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    Measurement Minute

    December 2023

    Julie Sonier, President and CEO, MN Community Measurement

    Julie Sonier, President and CEO, MN Community Measurement

    As 2023 draws to a close, it’s that time of year when organizations are looking back at their annual accomplishments. It’s been a busy year for MNCM, and we have a lot to be proud of! My list this year includes work that builds on and enhances MNCM’s core strengths related to quality measurement and reporting; major progress toward completing the transition to the modernized PIPE data collection system; new projects and collaborations aimed at improving health care quality, affordability, and equity; and much, much, more!

    I am particularly excited to share some recent news related to MNCM's CHIRP (Common Health Information Reporting Partnership) program. CHIRP is a collaborative effort to standardize and streamline the sharing of data between health care payers and providers, with the goal of driving health care improvement through data that is timely, actionable, consistent, and complete. One of CHIRP’s benefits is that it supports health plans in their quality measurement activities for accreditation and regulatory purposes. To that end, MNCM participated this year in the National Committee for Quality Assurance’s (NCQA) Data Aggregator Validation program. Data streams that are validated through this program can be used as “standard supplemental data” for NCQA’s quality measurement programs. MNCM’s ability to bring medical groups through this process to secure validation of data streams submitted via PIPE is expected to save time and money for both health plans and health care providers.

    I’m pleased to announce that the two medical groups’ data streams MNCM brought through the Data Aggregator Validation program this year successfully passed the rigorous process and are now certified. This sets the stage for future growth in the CHIRP program that benefits all MNCM stakeholders. I especially want to thank the health plans and providers that have partnered with MNCM in this effort, and all the MNCM staff whose work led to this significant milestone.

    cole.jpgThis edition of Measurement Minute includes information about the CHIRP program and many other updates on MNCM data collection, reporting, and projects.

    Best wishes from everyone at MNCM for a happy and healthy holiday season!


    MNCM Announces New Resources on CHIRP Facilitated Data Sharing Programs, Enrollment Now Open to Medical Groups and Payers

    MNCM recently updated its website to provide stakeholders access to the most current information on the CHIRP program that is focused on facilitating the sharing of data between health care payers and providers to advance improvements in health care quality and population health management. MNCM is currently enrolling both health plans and medical groups into the CHIRP program.  Medical groups that have onboarded onto PIPE will have the opportunity to sign up for the program, designate which participating payers they agree to share clinical data with, and receive assistance from MNCM in bringing their data stream through the NCQA Data Aggregator Validation process. There is no charge to medical groups for the CHIRP Provider-to-Payer data sharing service. To learn more about CHIRP, please visit the Facilitated Data Sharing section on the MNCM website. For further interest, please contact the CHIRP Program Manager, Maegi Yang, at

    Medical Groups May Now Submit Social Risk Factors Data via PIPE in 2024

    MNCM is excited to announce that medical groups may begin submitting social risk factor (SRF) data in PIPE starting in January 2024.

    With guidance from a technical advisory group, MNCM has built a value set of questions, responses, and diagnoses used to identify 11 SRFs including food insecurity, housing instability, transportation, utility assistance, interpersonal violence, education, financial strain, social isolation, substance use, homelessness, and alcohol use during pregnancy. Data on SRFs will be submitted using the new Social History File, which is a new table added to PIPE as part of the PIPE data standard.

    The collection and use of data on SRFs to improve health outcomes and health equity is currently a high priority in Minnesota and nationally, and the landscape is evolving rapidly. The primary goal of collecting this data is to gain an understanding of how SRFs affect health outcomes and submitting this data will allow for comparative information to identify opportunities for improvement, potential use in risk adjustment of quality measures, and also support value-based purchasing programs and emerging SRF measures.

    Medical groups will be able to submit additional questions and answers for MNCM to consider adding to the SRF value set. More information about how to do this will be sent out to medical groups soon. A recorded webinar and slide deck discussing MNCM’s SRF data roadmap are available here, as well as specifications for the new data file.

    2023 Measurement Year Data Submission Cycle Preview

    The PIPE and DDS portals will open for 2023 Measurement Year (2023 MY) submission on January 8, 2024. This is the last year that the Direct Data Submission (DDS) portal will be available. The deadlines for data submission are listed below. Please note that MNCM is not able to grant deadline extensions or accept data after the deadlines listed below in order to ensure timely delivery of required reports and deliverables.

    Deadline Activity
    11/17/2023 PIPE Data Submission Certification** due
    2/2/2024 Complete final imports for all data through the end of 2023 dates of service
    2/16/2024 Complete all measure calculations and submissions

    *NEW MY2023: Medical Groups that previously submitted through PIPE will need to complete PIPE Data Submission Certification to confirm if significant changes have been made to the PIPE queries.

