2014 Health Care Quality Report

Transcription

1 2014 Health Care Quality Report Compare Clinic, Medical Group and Hospital Performance Measuring and Tracking Health Care Quality in MN To download the report and find more information visit: mncm.org Searchable results are available at our consumer-friendly website: MNHealthScores.org

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3 December 2014 MN Community Measurement (MNCM) is excited to release the 2014 Health Care Quality Report. Eleven years after the first edition, this annual report continues to expand and evolve. The first report featured data from just 61 medical groups on seven HEDIS quality measures. This report highlights information on 871 clinics, 183 medical groups and approximately 130 hospitals on more than 71 measures. These exciting accomplishments remind us that Minnesota is at the forefront of health care measurement and improvement; however, we cannot rest on our laurels. We must maintain the gains we ve made while identifying the next areas of measurement and data collection that will help push our community to achieve even more. Health care is increasingly measured in the value that it creates for those served. For the first time, in addition to quality of care and patient experience measures, this report also includes information on Total Cost of Care. Each year, the Health Care Quality Report shines a light on health care in Minnesota. We strive to provide measures that truly improve the value of care in our community. We also create new measures that seek to address complex conditions and health care issues which are meaningful for both providers and patients. This year, we expanded our focus on new patientreported outcome and specialty care measures. We reached a new milestone with our first-ever measure evaluating the care of over one million Minnesotans. Our colorectal cancer screening measure evaluated the care of more than 1.1 million patients between ages 51 and 75 from Minnesota and neighboring communities. We released our Total Cost of Care measure, the first standardized, repeatable measure of its kind in the nation. It includes all costs associated with treating patients, including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services. The measure will give medical groups additional information to target unwarranted variation in care and give consumers a better understanding of their health care costs. MNCM remains committed to focusing our efforts on measures that have the greatest potential for impact, thus enhancing the benefits and reducing the burdens of reporting for medical groups. We also intend to remain a trusted source for data sharing, particularly as more stakeholders share information that can benefit and be used by the entire community. As we look ahead to 2015 and MNCM s 10th organizational anniversary, we know that our trusted record of collaborating with the community to address complicated challenges in the health care system will be more important than ever. The demand for value accountability will continue to increase the need for meaningful measures that improve the lives of those served. We are thankful to all our stakeholders - providers and health plans, employers and consumers, community partner organizations - for continually coming together to collaborate toward our common goal of providing Minnesotans with the best care and the best experience at the most efficient cost. We look forward to the continued partnership and the road ahead. We also released our inaugural Health Equity of Care Report Jim Chase in early 2015, with 2014 report year data. The report featured President, MN Community Measurement health outcomes in five key areas segmented by race, Hispanic ethnicity, preferred language and country of origin. Based on data collected from patients by medical groups, it s the first comprehensive look at health disparities in Minnesota and the first time regional information has been available. This will help Penny Wheeler, MD medical groups, policy makers, advocates and community Board Chair, MN Community Measurement leaders better target efforts to reduce and eliminate health inequities in our state. 3

4 2014 Health Care Quality Report Report Preparation Direction Anne M. Snowden, MPH, CPHQ Director of Performance Measurement & Reporting Key Contributors Rachel Mlodzik, MPH Data Analyst/Project Specialist Erin Ghere, MPP Manager of Communications & Engagement Direct questions or comments to Anne M. Snowden (612)

5 Introduction 6 Executive Summary 7 Changes in the 2014 Report 10 Measure Overview 11 quality: clinic and medical group New Measures/Measures with Specification Changes for 2014 Reporting 15 Breast Cancer Screening 16 Maternity Care: Primary C-Section Rate 19 Total Knee Replacement 22 Large Increase in Statewide Rate 27 Contents Optimal Asthma Care Ages 5-17 and Ages Moderate Increase in Statewide Rate 45 Immunizations for Adolescents 46 Avoidance of Antibiotics in the Treatment of Adult Bronchitis 50 Small Increase in Statewide Rate 54 Optimal Vascular Care 56 Use of Spirometry Testing in the Assessment and Diagnosis of COPD 66 Optimal Diabetes Care 70 Colorectal Cancer Screening 80 Appropriate Treatment for Children with URI 91 PHQ-9 Utilization 95 Depression Remission, Response, and PHQ-9 Follow-Up at Six Months 105 Controlling High Blood Pressure 113 Depression Remission, Response, and PHQ-9 Follow-Up at 12 Months 117 Small Decrease in Statewide Rate 125 Appropriate Testing for Children with Pharyngitis 126 Chlamydia Screening in Women 130 Follow-up Care for Children Prescribed ADHD Medication 134 Childhood Immunization Status (Combo 3) 138 quality: hospital 142 Patient experience of care: clinic 146 Patient experience of care: hospital 148 total cost of care 150 health information technology: clinic 152 Statewide and Medical Group Summary by Measure 157 Highest Performers in 2014 by Medical Group Type for Clinical Measures 159 Future Plans 164 Acknowledgements 166 List of Medical Groups and Hospitals Reported 167 Summary of Risk Adjustment and Non-Risk Adjustment Results by Measure 170 Appendix 1: Data Sources and Data Collection 324 Appendix 2: Methodology 326 Appendix 3: MNHealthScores.org 333 5

