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Additional Hospital Measures Released

MN Community Measurement (MNCM) recently published new results for two hospital-based health care quality measures and a refresh of five existing readmission measures. This information can be used to compare hospitals within Minnesota with state and national averages.

The results are available at MNCM’s public reporting website MNHealthScores.org.

The two quality measures are relatively new composites that are required by Centers for Medicaid and Medicare Services (CMS).

Value Based Purchasing Composite

The Hospital Value-Based Purchasing (VBP) composite measures the performance of acute-care hospitals on the quality of care they provide to Medicare beneficiaries, how closely best clinical practices are followed and how well hospitals enhance patients’ experiences of care during hospital stays.

The VBP measure combines results from different measure components into a single score for a hospital. A hospital score can range between 0 and 100. The statewide score is 46.0. A hospital’s performance rating is a comparison to the statewide score and is noted as “above average” (better), “below average” (worse) or “average” (the same). This information is from patients seen between January 1, 2015 and December 31, 2015.

Hospital Acquired Conditions Composite

One way to measure hospital quality is to see how many patients developed infections or other specific health issues as a result of their hospital stay, such as bloodstream infections, pressure ulcers, surgical complications, kidney damage, blood clots and other serious conditions.

The Hospital Acquired Conditions Composite measure combines results from different measure components into a single rating for the hospital. A hospital score can range between 1 and 10. The statewide score is 4.94. A hospital’s performance rating is a comparison to the statewide score and is noted as “lower than average” (better), “higher than average” (worse) or “average” (the same). This information is from patients seen between January 1, 2015 and December 31, 2015.

Refreshed Data

Additionally, MNCM refreshed data for five readmission measures for the period of July 1, 2012-June 30, 2015. Measures with refreshed data include Chronic Obstructive Pulmonary Disease (COPD), Heart Failure,    Acute Myocardial Infarction (AMI), Pneumonia and Knee or Hip Surgery.

Results for these and other health care quality measures are available at MNCM’s public reporting website MNHealthScores.org.

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Equity Report Shows Continued Gaps in Health Care for Many Minnesotans

For many Minnesotans, good health can be elusive, especially for people of color and new immigrants. Health care outcomes vary widely based on where a person lives, their race, preferred language or country of origin, according to a new report from MN Community Measurement (MNCM).

The 2016 Health Equity of Care Report pinpoints distinct differences in health care between numerous patient populations and geographic regions across Minnesota. Results in the 2016 Health Equity of Care Report clearly show that some racial, ethnic, language and country of origin groups have consistently poorer health care outcomes than other groups. The report also shows how those rates vary by medical group across the state and gives examples of what groups are doing to improve outcomes for their patients.

“Minnesota is one of the healthiest states in the nation, at the same time we have some clear and persistent inequities in health status,” said Jim Chase, MNCM President. “Patients from specific geographic regions and populations, including those in Greater Minnesota, people of color, people who identify as Hispanic, immigrants and people who do not speak proficient English are less likely to receive preventive screenings and more likely to suffer from negative health outcomes.”

The third annual Health Equity of Care Report released by MNCM provides a new benchmark in understanding health inequity in Minnesota. The report is at https://mncm.org/reports-and-websites/reports-and-data/health-equity-of-care-report/

The report’s major findings include:

  • White patients generally had better health care outcomes across most measures and most geographic areas.
  • Patients in Greater Minnesota overall had poorer health outcomes than patients in the 13-county Metro area.
  • Patients born in Asian countries tend to have better outcomes across multiple quality measures and geographic regions than patients in other country of origin groups.
  • Generally, patients from large medical groups in the Metro area had higher rates of optimal care.
  • Across measures and geographic areas, American Indian or Alaska Native and Black or African American patients generally had the lowest health outcomes both statewide and regionally.
  • Hispanic patients generally had poorer health care outcomes than non-Hispanic patients across all quality measures and most geographic regions.
  • Patients born in Laos, Somalia and Mexico generally had poorer outcomes than other groups.
  • Patients who preferred speaking Hmong, Somali and Spanish generally had lower screening and care rates compared to other preferred language groups.

Despite the somewhat stark results, examples of success exist and several such examples are featured in the 2016 Health Equity of Care Report. South Lake Pediatrics is highlighted in the report as one such example for their positive results for numerous populations for the Optimal Asthma Control for Children measure.

“We are very proud of our asthma work,” said Laura Saliterman MD, with South Lake Pediatrics. “A great deal of effort has gone into our asthma program and it has produced great results for our patients.”

