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Report compares care delivered to patients with public and private insurance.
MN Community Measurement (MNCM), an independent non-profit organization that collects and reports health care data to drive statewide system improvement, today released the 2017 Health Care Disparities Report with the Minnesota Department of Human Services (DHS). The report shows significant room for improvement in closing health care gaps for patients enrolled in state health plans.
The Health Care Disparities Report provides health care performance rates for patients enrolled in the managed care component of Minnesota Health Care Programs (MHCP), including Medical Assistance and MinnesotaCare. As enrollment in these programs continues to increase, the Health Care Disparities Report helps the state and health care providers identify opportunities to improve health care and health outcomes for people served by state programs. DHS contracts with MNCM to produce the report.
Overall, patients enrolled in MHCP managed care received cancer screenings and immunizations less frequently than Minnesotans who have private or employer-based health insurance. Performance rates and health outcomes for MHCP patients who have asthma, depression or diabetes are also worse than privately insured patients. MHCP patients, when compared with the overall population of the state, are of lower socioeconomic status, include a disproportionate number of persons of color, and often experience barriers to care.
“The latest Health Care Disparities Report calls for community-wide action to ensure everyone has the opportunity to be healthy and get the care they need,” said Acting Human Services Commissioner Chuck Johnson. “This is the eleventh year of the report and, over time, statewide gaps in the care delivered to low-income Minnesotans have continued to narrow. We are hopeful that initiatives like the Integrated Health Partnerships – which encourage providers to work with one another and community organizations to address barriers to health – will continue to reduce the disparities identified in this report.”
This annual report reveals considerable disparities, highlighting three measures with the largest gaps – Childhood Immunization Status, Breast Cancer Screening and Colorectal Cancer Screening. The report includes medical group and clinic level results for 11 measures, as well as analysis by race/ethnicity and region.
Childhood Immunization Status rates, an updated measure this year, had a gap of 23 percentage points between patients with MHCP and other purchasers. This was the largest gap for any measure in this year’s report.
“While we can’t yet see trends for this Childhood Immunization measure, this large gap in childhood immunization rates between MHCP patients and others points to a need for close attention,” said Julie Sonier, MNCM President. “Immunizations by age two are vital to childhood health.”
Vaccination is safe, effective and can protect children from serious illness. Vaccine-preventable diseases are still a threat, resulting in hospitalizations and deaths every year. According to the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion, approximately 300 children in the United States die each year from vaccine-preventable diseases.
Eight medical groups had above average Childhood Immunization Status rates for MHCP patients, with HealthEast Clinics having the highest rate at 59 percent.
Disparities in Cancer Screenings
Colorectal Cancer Screening and Breast Cancer Screening also had large gaps in this year’s Health Care Disparities Report. There was a 20 percentage point gap between MHCP adult patients and patients with other insurance for Breast Cancer Screening and a 19 percentage point gap for Colorectal Cancer Screening.
The American Cancer Society website has specific recommendations for cancer screenings and guidelines for early detection of cancer. These cancer measures have had consistent gaps for many years between MHCP patients and patients with other forms of insurance.
Despite the gaps, MHCP patients have seen improved health outcomes in many areas measured since the first Health Care Disparities Report was issued over 10 years ago. Since 2011, for example, nearly 9,700 more MHCP patients have been screened for colorectal cancer.
Medical Group Highlights
There were five medical groups with above average ratings for the MHCP population in all three measures (Childhood Immunization Status, Breast Cancer Screening and Colorectal Cancer Screening):
- Allina Health
- CentraCare Health
- HealthPartners Clinics
- Mankato Clinic, Ltd.
- Mayo Clinic
“Progress is being made, but gaps in many of these areas still exist,” said Sonier. “It’s encouraging to see improvements over time. As a community, we all have a role to play in closing these gaps and making sure that disparities between MHCP patients and patients with other types of insurance are diminished.”
For the full list of medical groups and more information on these measures, view the report.
