At our 2018 Annual Seminar, MNCM President Julie Sonier sat down with Executive Vice President and COO of ABIM Foundation Daniel Wolfson to discuss the Choosing Wisely campaign and the progress it has made in reducing low-value care.
The Power of Conversation
Since its launch in 2012, the power of conversation has been the driving force of the Choosing Wisely campaign, an initiative of the ABIM Foundation. With its mission to promote conversations between clinicians and patients in order to avoid unnecessary medical tests, treatments and procedures, the Choosing Wisely campaign has called national attention to this vital initiative. Choosing Wisely has created a number of resources, for both physicians and patients, to help facilitate conversations about care, including:
- A list of campaign partners
- Patient-friendly informational materials
- Communication education modules to aid physicians in conversations with their patients
- Videos featuring prominent health care leaders on the impact of the campaign
- Stories that highlight the work of organizations implementing the campaign across the country
Empowerment is Key
In the discussion between Sonier and Wolfson, Wolfson stressed the importance of patients being empowered with the knowledge and tools necessary to advocate for their own health care. Choosing Wisely, along with medical specialists, partnered with Consumer Reports to create a list of five basic questions that all patients, regardless of background, could understand and use to prompt a conversation with their physicians.
The five questions were printed on cards and have been distributed to over 200,000 patients across the United States. The questions are as follows:
- Do I really need this test or procedure?
- What are the risks and side effects?
- Are there simpler, safer options?
- What happens if I don’t do anything?
- How much does it cost, and will my insurance pay for it?
These guiding questions allow patients to get the answers they need in order to make educated decisions regarding their health care.
To read more about the Choosing Wisely campaign, read success stories, or access resources available to both health care professionals and patients, visit choosingwisely.org. More
MNCM’s Data Portal opened November 1 for annual clinic and provider registration. Every year, all eligible Minnesota clinics and providers are required to register and update their information.
To get started, please download and review the registration instructions and educational webinar from the MNCM Data Portal Resources tab or from the Training and Guidance section. Organizations that have not registered with MNCM previously can request a portal account today. Registration is a prerequisite to submitting data for the clinical quality measures in 2019. Although the portal will be open for registration through Feb 8, 2019, we encourage data submitters to register early. There are no changes to the registration requirements this year.
Questions? Please contact MNCM at 612-746-4522 or firstname.lastname@example.org. More
MNCM has been involved and contributing data to a five-year program to test the feasibility of measuring regional variation in total cost of care, relative resource use, and overall commercial health care pricing.
This program was funded by Robert Wood Johnson Foundation and coordinated through the Network for Regional Healthcare Improvement (NRHI). Using the same methodology developed by HealthPartners that MNCM uses for the Minnesota market total cost of care measure, the project compared the cost, use, and prices of Colorado, Maryland, Minnesota, Oregon, Utah, and the St. Louis area.
The recent report compares costs, resource use, and pricing across regions for 2016. More
On November 1, The Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2019 Medicare Physician Fee Schedule, including changes to the Quality Payment Program (QPP).
Four MNCM measures have been added to the QPP for 2019:
- Average change in leg pain lumbar fusion
- Average change in functional status lumbar fusion
- Average change in functional status total knee replacement
- Average change in functional status lumbar discectomy/laminotomy
In addition to these new measures, seven other MNCM Measures are already included in the QPP:
- Depression Remission at 12 Months
- Depression Remission at 6 Months
- Depression Utilization of the PHQ-9
- Optimal Asthma Control
- Average change in back pain lumbar discectomy/laminotomy
- Average change in back pain lumbar fusion
- Average change in leg pain lumbar discectomy/laminotomy
MNCM is pleased to have measures that were developed through our community stakeholder process included in federal programs. More
MNCM has released a new report on Depression Care in Minnesota, which includes summary information and detailed results of all of the data submitted to MNCM in 2018 related to depression.
