New Report Shows Post-Pandemic Decline in Many Key Minnesota Health Care Quality Measures

Childhood immunizations among the largest impacts

A new report from MN Community Measurement (MNCM) finds that while several measures of preventive health care and care for acute and chronic conditions improved in 2022, some key measures worsened and only one has improved compared to pre-pandemic levels. MNCM is an independent non-profit that serves as an objective, trusted source of information on Minnesota health care quality, cost, and equity.

The report, Minnesota Health Care Quality Report Part 2: Clinical Quality Measures Reported by Payers, includes 2022 data for eleven measures of preventive care like immunizations and cancer screening as well as care for acute and chronic health conditions. MN Community Measurement collected the data from ten health plans that provide insurance coverage in Minnesota. In addition to statewide averages and trends presented in the report, a detailed set of appendix tables includes results for each quality measure by medical group.

Key Report Findings

• In 2022, statewide performance rates improved for four measures and declined for three. The largest improvement was seen in appropriate prescribing of antibiotics for acute bronchitis (7.5 percentage points), and the largest decline was in immunizations for children (4.9 percent points).
• Compared to pre-pandemic levels (2018 data), seven of the eleven measures included in the report were significantly worse in 2022, and one measure (immunizations for adolescents) was better. The biggest declines compared to pre-pandemic performance were for measures of spirometry testing for diagnosis of chronic obstructive pulmonary disease, or COPD (9.4 percentage point decline) and childhood immunizations (8.0 percentage point decline).

Childhood Immunizations

The measure used in the MNCM report for childhood immunizations represents the percentage of children who received a series of recommended vaccinations by their second birthday and is also referred to as the Childhood Combo 10 immunization rate. It is important to better understand the factors driving the large decline in this measure in 2022 and compared to pre-pandemic levels. According to Steven Inman, MD, a practicing pediatrician and Medical Director for Children’s Health Network, a majority of the decline in the childhood immunizations measure has been driven by children missing influenza vaccinations. Dr. Inman is also a member of MN Community Measurement’s Board of Directors.

According to Dr. Inman, in 2020 the Covid-19 pandemic resulted in a greater than usual increase in Childhood Combo 10 immunization rates at Children’s Health Network as parents worried about Covid-19 vaccinated their children for influenza in greater numbers due to fear of the “triple pandemic” (Covid-19, RSV and Influenza).  In 2022, the Children’s Health Network Combo 10 rate was down 4.8 percentage points from its peak in 2020 driven in large part by a 5.9 percentage point decrease in the influenza immunization rate.  Because the Combo 10 measures vaccines given over a 2-year period the “Covid-19 bump” persisted somewhat in the 2021 measure year, but now we are starting to observe the effects of declining influenza immunization rates. “Unfortunately, that trend has continued. Through October 2023, the Children’s Health Network influenza immunization rate is down 9.3 percentage points from the 2020 peak, which may be an indicator that the statewide rate for the Combo 10 measure will decline further in 2023,” said Dr. Inman. The data from Children’s Health Network represent a combination of pediatric practices that are reported separately by MNCM.

Overall Trends

“It’s clear from the findings in this report and earlier findings from MNCM that there is still a lot of work ahead to get important measures of health care quality back to where they were prior to the COVID-19 pandemic,” said Julie Sonier, MNCM President and CEO. “In addition, the medical group level results in this report show that there is substantial variation and room for improvement even beyond that baseline.”

Importance of Measurement

Measuring and reporting on health care cost, utilization, and quality helps consumers understand how care varies across providers, allows providers to identify improvement opportunities and how their measures compare to others, and helps health plans and other purchasers better understand and improve value for money that is spent on health care.

“Minnesota is unique in the capabilities that we’ve built to measure and report on a robust set of measures related to health care cost, utilization, quality, and disparities,” said Sonier. “Having a common set of priorities and common set of data have been huge assets to our state in focusing efforts to drive improvement.”