The 2016 Health Equity of Care Report contains information collected from patients seen for appointments at medical groups throughout Minnesota, and evaluates health care quality in seven areas. Results for the seven health care quality measures were segmented by race, Hispanic ethnicity, preferred language and country of origin. These measures are further reported at statewide, regional and medical group levels. The seven measures are: Adolescent Mental Health and/or Depression Screening, Adolescent Overweight Counseling, Colorectal Cancer Screening, Optimal Asthma Control for Adults, Optimal Asthma Control for Children, Optimal Diabetes Care and Optimal Vascular Care. The Adolescent Mental Health and/or Depression Screening and Adolescent Overweight Counseling measures are new in the 2016 Health Equity of Care Report.

“To reduce and eliminate the barriers to health equity, we must understand where they exist and their scope,” said Chase.

Background

This report is unique because medical groups across the state report the data in a standardized format, which allows MNCM to compare results across medical groups and regions.

MNCM released The Handbook on the Collection of Race/Ethnicity/Language Data in Medical Groups in 2008. This handbook defined and standardized the information that is to 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 (REL) data. In 2016, nearly all Minnesota providers submitted REL data to MNCM and most did so using best practices. 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.

Understanding why the gaps exist from one group to another and what can be done to reduce the barriers to optimal health are the reasons behind the MNCM effort to collect and report this information. Specific questions of why, and what is being done, according to Chase, are questions best answered by the state’s medical groups and others health equity advocates.

“We share this report with the community so that advocates, policymakers, public health professionals, communities of color and medical groups can take the necessary steps toward addressing the unique health concerns of their patients, stakeholders and constituents,” said Chase.

About Us

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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New report seeks to better understand the cost of care at Minnesota medical groups

New report seeks to better understand the cost of care at Minnesota medical groups

A new report from MN Community Measurement (MNCM) highlights the significant variation of costs across medical groups in Minnesota and examines the drivers that impact and influence health care costs.

“The continued rise of health care costs and the burden this places on families, businesses and the community makes it critical for medical groups and the community to work together,” said Jim Chase, MNCM President. “This is our endeavor in this new report.”

The 2016 Cost & Utilization Report features analysis and comparative data on medical group performance in Total Cost of Care (TCOC), which includes all costs associated with treating commercially-insured patients, including professional, facility inpatient and outpatient, pharmacy, lab, radiology, behavioral health and ancillary costs. MNCM posted total cost results in the fall on MNHealthScores.org. New in this report is information that breaks out the total cost into price and utilization.

This report shows the variation or difference in total cost by medical group. Further, the report shows how much of the variation was due to the amount medical groups were paid relative to others and how much was due to the utilization or use of services. The report also contains more detailed utilization measures such as the rate of admissions, emergency room visits, office visits and pharmacy use, using the same patients and time period as TCOC.

For example, the 2016 Cost & Utilization Report shows that depending on where you go for care:

  • A strep test can range from $8 to $101
  • Total Cost of Care can range from $365 to $914 per month on a risk adjusted basis
  • Amount of resource use for a patient ranges from 22 percent below average to 33percent above average, after accounting for patient risk
  • Emergency room use (utilization of ER as a health care service) ranges from 37 percent less than expected to 104 percent more than expected, after accounting for patient illness

A goal of the 2016 Cost & Utilization Report is to help medical groups better identify opportunities to reduce costs for their patients. The report helps evaluate the categories of care that are driving the majority of providers’ costs and the medical groups can then take actions to reduce their costs and provide more efficient care. The report helps consumers make informed decisions on where to receive care. Further, the report can be used by health plans, employers, and policy makers, all of whom have a stake in addressing the challenges of rising health care costs.

The 2016 Cost & Utilization Report includes a suite of measures which encompasses 119 separate measures of cost and utilization to give a comprehensive view of the drivers of health care costs.

The 2016 Cost & Utilization Report provides insight into individual procedure costs (Average Cost per Procedure chapter), statewide and regional views into total cost of care (TCOC chapter), along with newly published perspective on the resources used (Resource Use and Price Index chapter) and the utilization of health care (Utilization Ratios chapter). When possible, this report displays information on these measures statewide, regionally, and by medical group for ease of analysis.

Reviewed and considered as a whole or individually by chapter, these measures provide unique insight into tracking, comparing and taking actions to manage and reduce health care costs.

The results of these measures are based on 2015 health insurance claims of more than 1.5 million commercially-insured patients enrolled with four Minnesota health plans: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne.

View the current, and previous MNCM cost of care reports here.

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New Data Shows MN Hospitals On Par With, Or Better Than, National Averages

MN Community Measurement (MNCM) today announced the availability of new results for five hospital-based health care quality measures. This information can be used to compare hospitals within Minnesota with state and national averages. The results are available at MNCM’s public reporting website MNHealthScores.org.

“These measures are relevant for patients seeking health care and also have value for hospitals as they strive to improve their quality of care,” said Jim Chase, MNCM President. “Hospitals have been submitting outcome data for years, and it’s important to draw attention to what they are reporting and to put it into context for patients.”