Data by Measurement Focus Area
This report is the first in a new series that presents data by measurement focus area. These reports will bring together performance results on both quality and health equity for measures relevant in each category. The series is intended to provide a more in-depth, user friendly view of measure results that can more effectively draw attention to the wealth of data that MNCM publishes, engage stakeholder audiences more effectively, and catalyze improvement.
Data from the report were featured at a recent community dialogue on mental health convened by the Minnesota Health Action Group. See below for links to the report, media coverage, and a Star Tribune editorial on the importance of improving depression care: More
MNCM is pleased to welcome Dr. Joseph Bianco as a new member of its Board of Directors.
Dr. Bianco is a board-certified family practice physician with Essentia Health, an integrated health system that serves northern Wisconsin, Minnesota, and western North Dakota. Dr. Bianco also serves as the Ambulatory Quality Leader for Essentia Health.
He has a strong interest in the management of pain. He is the Chairman of the Essentia Opioid steering committee, which is accountable for establishing opioid prescribing guidelines. He also helped to author the Institute for Clinical Systems Improvement (ICSI) guidelines for pain management published last year. He serves on the ICSI Opioid Oversight committee as well as the Addiction committee.
Additionally, he has a long-standing interest in the education of medical students and the role of the primary care physician as mentor to future family physicians and to the Duluth Family Practice Residency Program.
Dr. Bianco was raised in northeast Minnesota and attended the University of Minnesota, School of Medicine and completed a family practice residency in Duluth. Dr. Bianco maintains a busy family practice in the small, rural town of Ely, Minnesota. More
MINNEAPOLIS – October 29, 2018 – MN Community Measurement (MNCM), an independent nonprofit organization that empowers health care decision makers with meaningful data to drive improvement, has released a report titled “Depression Care in Minnesota.” The report marks the first in MNCM’s new topical report series and highlights progress that has been made in identifying and caring for depression among adults and adolescents in Minnesota. MNCM has been collecting and publishing data on depression outcomes since 2009.
Depression affects millions of individuals across the United States, regardless of geography, age, gender, or race. The outcome measures in this report reflect over 110,000 adult patients in Minnesota whose depression screening indicated the need for treatment. “Depression Care in Minnesota” helps to shine a light on the work that is being done to identify and treat depression and also illustrates the need for improvement in care. The full report can be viewed at www.mncm.org/depressionreport2018.
Key findings of MNCM’s “Depression Care in Minnesota” report reveal that depression remission and response rates remain relatively low, and improvement has been slow. Analysts point out that one reason for this is that many patients with depression aren’t receiving the necessary follow-up assessment, and missed follow-up affects the rates for all outcome measures.
Despite low statewide average rates of depression remission and response, there are noteworthy bright spots with several medical groups and clinics achieving significantly better outcomes. In using data to help improve their efforts and taking innovative approaches to make improvements in follow-up communication, a handful of medical groups received a top rating on the Depression Remission at 12 Months outcome measure. These medical groups are Entira Family Clinics, Essentia Health, Park Nicollet Health Services, HealthPartners Clinics, and Grand Itasca.
For adolescents, mental health and/or depression screening rates have significantly improved since 2015 and have shown considerable improvement every year. Most medical groups in Minnesota are now administering a depression screening tool to their adolescent patients at well-child visits. Because screening for depression and other mental health issues was not consistently occurring in the adolescent population previously, it was selected as a focus for measurement in Minnesota. Beginning in 2020, MNCM’s data collection for depression outcomes will be extended to include adolescents.
President of MN Community Measurement, Julie Sonier, says, “There’s absolutely no question that the mental health of our community deserves our attention. We’ve collaborated with a range of stakeholders to develop measures that matter most to improve patient outcomes in depression care. Our outcome measures purposefully focus on the need for follow-up because depression is an isolating condition and our community strongly felt that it was through that follow-up that providers could have the most impact. While we’ve seen slow progress, the data is showing us what’s possible and will inform us and motivate us to move forward and improve our systems of care.”