6 Introduction The compares clinic, medical group and hospital performance on quality, patient experience, cost, and health information technology measures. Quality measures range from preventive to chronic care, along with hospital care for acute and surgical needs. This year marks MNCM s 11th annual report. The report provides valid, reliable and comparable information for clinics, medical groups and hospitals to use in their efforts to improve patient care and outcomes. MNCM began publicly reporting health care performance results in 2004 with a vision of improving health and health care in Minnesota and neighboring communities by driving change in the cost, quality and patient experience of care. That inaugural effort utilized Healthcare Effectiveness Data Information Set (HEDIS) measures, aggregating data from 10 health plans and reporting results at a medical group level. One year later, MNCM became an independent, collaborative, non-profit organization. Our Board of Directors includes physicians; health plans, hospital and state government representatives; employers; and consumers. We continued to publicly report HEDIS measures, and in 2005 also put the results online for the first time. As we gained momentum and experience, medical group leaders encouraged us to obtain data from the most accurate source: their own electronic health record systems. In 2007, we piloted a process to collect data directly from clinics, known as Direct Data Submission (DDS). Several clinics voluntarily participated in this pilot by submitting data directly to MNCM for the Optimal Diabetes Care measure. This process made reporting results for individual clinic sites possible. During the first year, 191 clinics were reported for the Optimal Diabetes Care measure; today, we report rates on more than 600 clinics for the Optimal Diabetes Care measure due, in part, to the state health reform law that made data submission mandatory for providers in In recent years, we have expanded the DDS process and this report to include additional clinical measures such as Optimal Vascular Care; Depression Remission and Response at Six and 12 Months; Optimal Asthma Care; and Colorectal Cancer Screening. In 2014, we continued measure expansion to include the Maternity Care: Primary C-Section Rate; Total Knee Replacement; Total Cost of Care; Depression PHQ-9 Utilization; and Depression PHQ-9 Follow-Up at Six and 12 Months. We appreciate the significant contributions of clinics, medical groups, health plans, hospitals and others who contribute to this report, as well as the multitude of community stakeholders who share their expertise on our committees and as sponsoring members. Achieving our mission to accelerate the improvement of health by publicly reporting health care information relies on this multi-stakeholder, collaborative effort. We continue to strive to be the trusted source for performance measurement, data sharing and public reporting in our community. 6

7 Executive Summary This is MNCM s 11 th annual Health Care Quality Report. Included in this report are clinic performance results on 26 clinical quality measures, one Total Cost of Care measure, results on the Health Information Technology (HIT) Survey, plans regarding the Patient Experience of Care survey results for 2015, and hospital measures. Key Findings Clinical Measures Two clinical measures showed noteworthy improvement in their statewide rates: Optimal Asthma Care for Children and Adults - For children, the statewide rate increased from 49 percent in 2013 to 56 percent in 2014, translating into 2,860 more children with asthma receiving optimal care. For adults, the statewide rate increased from 40 percent in 2013 to 47 percent in 2014, translating into 4,211 more adult patients with asthma receiving optimal care. Four clinical measures showed noticeable improvement in their statewide rates: Immunization for Adolescents - The statewide rate increased from 59 percent in 2013 to 62 percent in 2014, translating into 208 more adolescents who received one dose of meningococcal vaccine and one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td) by their 13th birthday. Appropriate Treatment for Adult Bronchitis - The statewide rate increased from 26 percent in 2013 to 29 percent in 2014, translating into 553 more adults diagnosed with acute bronchitis that did not receive antibiotic prescription (appropriate treatment is no prescription for an antibiotic). PHQ-9 Follow-Up at Six Months - The statewide rate increased from 28 percent in 2013 to 31 percent in 2014, translating into 2,807 more patients with a diagnosis of major depression or dysthymia and a PHQ-9 score greater than nine having a follow-up 7 PHQ-9 test at six months from the index date. Ten other clinical measures showed small improvements in their statewide rates: Optimal Vascular Care Use of Spirometry Testing in the Assessment and Diagnosis of COPD Optimal Diabetes Care Colorectal Cancer Screening Appropriate Treatment for Children with URI Depression Response at Six Months Depression Remission at Six Months Controlling High Blood Pressure Depression Remission at 12 Months Depression Response at 12 Months Two new clinical measures were collected and submitted using MNCM s Direct Data Submission (DDS) process. First, Maternity Care: Primary C-Section Rate with a statewide rate of 22 percent, meaning that 22 percent of deliveries were performed by cesarean section. The results this year show variation and room for improvement. For this measure, a lower rate is preferable. The second new clinical measure set includes the Total Knee Replacement (TKR) measures. Three process measures are reported this year and are summarized in the New Measures for 2014 Reporting section. The outcome measures are slated to be publicly reported in The Breast Cancer Screening measure experienced revisions to its age criterion this year. For 2014, the age criterion includes women between the ages of The age criterion for previous years included ages Due to this change, no trend data is available for this measure.

8 Executive Summary This was the first year of reporting statewide rates for the PHQ-9 Follow-Up measures at six and 12 months in this report. As stated previously, the statewide rate for PHQ-9 Follow-Up at Six Months was 31 percent. The statewide rate for PHQ-9 Follow-Up at 12 Months was 23 percent, meaning that 23 percent of patients with a diagnosis of major depression or dysthymia and an initial PHQ-9 score greater than nine had a follow-up PHQ-9 test at 12 months from the index contact date. Both measures show room for improvement. This was also the first year of reporting statewide rates for the PHQ-9 Utilization measure. The statewide rate was 70 percent, meaning that 70 percent of patients with major depression or dysthymia completed a PHQ-9 test during the measurement period. Patient Experience of Care - Clinic The 2014 results for the Patient Experience of Care Survey will be collected and reported at the clinic level in the third quarter of Patient Experience of Care - Hospital The most current H-CAHPS data that is publicly reported was collected from admission dates January December 2012 and reports on 10 domains. Results for the H-CAHPS hospital measures can be found at MNHealthScores.org. Please also visit the Minnesota Hospital Association s Hospital Quality Report for an expanded list of H-CAHPS measures at mnhospitalquality.org. Cost measures A new report was published in December 2014 by MNCM that allows consumers for the first time to compare the total cost of care at medical groups across the state. Costs from more than 1.5 million patients were included in the report, which is the nation s most comprehensive 8 look at the total cost of care. Information is available for 115 medical groups, representing 1,052 clinics across Minnesota and in neighboring communities on MNHealthScores.org. Health Information Technology (HIT) measure 1,364 clinics in Minnesota and bordering states responded to the 2014 Health Information Technology (HIT) Ambulatory Clinic Survey. The 2014 response rate was 86 percent, compared to 80 percent in 2013 and 83 percent in We report milestones achieved under adoption, use, and exchange at MNHealthScores.org. Adopt: Information about a patient and the care the patient needs is recorded in an electronic health record (EHR) instead of a paper medical record. Utilization: A patient s doctor uses the EHR to order lab tests, track health problems and improve the patient s care. Exchange: A patient s information is sent and received in a secure manner between the doctors involved in the patient s care. Ninety-one percent of clinics have an EHR installed and have it in use in all areas of their clinics. This shows expanded use of EHRs across and within clinics; in 2013, only 83 percent of clinics met this threshold, and in 2012 it was 75 percent. The advancements of EHR utilization continue to increase over time. The most advanced phase of utilization, which includes data benchmarking and creating patient preventive exam reminders, saw the greatest reported increase from 44 percent of clinics in 2013 to 60 percent of clinics reporting in The ability of clinics to electronically send patient care information directly to other sites of care, both in and out-of-network, increased substantially: 55 percent of clinics exchanged patient information within their network as compared to 40 percent last year; and in 2014, one-third of clinics are able to exchange patient

