MN Community Measurement©: Measure Up to Better Health
AHRQ's 2012 Annual Conference Slide Presentation
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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
