© mn community measurement. all rights reserved.. lessons from the school of hard knocks september...

© MN Community Measurement. All rights reserved. .

Lessons from the School of Hard KnocksSeptember 10, 2012

MNCM all rights reserved 2008

MN Community Measurement

Accelerating the Improvement of Health Through Public Reporting

• The trusted source of information across the spectrum of care and the IOM six aims

• Used by providers to improve care and by patients to make better decisions

• Our community works together on measurement

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

Measurement Challenges

• Orthopedic Surgery– Total Knee Replacement– Back surgery

• Provider Peer Grouping (Cost and Quality Measure)

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

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Dartmouth Atlas Knee Replacement Rates


Orthopedics Measures

Total Knee Replacement

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



http://www.k5kj.net/ChaseEvents/2005/20050612/2005061210.jpg

Concerns with the TKR Measure

• Too broad

• No risk adjustment

• Patient factors

• Patient reported data

• Low participation

• Who gets to decide

• Conflicts of interest


http://thegospelcoalition.org/blogs/justintaylor/2010/10/25/95-theses/

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


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

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


What We Learned (Part II)

• Start small and pilot test

• Focus on users not experts

• Verifiable data

• Tie to improvement


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


© mn community measurement. all rights reserved.. lessons from the school of hard knocks september...

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