9 Executive Summary information with hospitals outside of their network. The HIT Survey will be fielded again in MNCM will continue to collaborate with HIT stakeholders statewide to implement a survey that provides a comprehensive assessment of HIT adoption, utilization, and exchange as well as continue to incorporate Meaningful Use Stage 2 guidelines. Hospital measures More information on hospital measures developed by the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare and Medicaid Services (CMS), see page 143. Results for AHRQ, CMS, and H-CAHPS hospital measures can be found at MNHealthScores.org. 9

10 Changes to the Report The layout for this year s report was re-designed to be more aligned with the Institute for Healthcare Improvement s Triple Aim framework: Quality, Patient Experience and Cost. The Quality section begins with new measures. The remaining ambulatory care quality measures are categorized based on the statewide average: increases (large, moderate, and small) and decreases (large, moderate, and small). Please reference page 174 for the category definitions. The Quality section also features information on hospital quality measures. The Patient Experience section features information on both ambulatory care and hospital patient experience. The Cost section includes information on another new measure set this year: Total Cost of Care. This report now features an indicator (*) for the Top 15 performers (medical groups and clinics) for each measure. This is aligned with our consumer-focused website, MNHealthScores.org. Charts for clinic and medical group level results are no longer included in this report since the newly re-designed MNHealthScores.org provides this information in convenient, sortable tables for view and download. There were several measures added to this year s report. Two new clinical measures were collected and submitted using MNCM s Direct Data Submission (DDS) process - Maternity Care: Primary C-Section Rate and Total Knee Replacement (3 process measures). This was the first year of reporting statewide rates for the PHQ-9 Follow-Up measures at Six and 12 Months and PHQ-9 Utilization in this report. Total Cost of Care is featured in this report for the first time. There was one measure suppressed this year: Cervical Cancer Screening. This measure underwent review by the MNCM Measurement and Review Committee (MARC) in 2014 to compare the administrative method of data collection to the hybrid method. Based on the review, MARC approved the use of the hybrid method of data collection for this measure. It is the method that reflects the most accurate Cervical Cancer Screening rate for medical group public reporting. Results for this measure, using the hybrid data collection method, will be reported in The Breast Cancer Screening measure experienced revisions to its age criterion this year. For 2014, the age criterion includes women between the ages of The age criterion for previous years included ages Due to this change, no trend data is available for this measure. A new MNHealthScores.org section is included in the appendices of this report. It details the website s redesign in 2014 and provides helpful tips for comparing results from this report to our website. 10

