans and provider organizations throughout Minnesota. He is the past chair of the Network of Regional Healthcare Improvement and currently serves on the Boards of Directors of the Institute for Clinical Systems Improvement and Apple Tree Dental.
Low-income patients in Minnesota with diabetes and vascular disease had better control over their conditions in 2014 than the year before, according to the eighth annual Health Care Disparities Report conducted by MN Community Measurement (MNCM) and sponsored by the Minnesota Department of Human Services (DHS). The report evaluates care outcomes for patients enrolled in Minnesota Health Care Programs (MHCP) on 12 quality performance measures.
The rate of optimal care received by MHCP patients with vascular disease increased by 8.5 percent while the rate of optimal care received by MHCP patients with diabetes rose 6.7 percent over the past year. High quality care for these conditions can reduce the risk of future complications such as nerve and eye damage, kidney disease, heart attacks and stroke.
These significant increases are notable, in part, because optimal care for all Minnesotans with diabetes and vascular disease only improved by one percent each in the past year
“The large improvement in care for patients on state public programs suggests improvement efforts by medical groups are having a particularly positive impact on low-income patients, who often face more challenges staying healthy,” said Jim Chase, President of MNCM.
Groups that had particularly large increases in these measures attribute their success with MHCP patients to a broad focus on care coordination and patient outreach that has resulted in more regular follow up care.
Entira Family Clinics increased the percentage of its MHCP-covered patients reaching optimal diabetes management by 21 percentage points over the past year. The group has emphasized care management of its patients with diabetes in recent years, according to Dr. Tim Hernandez, Medical Director of Quality at Entira. A critical component of care management is patient outreach, follow up and education.
Low-income patients are often more mobile than other patients, making consistent medical care for chronic conditions a challenge. “Care management may be particularly helpful for these patients,” Dr. Hernandez explained.
Altru Health System had a 25 percentage point increase in its MHCP-patients with vascular disease reaching optimal management over the past year. Similarly, Altru credits much of this improvement to a focus on follow up and care coordination efforts in recent years. Medical home coordinators in each primary care clinic answer patient questions, focus on after-visit follow up and do outreach to get patients into the clinics for annual and follow up appointments, explained Heather Strandell, Administrative Director of Care Management at Altru. The efforts have been particularly targeted at patients with high blood pressure, diabetes and those who need to be screened for colorectal cancer.
Strandell also noted that Altru has seen an increase in low-income patients with insurance coverage, which is increasing their ability to come in for the regular checkups that keep their chronic conditions well managed.
Additional Report Findings
Ten of the 12 measures evaluated by this report showed significantly lower outcomes for low-income patients. In addition to colorectal cancer screening, the largest inequities exist in Optimal Asthma Care for Adults (16 percentage points) and Breast Cancer Screening (14 percentage points).
However, progress is being made slowly: seven of the 12 measures evaluated have improved since last year; three remained relatively stable; and only one declined. And of the 11 measures that have been tracked for three or more years, ten have shown improvement over time.
Other notable results include:
- The highest rate reported was for Appropriate Treatment for Children with Upper Respiratory Infections (URI), where 91 percent of MHCP-children received the recommended care. This rate was 2.3 percent higher than that for non-MHCP patients. This means more MHCP-covered children are not dispensed an antibiotic when given a diagnosis of URI.
- The lowest rate of optimal care reported was for Depression Remission at Six Months. Only 5.3 percent of MHCP patients achieved remission of their depression symptoms six months after being diagnosed, compared to 9.4 percent of non-MHCP patients.
- The gap between MHCP patients and patients covered by other insurance in colorectal cancer screenings has stubbornly remained around 20 percentage points for five years. It continues to be the largest disparity noted in the report. While screening rates have increased for both patient populations, the gap persists.
- The rate of optimal care for MHCP-covered children with asthma increased 6.7 percent, resulting in an 829 additional children having their asthma symptoms well managed. This increase mirrors an overall increase in the quality of asthma care for children statewide in 2014.
