MN Community Measurement©: Measure Up to Better Health

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Slide 1

MN Community Measurement©
Measure Up to Better Health

Lessons from the School of Hard Knocks
September 10, 2012

Image: The MN Community Measurement© logo is shown: A stylized outline of the State of Minnesota with a tape measure around its "foot."

Slide 2

MN Community Measurement (MNCM)

Accelerating the Improvement of Health Through Public Reporting

• The trusted source of information across the spectrum of care and the Institute of Medicine (IOM) six aims.
• Used by providers to improve care and by patients to make better decisions.
• Our community works together on measurement.

Slide 3

MNCM Health Care Quality Report

• Reports on 18 clinical quality measures, Health Information Technology, patient experience, cost of care, and hospital measures.
• Reports on 315 medical groups and 672 sites of care.
• Data from health plans, hospitals and medical groups.

Image: The cover of the 2011 Health Care Quality Report is shown.

Slide 4

Image: A photograph shows a bear standing midstream, about to catch a leaping salmon in its mouth.

Slide 5

Measurement Challenges

• Orthopedic Surgery:
  • Total Knee Replacement.
  • Back surgery.
• Provider Peer Grouping (Cost and Quality Measure).

Slide 6

Our First Specialty Measure Went Well

Colonoscopy Quality:

• Physician Champion.
• Recognized gap in outcome.
• Groups working on improvement.

Wide agreement on measure even with questions on data collection and reporting.

Slide 7

Dartmouth Atlas Knee Replacement Rates

Image: A map of the United States shows total knee replacement rates per 1,000 Medicare beneficiaries by Hospital Referral Region.

Slide 8

Orthopedics Measures

Total Knee Replacement (TKR)

Went well:

• Champion led.
• Limited participation.
• Acceptable data source.

Led to innovative patient status measure.

Spine Surgery

Not so well:

• No clinician agreement.
• Proposed measure to narrow.
• Many meetings/Many referrals.

But gained consensus.

Slide 9

Image: A photograph shows a sunset as seen through a curtain of rain from a distant storm across a field.

Slide 10

Concerns with the TKR Measure

• Too broad.
• No risk adjustment.
• Patient factors.
• Patient reported data.
• Low participation.
• Who gets to decide.
• Conflicts of interest.

Image: Martin Luther is shown nailing his 95 Theses to the church door.

Slide 11

Five Stages of Measurement

• Can't measure quality.
• The measure must be wrong.
• My patients are sicker.
• Others are responsible.
• Acceptance—actions that lead to improvement.

Slide 12

What We Have Learned

• Agree on purpose with new participants.
• Tie measures to improvement:
  • Is it actionable?
• Communicate Decision Process:
  • Multi-Stakeholder.
  • Input or approval.
  • Consensus on what can accept.
  • Only vote on final.

Slide 13

Provider Peer Grouping

• 2008 Health Reform Law—Total Cost of Care plus quality for medical groups and hospitals.
• State-led multi-stakeholder process.
• Initial results rejected by providers.
• Legislature delayed implementation in 2012.

Slide 14

What We Learned (Part II)

• Start small and pilot test.
• Focus on users not experts.
• Verifiable data.
• Tie to improvement.

Slide 15

Next Steps on Cost of Care

• Support PPG, but develop other options.
• Reduce scope, test on commercial groups.
• Build on/align existing measures.
• Narrow initial use—public reporting on variation—but remain flexible.

Slide 16

Questions or Comments

Jim Chase
President, MN Community Measurement
612-454-4812
chase@mncm.org
http://www.MNHealthScores.org