11 Measure Overview The measures in this 2014 Health Care Quality Report were recommended by MNCM s Measurement and Reporting Committee (MARC) and approved by our Board of Directors. We have expanded, revised, and retired measures to stay aligned with evidence-based guidelines. Measurement changes across years are reflected in Table 1. Measures (Data Source: Health Plans) Appropriate Testing for Children with Pharyngitis Appropriate Treatment for Children with Upper Respiratory Infection Avoidance of Antibiotics in the Treatment of Adult Bronchitis Childhood Immunization Status - Combo 3 Immunizations for Adolescents Well Child Visits (Retired due to measure inconsistencies with guidelines) Use of Appropriate Medications for People with Asthma (Ages 5-50) (Retired and replaced with measures that use data submitted by medical groups) Breast Cancer Screening (Ages 50-74) Cervical Cancer Screening (Ages 24-64) Colorectal Cancer Screening (Ages 51-75) (Retired and replaced with measure that uses data submitted by medical groups) Cancer Screening Combined (Breast, Cervical, Colorectal) (Ages 51-75) (Retired due to retirement of Colorectal Cancer Screening; used same denominator) Chlamydia Screening in Women (Ages 16-24) Controlling High Blood Pressure <140/90 mmhg Optimal Diabetes Care (Retired and replaced with measure that uses data submitted by medical groups) Optimal Vascular Care (Retired and replaced with measure that uses data submitted by medical groups) Depression Treatment - Acute Phase Medication Management (Retired and replaced with measure that uses data submitted by medical groups) Depression Treatment - Continuous Phase Medical Management (Retired and replaced with measure that uses data submitted by medical groups) Use of Spirometry Testing in the Assessment and Diagnosis COPD Follow-up Care for Children Prescribed ADHD Medication Maternity Care: Primary C-Section Rate Total Knee Replacement (three process measures) 11 Medical Group Results (HEDIS measures) TABLE 1: performance measures over the years Report Year X X X X X X X X X X X X Total Medical Groups Clinic Results X X (Data Source: Medical Groups) X X Optimal Diabetes Care (ODC) X # X # X # X^^ X X X X Optimal Coronary Artery Diesase (CAD) Care (Retired and replaced with OVC) X Optimal Vascular Care (OVC) X X X X` X X X Depression Remission at Six Months X X X X X X Depression Response at Six Months X X X X Depression Remission at 12 Months X X X X X Depression Response at 12 Months X X X X Optimal Asthma Care - Ages 5-17 and Ages X X X X Colorectal Cancer Screening X X X X PHQ-9 Follow-Up at Six Months X PHQ-9 Follow-Up at Twelve Months X PHQ-9 Utilization X Total Clinics (# Medical Groups/# Clinics) 28/191 62/321 70/ / / / / /871 Other Results Patient Experience of Care: Clinics (repeated every other year) Health Information Technology (HIT) Hospital Payment by Procedure Total Cost of Care * Childhood Immunization Status - Combo 2 only ** Chlamydia Screening in Women - Ages *** Controlling High Blood Pressure - <=140/90 mmhg ^ Optimal Diabetes Care - Hem A1c <=8, Blood Pressure <130/85, LDL-C <130 mg/dl, Aspirin Use, Tobacco Free ^^ Optimal Diabetes Care - Hem A1c <=8, Blood Pressure <130/80, LDL-C <100 mg/dl, Aspirin Use, Tobacco Free # Optimal Diabetes Care - Hem A1c<7, Blood Pressure <130/80, LDL-C,100 mg/dl, Aspirin Use, Tobacco Free Optimal Vascular Care - Blood Pressure <130/80, LDL-C,100 mg/dl, Aspirin Use, Tobacco Free ` Optimal Vascular Care - Blood Pressure <140/90 if co-morbidity of diabetes, <130/80 if IVD only, LDL-C,100 mg/dl, Aspirin Use, Tobacco Free & Use of Appropriate Medications for People with Asthma (Ages 5-56) ~ Colorectal Cancer Screening (Ages 51-80) ~ Cancer Screening Combined (Breast, Cervical, Colorectal) (Ages 51-80) < In 2009 reported AHRQ measures only; in 2010 and 2011 reported AHRQ and CMS hospital measures + Breast Cancer Screening (Ages 50-69) X* X X* X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X & X & X & X & X & X & X X + X + X + X + X + X + X + X + X + X + X X X X X X X X X X X ~ X ~ X ~ X ~ X X ~ X ~ X ~ X ~ X X ** X ** X ** X ** X ** X X X X X *** X *** X *** X X X X X X X^# X^# X^# X # X # X # X X X X X < X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

12 Measure Overview The 2014 Health Care Quality Report is the first to feature information on all three elements necessary to reach optimal health care performance: quality, patient experience and cost. As a result, the 2014 report is organized differently than in previous years. The Quality section features information on 26 measures. It begins with four new ambulatory care measures: Maternity Care: Primary C-Section Rate and three Total Knee Replacement process measures. The remaining ambulatory care quality measures are organized into the following categories based on the statewide average: Increases: Large, moderate, and small Decreases: Large, moderate, and small Please see page 174 for category definitions. Two measures had large increases in their statewide average: Optimal Asthma Care - Children Ages 5-17; and Optimal Asthma Care - Adults Ages Three measures had moderate increases in their statewide average: Immunziations for Adolescents; Avoidance of Antibiotics in the Treatment of Adult Bronchitis; and PHQ-9 Follow-up at Six Months. Twelve measures had small increases in their statewide average: Optimal Vascular Care; Use of Spirometry Testing in the Assessment and Diagnosis of COPD; Optimal Diabetes Care; Colorectal Cancer Screening; Appropriate Treatment for Children wth Upper Respiratory Infection; PHQ-9 Utilization; PHQ-9 Follow-Up at 12 Months; Depression Remission at Six Months; Depression Response at Six Months; Controlling High Blood Pressure; Depression Remission at 12 Months; and Depression Response at 12 Months. Four measures had small decreases in their statewide average: Appropriate Testing for Children with Pharyngitis; Chlamydia Screening in Women; Follow-up Care for Children Prescribed ADHD Medication; and Childhood Immunization Status (Combo 3). In 2014, no measures had moderate or large decreases in statewide rates between 2013 and 2014; therefore, those categories are not included in this report. Two types of measures are included in this section: Direct Data Submission (DDS) measures and HEDIS measures. DDS measures can be reportable on both the clinic and medical group levels. These measures relied on data specifications published in the 2014 Direct Data Submission Guides for each applicable measure. These measures are aligned with clinical guidelines established by the Institute for Clinical Systems Improvement (ICSI). This report includes 16 DDS measures: Optimal Asthma Care - Children Ages 5-17; Optimal Asthma Care - Adults Ages 18-50; Optimal Vascular Care; Optimal Diabetes Care; Colorectal Cancer Screening; Depression Remission at Six Months; Depression Response at Six Months; PHQ-9 Follow-Up at Six Months; Depression Remission at 12 Months; Depression Response at 12 Months; PHQ-9 Follow-Up at 12 Months; PHQ-9 Utilization; Total Knee Replacement process measures; and Maternity Care: Primary C-Section Rate. HEDIS measures use data collected from health plan claims data. Health plan data collection uses either the administrative method (claims only) or hybrid method (claims plus chart review). Measures using health plan data relied on National Committee for Quality Assurance s (NCQA) HEDIS specifications, which are also aligned with ICSI s clinical guidelines. HEDIS is a national set of standardized performance measures originally designed for the managed care industry. The measures have been adopted for use by MNCM to evaluate the performance of medical groups. MNCM reports on 10 HEDIS measures: Breast Cancer Screening; Immunization for Adolescents; Avoidance of Antibiotics in the Treatment of Adult Bronchitis; Use of Spirometry Testing in the Assessment and Diagnosis of COPD; Appropriate Treatment for Children with Upper Respiratory Infection; Controlling High Blood Pressure; Appropriate 12

13 Measure Overview Testing for Children with Pharyngitis; Chlamydia Screening in Women; Follow-up Care for Children Prescribed ADHD Medication; and Childhood Immunization Status (Combo 3). The Quality section also features information on hospital quality measures. These measures are developed by the Agency for Healthcare Research and Quality (ARHQ) and the Centers for Medicare and Medicaid Services (CMS). Results are provided to MNCM by the Minnesota Hospital Association (MHA) for public reporting. The Patient Experience section features information on both ambulatory care and hospital patient experience. The ambulatory care patient experience data utilizes the CG-CAHPS 12-month survey and is implemented throughout the state every-other-year. In 2013, MNCM published the first year of statewide patient experience survey results. The next iteration of results will occur in The hospital patient experience data utilizes the H-CAHPS survey designed for hospitals, and is reported annually. These results are also provided to MNCM by MHA for public reporting. The Cost section includes information on another new measure set from MNCM this year: Total Cost of Care. There is Total Cost of Care Overall, which is also segmented by adults and pediatric patients. This measure uses data (commercial only) collected from four health plans in Minnesota: Blue Cross Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne. It includes all costs associated with treating patients, including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services. Finally, the Health Information Technology section includes information on how well ambulatory care clinics have integrated electronic medical records into their practices. This information is based on an annual survey conducted by MNCM on behalf of the Minnesota Department of Health. See the Methods appendix for more information on the methodology for each measure. In the Results by Measure section, results are listed with a description of the measure; charts, tables and figures describing the results; and a listing of performance highlights for that measure. 13

14 Please see next page. 14

15 results by measure New Measures/Measures with Specification Changes for 2014 Reporting Section Contents Breast Cancer Screening - Measures the percentage of women ages who had a mammogram during the measurement year or prior year. Maternity Care: Primary C-Section Rate - Measures the percentage of live, singleton, vertex position, term newborns who were delivered via cesarean section to nulliparous women (first birth). Total Knee Replacement process measures - Percent of procedures with pre-operative Oxford Knee Score (OKS) tool administered Percent of procedures with one year post-operative OKS tool administered Percent of procedures with both pre-operative and one year post-operative OKS administered The medical group level data for this measure is available to view on MNHealthScores.org. 15

16 New measures/ measures with specification changes for 2014 reporting Breast Cancer Screening This measures the percentage of women ages who received a mammogram during the prior two years (the measurement year or prior year). The age criterion for this measure was revised from years to years this reporting year. Due to this change, no trend data is available for this measure at this time. The statewide rate for Breast Cancer Screening is 76 percent. Table 2 displays the details of this statewide rate. Data for this measure are collected from health plan claims. TABLE 2: STATEWIDE RATE FOR breast cancer screening Statewide Average 95% Cl Numerator (Patients who were screened) Denominator Breast Cancer Screening 76.2% 76.1%-76.4% 202, ,994 *Statewide Average (above) includes those patients attibuted to a medical group AND those who could not be attributed to a medical group. There is no trend chart since measure specifications were changed this year. 16

17 performance highlights for breast cancer screening Medical Group Results Highest performers in 2014 Medical group results showed that an average of 82 percent of women years of age had a mammogram. Sacred Heart Mercy Health Care Center set the benchmark of 96 percent. Twenty-four of 162 medical groups had rates and confidence intervals fully above the medical group average. These groups are listed below from high to low performance. An asterisk (*) indicates a Top 15 performer for this measure. Sacred Heart Mercy Health Care Center* Paul Larson Ob/Gyn Clinic* Mn Gyn And Surgery* Clinic Sofia Ob/Gyn* John A. Haugen Assoc.* HealthPartners Clinics* Premier OB/GYN of Minnesota* Obstetrics & Gynecology Associates* Mayo Clinic* Family Practice Medical Center Of Willmar* CCMH - Montevideo Clinic* Mayo Clinic Health System - Owatonna* CentraCare Health System* Alexandria Clinic* Allina Health System* Mayo Clinic Health System - Mankato Mayo Clinic Health System - Red Wing Sanford Bagley Affiliated Community Medical Centers Sanford Health - Sioux Falls Region Park Nicollet Health Services Essentia Health - East Region Mankato Clinic Fairview Medical Group Biggest improvement from Not applicable due to measure specification changes. Medical group performance over time ( ) Not applicable due to measure specification changes. 17

18 Please see next page. 18

19 new measures/ Measures with specification changes for 2014 reporting Maternity Care: Primary C-Section Rate This measure assesses the percentage of nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section between July 1, 2013 and June 30, 2014 patients who had a C-section delivery. Any clinic that is part of a medical group in which the medical group has providers who perform cesarean deliveries were eligible to report data for this measure. The statewide rate for Maternity Care: Primary C-Section Rate was 22 percent (a lower rate is better for this measure). Table 3 displays the details of this statewide rate. This is a first year measure so trending over time is not available. In maternity care, patients often seek care from multiple providers across locations within a medical group. Additionally, there are some providers who provide maternity care but may not perform c-sections, and patients who require a c-section are referred to a physician who does. Previous clinic level reporting of the maternity care measure did not include the deliveries performed by providers at a site without providers who performed c-sections, and as a result, rates for the state and at the medical group level had the potential to be artificially elevated. The maternity care measure is most appropriately calculated and reported at the medical group level in order to account for these considerations. Data collected for this measure are submitted directly to MNCM by medical groups from electronic health records or paperbased medical charts. TABLE 3: STATEWIDE RATE FOR maternity care: primary c-section rate Statewide Average 95% Cl Numerator Denominator (Patients who had a delivery via C-section) (Deliveries) Maternity Care: Primary C-Section Rate 22.2% 21.6%-22.8% 3,947 17,781 There is no trend chart because this is the first year of public reporting for this measure. 19