About the Health Care Disparities Report
In 2016, more than 900,000 Minnesotans received health care coverage through Medical Assistance or MinnesotaCare programs overseen by the Department of Human Services (DHS). MNCM has partnered with DHS to produce the Health Care Disparities Report since 2007. This report supplies objective, transparent data that can be used to evaluate performance and identify improvement opportunities. View the full report for more information.
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 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.
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MNCM’s Cancer Care Measure Development Workgroup recently completed pilot testing of four new patient reported outcome (PRO) based Symptom Control During Chemotherapy (SCDC) measures. The Workgroup concluded that the four measures tested are feasible to collect and demonstrate variation and opportunity for improvement. They recommended implementation of the measures for oncology practices in the 2020 report year (2019 dates of service).
The results of the pilot testing and the Workgroup’s measure recommendations were presented to the Measurement and Reporting Committee (MARC) at their meeting on February 14, 2018. MARC members had a thoughtful discussion and approved the recommendation as presented. The measures were approved by the MNCM Board on February 21, 2018. The measures include:
- Symptom Severity Assessment During Chemotherapy (process; PRO tool administration)
- Symptom Control During Chemotherapy: Pain (outcome)
- Symptom Control During Chemotherapy: Nausea (outcome)
- Symptom Control During Chemotherapy: Constipation (outcome)
These measures will support MNCM’s goals to include more specialty and patient reported outcomes (PRO) measures in our slate of measures for public reporting.
All oncology practices in Minnesota and surrounding communities are encouraged to begin implementing this symptom assessment tool in their practices in 2018 but no later than January 1, 2019. An educational webinar will be scheduled in the fall of 2018.More
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MN Community Measurement (MNCM), an independent non-profit organization that collects and reports health care data to drive statewide system improvement, today released its 2017 Health Care Quality Report. This 14th annual report provides data related to preventive and chronic care comparing statewide, regional, medical group and clinic performance.
A highlight of this year’s analysis is improvement in quality measures related to mental health. The rate of Adolescent Depression and/or Mental Health Screening increased by nine percentage points since last year’s report, from 64 to 73 percent. Since 2015, the rate for this measure has improved 33 percentage points resulting in over 45,000 more adolescents across Minnesota receiving screening for depression during this time period.
Improvements were also seen in measures for adult depression care follow-up and outcomes. Depression is a common and treatable mental disorder. According to a recent National Health and Nutrition Examination Survey (NCHS), it is estimated that over 8 percent of American adults had an episode of major depression in a given two week period. MNCM’s suite of depression measures was developed to increase follow-up and improve depression outcomes.
This year’s report shows improvement in three of the depression measures:
- The depression follow-up rate at 12 months increased by nearly five percentage points, from 22.8 to 27.3 percent;
- The depression response rate at 12 months (fewer symptoms after starting treatment) improved by nearly two percentage points, from nine to 11 percent; and
- The depression remission rate at 12 months (no symptoms or very few symptoms after starting treatment) improved by over one percentage point, from five to six percent. This represents over 5,800 patients with depression symptoms in remission.
Entira Family Clinics – West St. Paul had the top depression follow-up rate at 69 percent, the top response rate at 44 percent and the top remission rate at 39 percent.
These improvements reflect better follow-up with patients and improved communication between patients and their primary care providers, and between primary care providers and behavioral health providers. Most importantly, these numbers reflect overall better outcomes for patients with depression.
“We still have a long way to go, but it’s encouraging to see progress in screening, follow-up and outcomes for depression,” said Julie Sonier, MNCM President. “While the statewide improvements may appear small, they reflect tangible improvements for real people with a very challenging chronic disease. The most important news is that the hard work of follow-up is showing progress, and patients are benefiting with improved depression outcomes. The fact that all of these measures are trending upward shows that Minnesota health care providers’ efforts in this area are paying off.”
Other notable improvements in quality measures and trends over time included:
- In the Colorectal Cancer Screening measure, the rate has increased nine percentage points since 2011 from 64 percent to 73 percent representing over 116,000 more patients being screened for colorectal cancer. Three medical groups had colorectal cancer screening rates at 90 percent or higher: Obstetrics, Gynecology and Infertility – Maple Grove, CentraCare Health Plaza – Internal Medicine and Catalyst Medical Clinic in Watertown.