- By age two, 72.6 percent of MHCP-covered children had received the recommended childhood immunizations. This is compared to 80.5 percent of two year olds covered by other types of insurance.
- The rate of chlamydia screenings in women continued a multi-year decline. After hitting a high of 59.1 percent in 2012, the rate dropped 3.3 percentage points to 55.8 percent this year. The decrease is not, however, unique to MHCP-covered patients; the rate for Other Purchaser patients also dropped 2.7 percentage points over this same period.
Additionally, the 2014 report includes a new regional breakdown of care outcomes for MHCP patients. This new analysis breaks the state into four regions: Northwest, Northeast, Metro and Southern. MHCP-covered patients in the Northwest region had the poorest outcomes overall, including the lowest results in five of the six measures evaluated regionally.
The Health Care Disparities Report highlights performance rates for patients in the managed care component of Medicaid programs, including Medical Assistance and MinnesotaCare. Since Minnesotans eligible for these programs have lower-than-average incomes, comparing this group of patients to commercially-insured patients is a strong way to illustrate Minnesota’s socioeconomic health care disparities. It should be noted that MNCM’s Health Equity of Care Report, which was released in January 2015, evaluates inequities that exist due to self-reported patient race, Hispanic ethnicity, preferred language and country of origin. These reports are companion pieces that evaluate health disparities in Minnesota through different lenses with the shared goal of shining a light on gaps in care so we can ultimately achieve health equity for all Minnesotans.
DHS sponsors the creation of the Health Care Disparities Report by MNCM as part of its mutual commitment to making health care disparities data public. Sharing this information helps providers and care systems recognize the gaps and take steps to close them.
“Before the release of the first Health Care Disparities Report in 2007, state or national reports of health inequities could be dismissed by Minnesota medical groups as not being about them,” Chase said. “Our partnership with the Department of Human Services has been critical to helping providers in our state see and understand disparities that exist within their own practices and address barriers faced by their patients.”
Read the 2014 Health Care Disparities Report, as well as all previous versions
Read the Minnesota Department of Human Services statement on the release of the 2014 Health Care Disparities Report.
Thousands more Minnesotans received the health care they needed during the past year, thanks to improvements made by clinics across Minnesota. This progress is charted in MN Community Measurement’s 2014 Health Care Quality Report, now in its eleventh consecutive year of publication.
In addition to ongoing reporting of clinic and medical group performance for 22 conditions, the 2014 report includes five new measures: Maternity Care: Primary Cesarean Section Rate; Total Cost of Care; and three Total Knee Replacement measures.
More than 310 medical groups and 1,600 clinics are registered to submit data to MNCM. The annual Health Care Quality Report is a compilation of all measures publicly reported by MNCM during the year. Individual medical group results are available year-round at MNHealthScores.org.
Improvements in Asthma Care
A growing number of Minnesota children and adults are getting their asthma under control. More than 2,800 additional children and 4,400 additional adults had their asthma well-controlled during the past year compared to the previous year.
“Since asthma is not curable, managing and controlling it is essential to leading a normal, healthy life,” explained Jim Chase, President of MN Community Measurement (MNCM). “If asthma is not well controlled, it can be serious and even life threatening.”
The percentage of Minnesota adults and children achieving high-quality asthma care both increased seven percent between 2013 and 2014. In addition, both measures have had the largest increases of any clinical quality measures tracked by MNCM since 2011 – 32 percentage points for children and 31 percentage points for adults.
“The gains in asthma care are a reflection of more and more medical groups in Minnesota implementing the patient tools and processes that are recommended for use with asthma patients in their practices,” Chase said.
The highest performing medical group in Minnesota for care of children with asthma was Advancements in Allergy and Asthma Care of Minnetonka with 93 percent; for adults with asthma, it was Allergy and Asthma Specialty Clinic of Willmar with 89 percent. Overall, the East Metro and West Metro regions had the most high-performing medical groups caring for both children and adults with asthma; the Central region had the third-most for both patient populations.