Three of the measures are based on mortality or death rates that occur within 30 days following hospitalizations for heart attack (acute myocardial infarction), heart failure and pneumonia. For these measures, lower rates of death are better. On all three measures, the statewide average was the same or lower than the national average. These results show that Minnesota hospitals had average or better than average performance compared to hospitals in other parts of the nation.

National Average/Minnesota Average

Heart attack      14.1%/13.5%
Heart failure      12.1%/12.1%
Pneumonia         16.3%/15.9%

For the heart attack measure, Mayo Clinic Hospital in Rochester performed significantly better (lower), at 11.6 percent, than the national average of 14.1 percent. Mayo Clinic Hospital was the only Minnesota hospital different than the national average. All other Minnesota hospitals were similar to the national average for the heart attack measure.

For the heart failure measure, Mayo Clinic Hospital in Rochester performed significantly better (lower), at 9.4 percent, than the national average of 12.1 percent. Mayo Clinic Hospital was the only Minnesota hospital different than the national average. All other Minnesota hospitals were similar to the national average for the heart failure measure.

For the pneumonia measure, Park Nicollet Methodist Hospital (13 percent) and Mayo Clinic Hospital (12.3 percent) performed significantly better (lower) than the national average of 16.3 percent. Park Nicollet Methodist Hospital and Mayo Clinic Hospital were the only two Minnesota hospitals different than the national average. All other Minnesota hospitals were similar to the national average for the pneumonia measure.

The remaining two measures are composites, meaning they combine two or more components of care and wrap them into one comparable result. This is a common way health care is analyzed nationally and in Minnesota.

Readmission Reduction Program (RRP) results
The RRP measure is a hospital’s readmission ratio. The goal is to avoid readmissions for the same condition within 30 days of discharge from the hospital. Two examples include pneumonia and Chronic Obstructive Pulmonary Disease. A ratio of less than 1.0 means there were fewer readmissions across conditions than the national average. A ratio greater than 1.0 means there were more readmissions than the national average. For this measure, lower readmission ratios are better.

The statewide readmission average is .97 or 3 percent below the national average. Four hospitals performed significantly better than the statewide average in readmissions: Mayo Clinic Hospital in Rochester, Lakeview Memorial Hospital in Stillwater, Mayo Clinic Health System in Mankato and HealthEast Woodwinds Hospital in Woodbury.

Emergency Department Transfer Communication (EDTC) results
One element of hospital quality can be seen in how hospitals communicate when transferring patients. The EDTC measure was developed to track communications and facilitate care coordination. It measures the percentage of patients with complete medical record documentation communicated to another healthcare facility prior to the patient being transferred. For this measure, higher results are better.

One hospital, Essentia Health in Fosston, scored 100 percent on this measure. The statewide EDTC average was 62 percent. This means that 62 percent of patients transferred from hospital emergency departments to another health care facility had the required documentation forwarded within 60 minutes of leaving the hospital.

Thirteen Minnesota hospitals performed significantly better than the statewide EDTC average, including: Bigfork Valley Hospital in Bigfork, CentraCare Health in Sauk Centre, CHI St Gabriel’s Health in Little Falls, CHI St Joseph’s Health in Park Rapids, Cuyuna Regional Medical Center in Crosby, Essentia Health in Fosston, Mayo Clinic Health System in Cannon Falls, Pipestone County Medical Center in Pipestone, Redwood Area Hospital in Redwood Falls, Riverwood Healthcare Center in Aitkin, Sanford Jackson Medical Center, Sanford Tracy Medical Center and Windom Area Hospital in Windom.

Hospital-based health care quality measures are available at MNCM’s public reporting website MNHealthScores.org.

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Total Cost of Care Results Released: Total Cost Increased Nearly 6 Percent from Previous Year

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.”

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Health Equity Report Expands to Include Patient Experience, Medical Group Quality Results

Health Equity Report Expands to Include Patient Experience, Medical Group Quality Results

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.”

Report Overview

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.”

Report Findings

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.
    Background

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.

About Us

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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New Measures Evaluate Rates of Obesity Counseling for Kids, Depression Screening for Teens

New Measures Evaluate Rates of Obesity Counseling for Kids, Depression Screening for Teens

October 29, 2015The 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.

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Total Cost of Medical Care in Minnesota Increased 3 Percent Last Year

Total Cost of Medical Care in Minnesota Increased 3 Percent Last Year

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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.

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Survey: Patients pleased with medical providers, but want easier access

Survey: Patients pleased with medical providers, but want easier access

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.”

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Chase Elected Vice Chairman of NQF Board of Directors

Jim Chase_MNCMJim 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.

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Significant Improvement in Diabetes and Vascular Care for Low-Income Patients

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.

Background

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.

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2014 Health Care Quality Report Highlights Significant Increases in High-Quality Asthma Care

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.

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