- Since 2012, the rate for adolescent immunization increased 33 percentage points from 53 to 86 percent. This means that 9,400 more adolescents in Minnesota received recommended immunizations (one dose of meningococcal vaccine and one tetanus, diphtheria toxoids and acellular pertussis vaccine) before their thirteenth birthday. Wayzata Children’s Clinic and Southdale Pediatrics Associates had the top adolescent immunization rate at 98 percent.
The report also highlights fifteen medical groups with consistent high performance on three or more quality measures over three years and 17 medical groups with consistent improvement on three or more quality measures over the same time period.
To read the full report and explore other measures statewide, visit mncm.org/health-care-quality-report. The annual report is a compilation of all quality measures publicly reported by MNCM during the year. Individual clinic and medical group results are available at MNHealthScores.org and updated as new data become available.
MNCM’s goal with the Health Care Quality Report and other initiatives is to provide reliable information to support both quality improvement in the medical community and health care transparency with the public. According to the 2017 Price Transparency and Physician Quality Report Card from Altarum Institute and Catalyst for Payment Reform, Minnesota was one of only two states that earned an “A” for our outstanding work in physician quality websites through MNHealthScores.org.
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 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 and MNHealthScores.org.More
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Measuring the quality of health care is an essential component to improving the care received by patients and ultimately to managing the total cost of care. In today’s environment, data for quality measurement is gathered through multiple data sources, including direct data submission by providers and claims information supplied by health plans and other payers. While the data supplied through these mechanisms have provided a strong foundation for quality measurement and the insights medical groups receive about their patients are extremely valuable to quality improvement, some challenges remain:
- Collecting the data for measurement can be time consuming, detailed and complex work that requires significant investment on the part of providers.
- Submission of data on an annual basis does not provide the opportunity for early identification and interventions to address quality issues as they are identified.
- Collection of data from multiple sources through different mechanisms requiring manual integration for measurement and reporting creates inefficiencies that delay the sharing of feedback with data contributors.
MN Community Measurement recognizes both the benefits and burdens of reporting health care data. Through this initiative, MNCM seeks to increase the benefits and lessen the burden for our data-contributing medical groups while delivering more timely information to inform quality improvement. The first phase of this project began with an internal review of the drivers of provider burden in quality measurement and reporting identified through a variety of sources – technical assistance provided through data submission and validation processes, feedback gathered in Q/A calls with data submitters, variance requests, information collected through the Direct Data Submission portal, and more.
MNCM will be engaging Minnesota providers currently submitting quality data to review the results of the internal evaluation to provide further insights on drivers of provider burden and potential solutions, as well as information on their data and what’s needed to advance quality improvement within their patient populations. This input will assist MNCM in defining the business requirements for the new quality information system, particularly as it relates to streamlining data submission as well as timeliness and presentation of the needed information.More
At the August 2017 strategic planning session of the MNCM Board of Directors, a new strategic priority was recommended and subsequently adopted as part of the MNCM 2017-2020 Strategic Plan. The focus of this strategic priority calls for a collaborative approach with MNCM and its key stakeholders to explore, potentially identify and begin developing solutions for collaborative provider feedback reporting. MNCM would work to create a collaborative, multi-payer system for timely, actionable provider feedback reporting on cost, resource use, and quality using both clinical and claims data.
The goal would be to reduce fragmentation of information received by providers, reduce duplication of efforts and increase the availability of timely and actionable information. This strategic priority builds on key MNCM strengths as a trusted source of data for health care quality and cost and as a forum for collaboration that improves efficiency and value.
The first step to begin this work is conducting an environmental scan – gathering information from both payers and providers – to determine the feasibility and define the appropriate scope for this type of service. MNCM anticipates the environmental scan will be completed during the first quarter and the findings will be presented to the MNCM Board at their May meeting. If the MNCM Board determines that there is sufficient interest for the effort to advance, MNCM will proceed with additional efforts to determine the best technical approach to accomplish the goals, the resources necessary to support the service and potential models for financial sustainability of the service.More