Other Report Highlights
Many other clinical quality measures had notable increases in performance last year, including depression care.
Improvement was noted across all six measures that evaluate outcomes for patients diagnosed with major depression. Depression is a complex condition that affects patients’ mood, thoughts and body; therefore, response to treatment and complete remission are challenging to achieve. In a three-month period, patients with depression miss an average of 4.8 days of work and suffer 11.5 days of reduced productivity. Additionally, the national expenditures for mental health services was estimated at over $100 million 2003, according to the Centers for Disease Prevention and Control.
Thus, small improvements in response to treatment and remission of symptoms for patients with depression are critically important. Between 2013 and 2014, the outcomes for these measures increased between one-half and three percentage points – resulting in 7,100 additional patients with major depression receiving critical health care services in 2014 compared to the year before.
Clinics in the Wisconsin, West Metro, St. Paul and Southeast Minnesota regions had the largest number of high-performing medical groups across all six depression outcome measures.
Other noteworthy results highlighted in the 2014 Health Care Quality Report include:
- The rate of adolescents who have received all recommended vaccinations by their 13th birthday increased three percent since 2013, and has increased nine percentage points since MNCM began tracking it in 2012. Similarly, the rate of two year olds with all recommended vaccinations has increased by seven percentage points since 2011. That rate remained stable at 78 percent between 2013 and 2014.
- Seventy percent of adults age 50 to 75 were up-to-date on recommended colorectal cancer screening, which was a one percentage point increase from 2013. This measure has increased six percentage points since 2011. Additionally, since cancer screenings are recommended for everyone – and not just if a patient has a particular condition – even a small increase has a significant impact. The one percentage point increase from 2013 to 2014 meant an additional 11,000 Minnesotans received potentially life-saving screenings last year.
- Only 22 percent of first-time mothers in Minnesota had cesarean deliveries last year. In this case, lower rates are better as they indicates fewer cesarean deliveries.
- Appropriate treatment for bronchitis in adults increased three percentage points between 2013 and 2014. The recommended care is to not prescribe antibiotics because bronchitis is a viral infection. Taking antibiotics unnecessarily increases the risk of patients developing a resistance to them. This rate has increased nine percentage points over the past three years, from 20 percent in 2011 to 29 percent in 2014, making it one of the fastest-improving clinical quality measures tracked by MNCM.
Review the full 2014 Health Care Quality Report for additional details including clinic performance highlights by region and over time.
Read the 2014 Health Equity of Care Report
January 12, 2015 – Dramatic health inequities exist in Minnesota – across racial and ethnic groups, languages, countries of origin, and regions of Minnesota – according to a first-of-its-kind report released today by MN Community Measurement (MNCM).
The Health Equity of Care Report: Stratification of Health Care Performance Results in Minnesota by Race, Hispanic Ethnicity, Preferred Language and Country of Origin contains information collected from patients seen in medical groups throughout Minnesota and evaluates health care outcomes in five areas:
- Optimal Diabetes Care
- Optimal Vascular Care
- Optimal Asthma Care for Adults
- Optimal Asthma Care for Children
- Colorectal Cancer Screening
Results in all five areas are broken down by patient race, Hispanic ethnicity, preferred language and country of origin. They are reported at statewide and regional levels. The report is available in the Reports and Data section.
“Minnesota is one of the healthiest states in the nation, but we also have some of the largest inequities in health status and incidence of chronic disease,” explained Jim Chase, MNCM President. “Patients from specific populations, including people of color, people who identify as Hispanic, immigrants, and people who do not speak proficient English, are less likely to receive preventive care and more likely to suffer from serious illnesses and have negative health outcomes.”
This report is unique as it is the first where medical groups across the state collected the information to help them improve care and tailor their approaches to patients with specific needs. Additionally, by collecting and reporting the data in a standardized format, we can appropriately compare what’s working across different groups and regions of the state.