Depression is one of the most common mental disorders in the United States. According to a study conducted by MNCM in 2015, nearly 10 percent of Minnesota adolescents who were screened for depression or other mental health conditions, screened positively. The National Institute of Mental Health reported in 2016 that over 16 million adults in the US (seven percent), experienced at least one episode of major depression in the past year. The large number of adult patients with this chronic episodic condition has a widespread effect on the workplace. A survey conducted by Gallup-Sharecare Well-Being Index reports that annually, U.S. workers diagnosed with depression miss an additional 68 million days, or an additional 4.6 days per individual diagnosed with depression as compared to workers who have never been diagnosed with depression. This loss of productivity is estimated at more than $23 billion per year.
In order to provide depression care beyond a screening, health clinics and medical groups will need to adjust their procedures. Entira has championed the use of MNCM’s measure data in its care and has seen measured results.
Entira Family Clinics Medical Doctor Tim Hernandez notes, “Of all the metrics that we are being measured on through MNCM, the depression remission measure has had the greatest impact on changing our care delivery. In order to be successful, one has to develop strategies to reach out to patients between visits. People who are struggling with mental health problems need between visit care perhaps more than people with other medical conditions. Finally, as we begin to manage adolescents who suffer with depression, we have had to use different strategies, such as texting, to reach different generations. The care coordination program that we developed for the depression remission measure became the foundation for our Health Care Home.”
Essentia has instilled new practices to ensure patients’ depression care doesn’t end with a screening, resulting in steadfast improvements to their follow-up care.
Essentia Health Medical Doctor Joe Bianco says, “We have worked hard at Essentia Health to promote best practices in the diagnosis of depression and its monitoring. Our principles of team-based care have allowed us to share the work of patient monitoring across the team. We engaged in a process improvement project to be proactive in outreaching to patients at six and 12 months. We have now centralized that process to serve the entire organization. Performance data is fully transparent to a provider and team level and is part of the Clinical Quality Dashboard which is updated weekly. By close monitoring we can follow-up with our patients in a more comprehensive and timely manner in order to address the complexity of treating depression.”
The dedication and innovation from medical groups like Entira Family Clinics and Essentia Health demonstrate the importance and impact of measurement and focused attention to improve patient outcomes.
About MN Community Measurement
MN Community Measurement is a nonprofit organization dedicated to empowering health care decision makers with meaningful data to drive improvement. A trusted source of health care data since 2003, MNCM works with doctors, hospitals, clinics, insurance companies, and state agencies to collect, analyze, and report health care data related to quality, cost, and patient experience. More
The October 2018 Measurement Minute is ready to view here. More
The Minnesota Department of Health (MDH) will not promulgate a Health Care Quality Rule for the 2019 reporting year because there are no significant changes to the reporting requirements for physician clinics and hospitals. In its place, MDH will issue technical guidance in November about any changes measure stewards have made to measure specifications and the removal of several hospital measures to maintain alignment with Centers for Medicare & Medicaid Services requirements.
In parallel, MDH expects to continue making progress in the development of the legislatively required quality measurement framework that will inform Minnesota’s approach to measurement in the future. MDH will provide a status update to the Legislature this year, continue developing the framework during 2019, and begin the implementation process in 2020. More
MNCM is launching a new report series this fall, organizing results by measurement focus area. These reports bring together performance results on both quality and health equity for measures relevant in each category.
The series is intended to provide a more in-depth, user-friendly view of measure results that can more effectively draw attention to the wealth of data that MNCM publishes, engage stakeholder audiences more effectively, inform discussions, and catalyze improvement.
The new reports present content more concisely using design, context, and streamlined visual displays. The 2018 series will include reports on the following themes:
- The first report in the series will be on depression measures, scheduled for release in late October.
- Other topic reports will focus on chronic and acute conditions, preventive health screenings, and child and adolescent health.
- MNCM will continue to publish summary reports for cost, quality, health equity, and disparities.