20 performance highlights for maternity care: primary c-section rate Medical Group Results Highest performers in 2014 Medical group results showed an average of 22 percent of live, singleton, vertex position, term newborns were delivered via cesarean section to nulliparous women (first birth). Tri-County Health Care set the benchmark of only 10 percent of women having a cesarean delivery. For this measure, a lower performance rate represents better care. There were six of 52 medical groups with rates and confidence intervals fully below the statewide average. The high-performing medical groups are listed below in order starting with the best performance. An asterisk (*) indicates a Top 15 performer for this measure. Hudson Physicians - Minnesota Healthcare Network* Winona Health* Alexandria Clinic* Lakewood Health System* Essentia Health - West* Park Nicollet Health Services* Biggest improvement from Not applicable because this is a first year measure. Medical group performance over time ( ) Not applicable because this is a first year measure. 20

21 Please see next page. 21

22 new measures/ measures with specification changes for 2014 reporting Total Knee Replacement (TKR) This is the first year of public reporting for the Total Knee Replacement measure set. For patients aged 18 and older who underwent a primary or revision total knee replacement procedure during the measurement period (January 1, 2012 to December 31, 2012), several outcome measures were calculated including: 1. Average post-operative functional status at one year for patients who underwent total knee replacement as measured by the Oxford Knee Score (OKS) tool. 2. Average post-operative quality of life at one year for patients who underwent total knee replacement as measured by the EQ5D tool. After review of pilot testing, initial results and the measure development workgroup s recommendations, the MNCM Measurement and Review Committee (MARC) approved a plan to suspend public reporting of the above outcome measures in 2014 based on low rates of patient-reported outcome tool administration. However, MARC approved publicly reporting three process measures as an interim step to promote tool administration, with the goal of eventually reporting the outcome measures as planned. The three process measures that will be publicly reported in 2014 include: The percentage of patients with a total knee replacement procedure who have an OKS assessment tool administered pre-operatively (within three months prior to the procedure). The percentage of patients with a total knee replacement procedure who have an OKS assessment tool administered one year post-operatively (nine to 15 months after the procedure). The percentage of patients with a total knee replacement procedure who have an OKS assessment tool administered both pre-operatively (within three months prior to the procedure) and one year postoperatively (nine to 15 months after the procedure). See Table 4 for statewide rates for these three process measures. The medical group level data for these three process measures are available to view on MNHealthScores.org. TABLE 4: STATEWIDE RATEs FOR the Total knee replacement measures Statewide Average 95% Cl Numerator Denominator (Patients who met treatment goals) Number of TKR Procedures w/pre-op OKS 35.7% 34.8% % 4,011 11,246 Number of TKR Procedures w/1 Yr Post-Op OKS 30.7% 29.8% % 3,452 11,246 Number of TKR Procedures w/pre-op & Post-Op OKS 18.2% 17.5% % 2,044 11,246 22

23 performance highlights for Tkr - number of tkr procedures w/pre-op oks Medical Group Results Highest performers in 2014 Medical group results showed an average of 36 percent of patients with a TKR procedure had an OKS assessment tool administered pre-operatively (within three months prior to the procedure). Affiliated Community Medical Centers set the benchmark of 97 percent. There were 11 of 33 medical groups with rates and confidence intervals fully above the statewide average. The high-performing medical groups are listed below in order starting with the best performance. An asterisk (*) indicates a Top 15 performer for this measure. Affiliated Community Medical Centers* Olmsted Medical Center* The Orthopaedic & Fracture Clinic* Allina Health Specialties* Heartland Orthopedic Specialists* Mayo Clinic* HealthPartners Clinics* * Lake Region Healthcare* Little Falls Orthopedics* Northern Orthopedics, Ltd.* Biggest improvement from Not applicable since this is a first year measure. Medical group performance over time ( ) Not applicable since this is a first year measure. 23

24 performance highlights for Tkr - number of tkr procedures w/one year post-op oks Medical Group Results Highest performers in 2014 Medical group results showed an average of 31 percent of patients with a TKR procedure had an OKS assessment tool administered one year post-operatively (nine to 15 months after the procedure). Affiliated Community Medical Centers set the benchmark of 79 percent. There were 14 of 33 medical groups with rates and confidence intervals fully above the statewide average. The high-performing medical groups are listed below in order starting with the best performance. An asterisk (*) indicates a Top 15 performer for this measure. Affiliated Community Medical Centers* Southwest Minnesota Orthopedics and Sports Medicine* Lake Region Healthcare* Allina Health Specialties* Northern Orthopedics, Ltd.* Essentia Health St. Mary s* Mayo Clinic* The Orthopaedic & Fracture Clinic* * HealthPartners Clinics* Little Falls Orthopedics* Heartland Orthopedic Specialists* Mayo Clinic Health System* St. Croix Orthopaedics* Biggest improvement from Not applicable since this is a first year measure. Medical group performance over time ( ) Not applicable since this is a first year measure. 24

25 performance highlights for Tkr - number of tkr procedures w/ pre-op and post-op oks Medical Group Results Highest performers in 2014 Medical group results showed an average of 18 percent of patients with a TKR procedure had an OKS assessment tool administered both pre-operatively (within three months prior to the procedure) and one year postoperatively (nine to 15 months after the procedure). Affiliated Community Medical Centers set the benchmark of 77 percent. There were nine of 33 medical groups with rates and confidence intervals fully above the statewide average. The high-performing medical groups are listed below in order starting with the best performance. An asterisk (*) indicates a Top 15 performer for this measure. Affiliated Community Medical Centers* Allina Health Specialties* The Orthopaedic & Fracture Clinic* * Northern Orthopedics, Ltd.* Lake Region Healthcare* Mayo Clinic* HealthPartners Clinics* Heartland Orthopedic Specialists* Biggest improvement from Not applicable because this is a first year measure. Medical group performance over time ( ) Not applicable because this is a first year measure. 25