“Providing information at a regional level is vital to focusing and evaluating population health improvement opportunities, and to driving public policy and resources to the areas and populations most in need,” said Anne Snowden, MNCM Director of Performance Measurement and Reporting.
“To reduce and eliminate health inequity, we must understand where it exists and its scope,” Snowden continued. “Never before has data on health outcomes been available at this granular level in Minnesota – making it actionable for advocates, policymakers, public health professionals, community leaders and medical groups.”
The Health Equity of Care Report offers a glimpse into disparities experienced by communities of color, immigrant communities and rural residents of Minnesota.
The most distinct example is the care received by Somali patients. Patients born in Somalia and/or who preferred speaking Somali had the lowest health care outcomes statewide in four of the five health areas evaluated. For example, only 22% of Somali immigrants were appropriately screened for colorectal cancer, compared to 70% of patients statewide. And only 25% of adults who preferred speaking Somali received optimal care for asthma, compared to 47% of adults statewide.
In contrast, patients who were born in Vietnam and/or preferred speaking Vietnamese had some of the best health care outcomes, and surpassed English-speaking and United States-born patients in all three categories where Vietnamese patients were reportable. Most notably, patients who preferred to speak Vietnamese had the highest statewide rates of any language group for both Optimal Diabetes Care and Optimal Vascular Care, and Vietnamese immigrants had the highest statewide rate for Optimal Diabetes Care of any country of origin group.
Other key findings include:
- White and Asian patients generally had high health care outcomes, while American Indian or Alaskan Native and Black or African American patients generally had low health care outcomes.
- Hispanics tended to have lower health care outcomes than non-Hispanics; however, this was not consistent across all regions. The East Metro and St. Paul regions had notably higher rates for Hispanics for Optimal Vascular Care and Asthma Care for Adults than Non-Hispanics.
- Patients born in Laos and/or who preferred speaking Hmong generally had lower health care outcomes than other Asian patients and other patients in general.
- Rates varied considerably across geographic areas of Minnesota. The East and West Metro regions generally had high health care outcomes across multiple measures and multiple populations. The Central region had notably high rates of Optimal Asthma Care, for both adults and children, across all racial groups.
- The outer regions of Minnesota tended to have worse health care outcomes across multiple measures and populations, including lower rates for white, English-speaking patients who were born in the United States. This is reflective of a trend that has been previously documented of overall lower health care outcomes for patients in rural areas. These patients often face additional access and language challenges than patients in urban and suburban areas.
Measuring health inequity has historically been complex and difficult. As a trusted source for performance measurement and public reporting in Minnesota and nationally, MNCM has the unique and crucial ability to highlight where health care disparities exist in our state.
MNCM began this community-based effort in 2008. The first significant milestone was achieved the following year with the release of The Handbook on the Collection of Race/Ethnicity/Language Data in Medical Groups. The handbook defined and standardized the information that should be collected from patients by clinics and medical groups, as well as set best practices for collection and reporting. The two most critical components of those best practices include:
- Patients must self-identify their race, Hispanic ethnicity, preferred language and country of origin; and,
- The clinic/medical group’s electronic medical record system must be able to collect and report more than one racial category for each patient.
Only data from medical groups who have successfully demonstrated to MNCM that they follow these best practices is included in this report.
Since the Handbook was released, Minnesota providers have steadily improved their collection and reporting of race, ethnicity, language and country of origin data. In 2014, more than 70% of medical groups statewide that voluntarily submitted this information to MNCM used best practices.
MNCM’s success relies on a multi-stakeholder, consensus-based, collaborative effort. We highly value the work of others in our community who are also focused on our shared goal of ending health inequities, and who have shared their expertise with us over the years, particularly from community leaders and medical groups.
“Our health care community should be extremely proud to have identified, prioritized and championed the standard collection and reporting of this information,” Chase said. “This landmark report and its positive impact on our community are only possible because Minnesota’s health care leaders and their teams rallied around this goal. They should be commended.”
Nevertheless, the release of the Health Equity of Care Report is only the beginning. “Data alone won’t reduce disparities or achieve health equity goals,” Snowden emphasized. “The real achievement will come when we begin to see the elimination of health inequities across our state and nation.”
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.
A new report has just been published by MN Community Measurement that allows consumers for the first time to compare the cost of care at medical groups across the state.
Costs from more than 1.5 million patients were included in the report, which is the nation’s most comprehensive look at the total cost of care. Information is available for 115 medical groups, representing 1,052 clinics across Minnesota and in neighboring communities on MNHealthScores.org.
The average monthly cost of medical care per patient is $435 and just a small reduction could save millions.
“What’s striking is the difference between medical groups in the middle – a range of more than $1,500 per patient annually just between those considered average cost,” said Jim Chase, President of MN Community Measurement.
Even a small decrease in the cost will make a considerable impact, according to Chase. A reduction in the average per patient cost of just $12 per month, or $144 per year, would save Minnesotans $750 million in health care costs annually.
“All stakeholders benefit from reliable cost data delivered in a consistent manner,” said Carolyn Pare, President and Chief Executive Officer of Minnesota Health Action Group. “Purchasers of health care, whether private sector employers or consumers, have a critical need for greater transparency in health care cost and quality information. Consumers are paying a greater share of their health care coverage. Although being used for different purposes, cost data built on the same definition, utilizing the same methodology, holds promise to benefit all as we seek to improve affordability,” Pare explained.
“We have our own data, but we’ve always wondered how we stack up against the rest of the community,” agreed Paul Berrisford, Chief Operating Officer of Entira Family Clinics. “It’s important to have reliable cost data so we know how to improve. You can’t improve what you don’t measure.”
Eighty percent of medical groups in Minnesota have an average range of costs. Individual medical group results ranged from $269 to $826 per patient per month. The statewide average for adult patients is $514 per month, and for pediatric patients is $216 per month.
“Medical groups can see where they stand on cost and to collaborate with others to learn what’s working to improve the value of care,” Chase said. “This helps everyone improve and drives change.”
Berrisford agreed. “It opens up dialogue about why Provider A is more expensive than Provider B. That drives consumerism and internal competition,” between medical groups, he said. “This will drive change through the competitive process it sets up.”
Total Cost of Care
Total Cost of Care is a National Quality Forum (NQF)-endorsed methodology, which includes all costs associated with treating commercially-insured patients, including professional, facility inpatient and outpatient, pharmacy, lab, radiology, behavioral health and ancillary costs. NQF is considered the gold standard of health care measurement.
This report includes data based on 2013 claims from the four health plans in Minnesota with the largest commercially-insured populations: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne. The health care costs evaluated for this report totaled more than $8 billion.
“This work is extremely important because it will help the broad community of stakeholders ask better questions about cost of care,” according to Dr. Lawrence (Larry) Lee, vice president and executive medical director for provider relations and quality at Blue Cross and Blue Shield of Minnesota. “The immediate value is establishing a robust foundation of data and methodology, upon which MNCM and participants will build successive versions and modules to answer increasingly specific questions. The answers will, I hope, lead to a more efficient, less distorted market.”
The total cost of care is the full cost – paid by both patients and health insurance companies. The amounts have been risk-adjusted and outlier costs have been removed to create a level playing field for all medical groups so true differences in cost can be evaluated.
“The philosophy of Blue Cross is that better information leads to better decisions,” Lee continued. “MNCM brings the track record of disciplined execution that’s needed to do this right.”
The amount spent on health care in Minnesota and nationally is growing. In 1960, just 6% of the nation’s gross domestic product was spent on health care; in 2013, that number was 17%. According to the Minnesota Department of Health, Minnesota’s health care spending rose $4.3 million (12%) between 2008 and 2012.