    Direct Data Submission (DDS)
    Deadline Activity
    1/8/2024 All presubmission forms due*
    2/9/2024 Optimal Diabetes Care & Optimal Vascular Care submission due
    2/16/2024 Asthma and Adolescent Mental Health and/or Depression Screening submission due
    2/23/2024 Colorectal Cancer Screening submission due
    3/1/2024 Depression Care submission due

    *NEW: Presubmission forms will not be accepted after the portal has opened for submission.

    Additional Opportunity for Participating in Chronic Kidney Disease (CKD) Dashboard

    In November, MN Community Measurement launched a new data analysis tool for medical groups and clinics onboarded in PIPE related to CKD screening and intervention for patients with diabetes. The Dashboard is available at no cost and only to participating medical groups (i.e., not publicly reported). More information on the CKD Dashboard can be found here under “Chronic Kidney Disease (CKD) Dashboard Initiative”.

    Medical groups can enroll in the project in one of the following time periods, including a recently added Cohort 1b:

    Cohort Enrollment Deadline Dashboard Access Start
    Cohort 1a 11/10/2023 11/21/2023
    Cohort 1b 2/23/2024 3/21/2024
    Cohort 2 4/26/2024 5/21/2024
    Cohort 3 10/25/2024 11/19/2024

    Currently, medical groups will have access to the CKD Dashboard through November 2025. Availability after November 2025 is contingent on continued interest and funding.

    To indicate interest in participating in one of the cohorts, please complete the following form.

     For questions, please contact Jess Donovan at

    MNCARES Study Enters Final Year - Release of Study Findings Begins and Continues through 2024

    The Minnesota Care Coordination Effectiveness Study (MNCARES) is focused on learning which approaches to care coordination for patients with complex health care needs and/or high health care costs produce the best outcomes for patients. As the study continues in its final year, the study team will be analyzing study data and writing papers that highlight learnings that have emerged regarding how care systems and care coordinators can produce the best care quality, utilization, and patient-centered outcomes.

    This issue of Measurement Minute showcases the second paper.  Please watch for additional publications to be highlighted in the newsletter in 2024.

    Highlighted Learnings from MNCARES Series:

    How did the pandemic affect patients with complex medical and social needs?

    In order to answer this question, we interviewed 19 patients from 19 different and diverse types and locations of primary care systems. These patients were potentially high risk for being seriously affected by health care and social disruptions during the early COVID pandemic. From careful analysis of these interviews, we learned:

    • There had been little or no impact on these patients’ physical health or their medical services.
    • On the other hand, most reported major disconnections from family, friends, and community. Together with anxiety about their health, this had serious impact on their mental health and wellbeing.
    • Those retired or on government support had few financial impacts, unlike those still working.
    • Nearly all reported that their care coordinators had been very helpful in providing support and connections with care needs.

    Key takeaways: Patients with complex medical and/or social needs found their relationship with their care coordinator to be especially important during the COVID-19 pandemic.

    Access to the full article is available here:

    Collette Cole Retirement

    Collette Cole

    Longtime MN Community Measurement Measure Developer Collette Cole is retiring at the end of 2023. Since she joined MNCM in 2008, Collette has been an instrumental part of MNCM’s work. She has been responsible for developing and/or maintaining many of the unique and nation-leading quality measures that MNCM uses today and contributing her clinical and data knowledge to many other efforts aimed at improving health care quality and equity. Along the way, she has facilitated many workgroups to develop multi-stakeholder consensus recommendations, which is no small feat! One testament to Collette’s work is that her expertise is frequently sought out by national organizations such as the National Quality Forum. And in addition, anyone who has worked with Collette knows that she is a wonderful colleague and team contributor. We wish her well in her retirement!

    Welcome New Staff

    MN Community Measurement has added three new staff since September. Two are new technical positions and the third is a replacement for Collette Cole who is retiring at the end of the year. We are excited to welcome Jeremy, Rowan and Roman to the team!

    Jeremy Griggs, Technical Support Specialist  

    Jeremy Griggs joined MNCM in December 2023 as an IT Support Specialist. He helps support the company's technical infrastructure and ensures that MNCM's employees are set up for success with their equipment. He has previously worked as an IT Specialist for Ear, Nose & Throat Associates in his hometown of Fort Wayne, Indiana. He has previously run a PC building service to assist others with the acquisition of parts as well as the installation of their components.

    Rowan Mahon, PharmD, MPH, MHI, Senior Clinical Analyst/Measure Developer

    Dr. Rowan Mahon joined MN Community Measurement in November 2023.  She has 11 years’ experience with a complementary range of expertise across quantitative research, data analytics, health economics outcomes research / real world evidence, leadership, project management, pharmacy, and clinical lab sciences. Dr. Mahon was the founder of the statewide public health program and medication wholesaler, RoundtableRx, which helps individuals obtain medications they otherwise could not afford. She obtained her Doctorate of Pharmacy, Masters in Public Health, and Master in Health Informatics from the University of Minnesota. She is a licensed and registered pharmacist in the state of Minnesota, and a certified clinical laboratory scientist.