26 Please see next page. 26

27 results by measure Large Increase in Statewide Rate Section Contents Optimal Asthma Care (ages 5-17 or 18-50) - Measures the percentage of patients ages 5-17 or with persistent asthma in the measurement period who met all three targets, including: asthma is well-controlled; patient is not at an elevated risk for exacerbation; and patient has been educated about asthma and selfmanagemenent of the condition by having a written asthma management plan in the medical record. 27

28 large increase in statewide rate Optimal Asthma Care This measures the percentage of patients ages 5-17 and ages with persistent asthma who have reached the following three targets to control their asthma: Evidence of well-controlled asthma determined through the use of an asthma control tool (e.g. Asthma Control Test (ACT); Childhood Asthma Control Test (C-ACT); Asthma Control Questionnaire (ACQ); and Asthma Therapy Assessment Questionnaire (ATAQ)) Not at risk for elevated exacerbation as evidenced by patient-reported emergency department visits and hospitalizations Patient has been educated about his/her asthma and self-management of the condition and has received a written asthma management plan The statewide rate for Optimal Asthma Care is 56 percent for children ages 5-17 and 47 percent for adults ages Table 5 displays the details of this statewide rate for both populations. Figure 1 shows the average rate for Optimal Asthma Care by age over time. The statewide rates for both patient populations have been increasing since For both populations, the statewide rate increased by seven percentage points this year. The 2014 statewide rate for children ages 5-17 is nine percentage points higher than the statewide rate for adults ages Data collected for this measure are submitted directly to MNCM by medical groups and clinics from electronic health records or paper-based medical charts. TABLE 5: STATEWIDE RATE FOR optimal asthma care - children and adults Statewide Average 95% Cl Numerator Denominator (Patients who met treatment goals) (Patients Sampled) Total Eligible Optimal Asthma Care - Children 56.3% 55.8%-56.7% 22,318 40,281 42,555 Optimal Asthma Care - Adults 46.8% 46.4%-47.2% 29,261 62,853 63, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 28 FIGURE 1: STATEWIDE RATES FOR optimal asthma care - children and adults OVER TIME 24% 37% 49% 56% 16% 30% 40% 47% Children Ages 5-17 Adults Ages Caution is recommended when making comparisons from year to year. Annual rate differences can occur due to natural variation, changes in measurement specifications, changes in data sources and other factors.

29 performance highlights for optimal asthma care - children Clinic Results Highest performers in 2014 Clinic results showed an average of 56 percent of children ages 5-17 with asthma met all three required components in this measure. Advancements in Allergy and Asthma Care, Ltd. set the benchmark of 93 percent. There were 87 of 291 clinics with rates and confidence intervals fully above the statewide average. The high-performing clinics are listed below in alphabetical order under their medical group name. An asterisk (*) indicates a Top 15 performer for this measure. AALFA Family Clinic - MHN Advancements in Allergy and Asthma Care, Ltd.* Allergy & Asthma Specialists, PA Maple Grove - North Memorial Medical Office Building Minneapolis Medical Arts Bldg Plymouth West Health Allergy & Asthma Specialty Clinic* Bandana Square (Aspen) Cambridge Champlin Coon Rapids Cottage Grove Eagan East Lake Street (Aspen) Elk River Forest Lake Maple Grove Northfield Ramsey St. Michael West St. Paul CentraCare Health Plaza - Pediatrics* Plaza - Allergy Central Pedatrics St. Paul Children s Respiratory & Critical Care Specialists Minneapolis Minnetonka St Paul Essentia Health East Region Duluth Clinic 1st St Essentia Health West South University Andover Clinic Children s Clinic Chisago Lakes Clinic Elk River Clinic* Lakes Medical Center* Lino Lakes Clinic Milaca Clinic* Ridges Clinic RidgeValley Clinic Rosemount Clinic Zimmerman Clinic Fridley Children s & Teenagers Medical Center HealthPartners Clinics Anoka* Apple Valley Brooklyn Center Coon Rapids Elk River* Inver Grove Heights Lino Lakes Roseville White Bear Lake HealthPartners Central Minnesota Clinics Hennepin County Medical Center (HCMC) Clinics Downtown Pediatric Clinic Mankato Clinic Daniel s Health Center Mayo Clinic Baldwin Building, Pediatrics Northeast* Northwest Mayo Clinic Health System Austin Faribault Hwy 60* Metropolitan Pediatric Specialists Edina Shakopee Northeast Pediatric Clinic Olmsted Medical Center Rochester Southeast Park Nicollet Health Services Bloomington Brookdale Carlson Champlin Eagan* Lakeville Maple Grove Plymouth* Rogers Shakopee St. Louis Park 3850 Bldg. St. Louis Park Asthma and Allergy St. Louis Park Family Medicine* Pediatric Services South Lake Pediatrics Chaska* Childrens West Eden Prairie Maple Grove Minnetonka Plymouth Southdale Allergy and Asthma Clinic LLC Southdale Pediatric Associates, Ltd Burnsville* Edina St Luke s Clinics Allergy & Immunology St. Mary s Innovis Health Clinic Detroit Lakes Stillwater Medical Group Curve Crest Clinic Biggest improvement from The greatest improvement since report year 2013 in Optimal Asthma Care for children ages 5-17 (clinic results) was made by Mayo Clinic Health System Albert Lea, whose score increased by more than 59 percentage points. 29

30 performance highlights for optimal asthma care - children Clinic Results Clinic performance over time ( ) We reviewed the data to identify patterns of clinic performance in clinics with three years of data beginning in We looked for patterns of consistently high performance, consistent improvement, consistent decreases, and/or relative stability. The results are below in alphabetical order under their medical group name. Thirty-six clinics achieved consistently high performance and above average rates over the past three years for Optimal Asthma Care - Children: Advancements in Allergy and Asthma Care, Ltd. Allergy & Asthma Specialists, PA Maple Grove - North Memorial Medical Office Building Minneapolis Medical Arts Bldg Plymouth West Health Allergy & Asthma Specialty Clinic Cambridge Champlin Coon Rapids Eagan Elk River Maple Grove CentraCare Health Plaza - Pediatrics Children s Respiratory & Critical Care Specialists Minneapolis Minnetonka Essentia Health East Region Duluth Clinic 1st St Andover Clinic Children s Clinic Chisago Lakes Clinic Elk River Clinic Lakes Medical Center Lino Lakes Clinic Milaca Clinic Ridges Clinic RidgeValley Clinic Rosemount Clinic HealthPartners Clinics Anoka Elk River Mayo Clinic Baldwin Building, Pediatrics Northeast Northwest Mayo Clinic Health System Faribault Hwy 60 Pediatric Services Southdale Allergy and Asthma Clinic LLC Southdale Pediatric Associates, Ltd Burnsville Edina Eighty-four clinics showed consistent improvement over three years: Affiliated Community Medical Centers Litchfield Clinic (West) Willmar Clinic Allergy, Asthma & Pulmonary Associates, PA Coon Rapids Cottage Grove Eagan Elk River Farmington Forest Lake Northfield Shoreview St. Michael West St. Paul Woodbury CentraCare Health Plaza - Pediatrics Central Pedatrics St. Paul Children s General Pediatric Clinic Minneapolis St. Paul Children s Pediatric & Adolescent Care of Minnesota (PACE) West St. Paul Children s Respiratory & Critical Care Specialists Minneapolis Minnetonka St Paul Children s Speciality Clinic St. Paul Essentia Health West Jamestown Moorhead Park Rapids South University Lakes Medical Center Lino Lakes Clinic Milaca Clinic Rush City Clinic Zimmerman Clinic Grand Itasca Clinic HealthPartners Clinics Andover Anoka Apple Valley Arden Hills Bloomington Brooklyn Center Coon Rapids Elk River Midway Riverside Roseville Woodbury HealthPartners Central Minnesota Clinics Hennepin County Medical Center (HCMC) Clinics Downtown Pediatric Clinic Richfield Clinic Whittier Clinic Integrity Health Network St. Cloud Medical Group - South - IHN Mayo Clinic Health System Austin Mankato Specialty Clinic Owatonna Metropolitan Pediatric Specialists Burnsville Edina Shakopee Midwest Allergy & Asthmas Burnsville Multicare Associates Blaine Medical Center Native American Community Clinic Northwest Family Physicians Rogers Olmsted Medical Center Rochester Northwest Rochester Southeast Park Nicollet Health Services Bloomington Brookdale Burnsville Carlson Chanhassen Eagan Maple Grove Plymouth Prior Lake Shakopee St. Louis Park 3850 Bldg. St. Louis Park Asthma and Allergy St. Louis Park Family Medicine Sanford Health Fargo Region Children s Southwest Clinic Southpointe Clinic St Luke s Clinics Allergy & Immunology Pediatrics Stillwater Medical Group Curve Crest Clinic United Family Medicine University of Minnesota Physicians Bethesda Clinic Broadway Family Medicine Pediatric Specialty Discovery Clinic 30

31 performance highlights for optimal asthma care - children Clinic Results Ten clinics showed consistent decreases over three years: Allergy & Asthma Specialty Clinic Community-University Health Care Center Essentia Health East Region West Duluth Clinic Brooklyn Park Clinic Maple Grove Medical Center Northeast Clinic Uptown Clinic HealthEast Clinics Maplewood Clinic Mayo Clinic Health System Faribault Hwy 60 Mendakota Pediatrics Five clinics had rates that were relatively stable over three years: Allergy & Asthma Specialists, PA Minneapolis Medical Arts Bldg Mankato Clinic Wickersham Campus Winona Health Winona Clinic Altru Health System Lake Region Main Ninety-seven clinics did not have a discernable pattern over three years. 31

32 performance highlights for optimal asthma care - children Regional Clinic Results Highest performers in 2014 by region Clinic results showed differences in performance among the different geographic regions in Minnesota. Boundaries of the nine regions were determined by synthesizing health care and geopolitical data, including from the Metropolitan Council and State of Minnesota. The results have been organized to identify areas of the state with the highest proportion of high-performing clinics. The nine regions are listed below based on their proportion of high-performing clinics from high to low. The number of high-performing clinics is shown along with the total number of clinic sites that submitted data for this measure. The high-performing clinics are listed in under their medical group name alphabetical order by region. West Metro - 18 out of 38 (47 percent) Advancements in Allergy and Asthma Care, Ltd. Allergy & Asthma Specialists, PA - Maple Grove North Memorial Medical Office Building Champlin East Lake Street (Aspen) Maple Grove Children s Respiratory & Critical Care Specialists Minnetonka RidgeValley Clinic Metropolitan Pediatric Specialists Shakopee Park Nicollet Health Services Carlson Champlin Maple Grove Rogers Shakopee South Lake Pediatrics Chaska Childrens West Eden Prairie Maple Grove Minnetonka East Metro - 14 out of 30 (47 percent) Bandana Square (Aspen) Cottage Grove Forest Lake Ramsey Andover Clinic Lino Lakes Clinic Ridges Clinic Rosemount Clinic HealthPartners Clinics Anoka Inver Grove Heights Lino Lakes Park Nicollet Health Services Lakeville Southdale Pediatric Assoc. Ltd Burnsville Stillwater Medical Group Curve Crest Clinic Central - 12 out of 30 (40 percent) Cambridge Elk River St. Michael CentraCare Health Plaza - Pediatrics Plaza - Allergy Chisago Lakes Clinic Elk River Clinic Lakes Medical Center Milaca Clinic Zimmerman Clinic HealthPartners Clinics Elk River HealthPartners Central Minnesota Clinics 32