“Total cost of care is a major problem in our society, not just for health care,” said Dr. David Satin, family medicine physician with University of Minnesota Physicians and assistant professor at the University of Minnesota’s Medical School. “There’s a wide swath of things we can do today to improve the total cost of care – in particular beginning to discuss and eliminate unwarranted variation in care.”
“This is an important place to start to tell us where that variation might exist,” Satin continued.
“Discussions around quality and cost are easier now with this transparency,” explained Bruce Penner, Director of Quality at Integrity Health Network. “Phrases like ‘we care’ need to be shifted to ‘we care more and cost less.’ Data like this will allow us to prove it.”
Three-Year Community Effort
The release of this Total Cost of Care report is the result of a three-year community effort, involving more than 40 representatives from medical groups, health plans, large employers, consumer groups, the State of Minnesota, professional associations and health care improvement organizations. Technical assistance and validation were also obtained from independent statisticians and local and national experts, including the National Quality Forum, the Network for Regional Healthcare Improvement and Johns Hopkins University.
Berrisford, a member of the Total Cost of Care workgroup, said he’s proud of the health care community in Minnesota for leading the nation in transparency. “We’re taking this important first step and not waiting for someone else,” he said.
“Minnesota’s providers and health plans are to be commended for working together to increase transparency of the cost of care and for using that information to improve the value of care,” Chase echoed. “These conversations are not always easy, but the results are essential for our community.”
Information will be used by varied stakeholders
Medical group representatives said they would use the report in a variety of ways to improve the affordability of care.
“We’ll work with our payer partners to look at where the costs are – are they surgical, inpatient, outpatient?” Berrisford said. Entira will pair that information with what they can learn from other medical groups to identify solutions and target areas for improvement.
“We use cost data to compel conversations with ourselves and with providers we engage through the continuum of care,” Penner said. “Physicians are considering where they refer to and what services they bring into the care continuum or any episode of care.”
Additionally, employers and consumers will use the information to evaluate options and ask questions.
“Currently the information employers receive from their health plans is based on their own population,” Pare said. “For employers, specifically, [the TCOC measure’s] large patient population will increase the validity and reliability of the total cost of care information that an employer has access to.”
“Employers are expressing more interest in Accountable Care Organizations (ACOs) and narrow network plan offerings, as they continue to look for ways to manage increasing health care costs,” Pare said. “Being able to access total cost of care information for a large number of medical groups that incorporates a larger patient population than their own or that of their health plan(s) will enhance their decision making.”
Consumers can pair this with the quality and patient experience information on our website, MNHealthScores.org. It gives consumers a sense of which clinics are higher and lower cost, which they can use to make provider choices or ask their clinic about why they’re more expensive.
“Information is knowledge,” Pare said. “Consumers benefit the most when they have access to actionable cost information for services they may be utilizing. When coupled with quality information, the basis for a decision is even stronger.”
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.
“The latest Health Care Disparities Report should be a call to action for the health care community to ensure all Minnesotans receive the health care they need. While we are heartened to see improvement in some areas for public program enrollees, there is much more work to do to close these gaps. Providers need to be held accountable for gaps in care that affect public program enrollees and people of color, and we will work with the health plans we contract with to address these disparities with providers. We are turning to the Cultural and Ethnic Communities Leadership Council to help keep us all focused on these issues and to identify solutions.”
Read the full statement here.
Seventh annual report shows gaps in care persist for key health screenings
Almost half of low-income adults in Minnesota weren’t screened for colorectal cancer in 2013, according to the seventh annual Health Care Disparities Report conducted by MN Community Measurement and sponsored by the Minnesota Department of Human Services. Colon cancer is the third leading cause of cancer-related deaths in the United States.
The disparity in colorectal cancer screening rates between Medicaid patients and all other patients continues to be the largest gap in care identified in the report. Only 51.8% of Medicaid-covered adults ages 50 to 75 were screened for colon cancer in 2013, compared to 71.8% of those covered by other types of insurance.