    Roman Pushkin, Senior Software Developer  

    Roman Pushkin is a Senior Software Developer with MN Community Measurement. Roman is renowned for his expertise in developing mission-critical software products. With over 20 years in the field, Roman has honed his skills in a variety of technologies, including Ruby on Rails, React, GraphQL, Golang, and cloud platforms like GCP and AWS. His professional journey includes impactful roles at Cisco, Atlassian, SAP, Grand Rounds, and Breakthrough Behavioral (MDLIVE). At Cisco, Roman spearheaded the development of a vulnerability management platform, driving significant improvements in customer experience and sales. His tenure at Atlassian was marked by his innovative approach to architecting incident management software, earning him recognition as an Atlassian Security Champion. Beyond his corporate achievements, Roman is an active open-source contributor, author, and inventor. His book, "Ruby Is For Fun," reflects his passion for programming, while his patent (pending) in a math practice system underscores his innovative capabilities. Roman holds a Master of Science in Computer Science from Kyiv Polytechnic University.

    Upcoming Reports & Webinars


    Upcoming Reports Content/Data source Timing
    Health Care Quality Report Part 2 Quality measures based on data collected from health plans December 20, 2023

    HCQR Parts 1 & 2 Webinar – January 23

    Health Care Quality Top Performers Recognizing high performance across all quality measures included in HCQR Parts 1 and 2 January 11, 2024

    HCQR Parts 1 & 2 Webinar – January 23

    Health Care Disparities by Insurance Type Combination of measures based on clinical data from medical groups and data collected from health plans April 2024


    Save the Date
    MNCM Annual Conference
    Wednesday, September 25, 2024
    Minneapolis Marriott Northwest, Brooklyn Park

    Join us as a sponsor or exhibitor at the MN Community Measurement Annual Conference 2024! You’ll have the opportunity to engage with hundreds of health care providers, payers, business leaders, and more.

    This conference will bring a focus on critical issues related to health care quality, cost, and equity. Attendees represent a diverse network of health and community leaders for a day of educational speakers and meaningful discussions.

    Each year, 200+ health care payers, health care providers, quality managers, employers and business leaders, and policymakers partner together at the MN Community Measurement Annual Conference. They share best practices, lessons learned, achievements, and future plans in the areas of quality measurement, quality improvement, patient care, and cost containment.

    Learn more and download the sponsor and exhibitor prospectus outlining the many benefits to sponsoring and exhibiting. Questions, please contact Kathie Pugaczewski, More details will be added to Conference Central over the next few months.

    Thanks to Our Conference Sponsors!

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    In Case You Missed It

    Recent Reports Released by MNCM

    Minnesota Health Care Disparities by Race, Ethnicity, Language, and Country of Origin (RELC) Report for care delivered in 2022

    View Report
    View Webinar
    View the Slides

    Minnesota Health Care Quality Report Part 1: Clinical Quality Measures Reported by Medical Groups, Results for care delivered in 2022

    View Report
    View Webinar
    View the Slides

    Minnesota Health Care Cost & Utilization in 2022

    View Report
    View Webinar
    View the Slides

    Nov Nordisk Logo
    Mission Supporter: Novo Nordisk

    Thank you to our Current Mission Supporters

    The MNCM Mission Supporter Program is for companies that support MNCM’s mission and want to demonstrate support and commitment to improving health care quality, equity, and affordability in our community. This program is designed for those who are not directly involved with the services MNCM provides, but still support the efforts of our organization and those who will benefit from those efforts.

    Supporters will have access to several benefits at two distinct levels. These benefits include recognition through our newsletter, on our website and on social media. Exclusive benefits are also offered to our gold level supporters. View Mission Supporter Program Details. For more information, or to join this program, please reach out to Kathie Pugaczewski at

    Financial support is essential to sustain and grow our objective, unbiased work. Our Mission Supporters help assure our independent work continues.

    Ways to Support MNCM

    MNCM values engagement by its members, employers, and industry partners to support MNCM’s mission. Below are several options to support MNCM and engage with us.

    Supporting Membership (for Medical Groups and Advocacy Organizations)

    Supporting membership is a great way to show your support and commitment to improving the quality and affordability of health care in our community through collaboration with other stakeholders. It also supports MNCM’s efforts to make quality measurement easier so clinic staff can spend more time on improvement activities. Annual membership dues are designed to be affordable and are based on the size of the medical group based on the number of providers reported by the medical group through annual registration for data submission.

    Benefits of Membership:

    Access to the Data Visualization Portal

    • Access to Interactive Benchmarking Tool, allowing you to compare your organization with several other peers on many different facets of quality, performance, and cost;
    • Access to MNCM Dynamic Tables 
    • Discounts on MNCM Events, including the MNCM Annual Conference;
    • And more!

    View details about supporting membership

    Thank you current, MNCM Supporting members: