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.
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.”