“Colon cancer is not only treatable and beatable, it is preventable,” said the American Cancer Society’s Matt Flory. “We are concerned that fewer Minnesotans insured by state public programs are getting simple tests that could stop cancer before it starts.”
This is the third year in a row that colorectal cancer screenings have had the largest disparity among the 13 measures tracked by the report.
Colon cancer rates nationally have dropped 30% during the past decade, largely due to an increase in screenings, according to Flory. Screenings can identify and remove polyps before they become cancerous, reducing the overall rate of cancer and associated deaths. “Lower rates of colon cancer screening could translate into higher rates of colon cancer,” he said.
While the overall rate of colon cancer screenings has increased in recent years, the gap in care for lower-income Minnesotans has persistently remained at 20% since 2010. During 2013, that meant more than 10,700 fewer Medicaid patients were screened than their counterparts.
Cervical cancer screenings
The report also identified a large decrease in cervical cancer screenings amongst Medicaid-covered women ages 24 to 64. The 7.5% drop in screenings resulted in the largest disparity for that measure since 2005. During 2013, only 61.6% of patients covered by Medicaid received the screening compared to 74.2% of patients covered by other insurance types.
Despite this, cervical cancer screenings is an area where Minnesota has had the most success eliminating disparities. The number of women on Medicaid being screened has increased 26 percentage points since 2004, from 42.8% to 61.6%. This is the largest improvement over time of all measures evaluated.
Like colon cancer, most cervical cancers begin with non-cancerous cells that can be treated and/or removed before they develop into cancer. Treating pre-cancerous cells can prevent almost all cervical cancers, according to the American Cancer Society.
Additional report findings
More work remains to be done to close gaps in care between people covered by Medicaid and those who have commercial insurance. Eleven of the 13 measures tracked showed significantly lower outcomes for patients covered by state programs. In addition to colorectal cancer screening, the largest gaps persist in optimal diabetes care, optimal vascular care and optimal asthma care for patients ages 18 to 50.
The report analyzes whether Medicaid patients are receiving better care over time. Seven of 13 measures improved for Medicaid patients from 2012 to 2013. For the 12 measures that have been tracked for three or more years, 11 have shown improvement over time.
It also evaluates differences in care by race and ethnicity within the population covered by Medicaid programs. Notable findings include:
- Blacks/African-Americans have a significantly lower rate for controlling blood pressure than the average for patients in state programs.
- Blacks/African-Americans have the highest rate of chlamydia screening, while Whites have the lowest and a significantly lower rate than the average for patients in state programs.
- American Indians continue to have the lowest rate of childhood immunizations, which looks at whether children have received all of the recommended vaccinations by age 2.
“People in public programs, especially those of color or with language barriers, have worse results from their health care than the general public,” said Jim Chase, president of Minnesota Community Measurement. “The recent expansion in the number of Minnesotans on public programs makes these disparities even more important to address now.”
More than one million Minnesotans receive health care coverage through Medicaid health care programs overseen by the Department of Human Services.
The Health Care Disparities Report publishes performance rates for patients in the managed care component of Medicaid programs, including Medical Assistance and MinnesotaCare. Because people who are poor, people with disabilities and people of color are over-represented in those programs, comparing Medicaid patients to commercial patients illustrates Minnesota’s health care disparities.
The Department of Human Services sponsors the report by MN Community Measurement as part of their mutual commitment to making health care disparities data public. Sharing this information helps providers and care systems recognize the gaps and take steps to close them.
“We’re focused on showing where medical groups have improved results for these patients, and using that information to encourage other groups to make progress as well,” Chase said.
View the full 2013 Health Care Disparities Report (PDF).
About MN Community Measurement
MN Community Measurement is a non-profit organization dedicated to improving health by publicly reporting health care information. A trusted source of health care quality measurement and public reporting since 2003, MNCM works with health plans, providers, employers, consumers and state agencies to spur quality improvement, reduce health care costs and maximize value.