Minnesota Bridges to Excellence

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Minnesota Bridges to Excellence. National Pay for Performance Summit February 7, 2006 Los Angeles. Agenda. Minnesota Marketplace Local Pay for Performance Building Blocks What it looks like today Whats in our future. Minnesota Market. Providers organized into care systems - PowerPoint PPT Presentation

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  • Minnesota Bridges to Excellence

    National Pay for Performance SummitFebruary 7, 2006Los Angeles

  • AgendaMinnesota Marketplace Local Pay for Performance Building Blocks What it looks like todayWhats in our future

  • Minnesota MarketProviders organized into care systemsLocally based non-profit health plansConsumer directed health care growingAll plans have tiered networksHome of UnitedHealth Group (no owned local presence)Home of multiple corporate headquarters Buyers Health Care Action Group (BHCAG) has been a catalyst for several advancements over last 15 yearsChoice Plus/Patient ChoiceICSILeapfrog GroupEvalu8eSmart Buy Alliance

  • BHCAG Members3MAMSBarry Wehmiller BemisCargillCarlson CompaniesCeridianCHSELCAGeneral MillsHoneywellJostensLand O LakesMedtronicMerck & Co.Minnesota Life

    MN DOERNorthwest AirlinesOlmsted CountyPark NicolletPfizerResource Training and SolutionsRosemountSUPERVALUTargetTennantTCF FinancialUniversity of MinnesotaUS BankXcel EnergyWells Fargo

  • MN P4P Building Blocks Providers and health plans develop consensus on evidence based guidelines, relevant measures, and provide implementation supportAggregate payer data, review physician performance according to ICSI measures, publicly report resultsReward performance through existing health plan programs and BTE

  • Institute for Clinical Systems Improvement Formed in 1993Independent, non-profit Members include 55 medical organizations representing over 7,500 physiciansSponsored by six Minnesota health plansProvides health care quality improvement services Guideline developmentSupport for implementationMeasureswww.icsi.org

  • Begun by Minnesota health plans in 2002Review qualityReport results Increase efficiency of reportingAggregated data from 7 health plansChart audits for clinical and administrative dataFour years of reporting2002 diabetes2003 nine clinical topics, 20 measures2004 first public reportLatest report released November 2005www.mnhealthcare.org

  • The New Website

  • Why BTE in Minnesota? Common direction - community-wide returnBuilds momentum and greater rationale for physician re-engineering effortsDespite years of work by ICSI and measurement, its still neededthe current best is poor6% of patients meet Optimum Diabetes Care (all 5 criteria) for 2004 performance

  • Members of the Guiding CoalitionBCBSMNHealthPartnersMedicaPreferred OneMN Community MeasurementStratis-QIOFairviewMN Medical AssociationCarlson CompaniesUnited HealthGroupResource Training and Solutions Securian3M

    Health PlansEmployersProvidersCommunity

  • Adapting Bridges to ExcellenceProgram design Which programs?Which measures?Where to set the bar?Comparison to existing health plan P4P programsGroup v. individual rewardsEmployer recruitmentVendorsContracting

  • Rewards for .All 5 measures must be met by each patientHbgA1c < 7LDL < 100BP < 130/80Non-smoking status40 y.o. + daily aspirin useThresholdsGoal of 10% of diabetic patients for 2004 (9 out of 53 medical groups)Goal of 15% in 2005Goal of 20% by 2006

  • Employer ParticipationObjections Paying for this already through disease management (they dont reward physicians) Health plans already have programs (but self funded employers arent funding them)Administrative costs too high (cut by 2/3 with local resources)Too much on their plates ROI not solid enough Participants so far include 91,300 covered lives from3MCarlson CompaniesGEMedtronicUPSWells Fargo

  • MN BTE Contract Arrangements91,399 covered livesQuality reviewData aggregationAttributionReportingRewards

  • Comparing MN to Vanilla BTEMinnesota ModelMN Community Measurement does chart review, data aggregation and attributionAnnual review and report on 51 physician groupsNo physician recruitment Annual paymentsOptimal Diabetes care; must meet all 5 measures Random sampling of all patientsAnnual increase in targets BTEMedstat does aggregation and attributionPhysicians apply for rewards to NCQA at any timeReport on rewarded physicians onlyPhysicians must applyQuarterly payments NCQA criteria rewards single measuresPatient sampling based on visit sequenceRewards for three years

  • Where we are goingJanuaryEmployer contractingObtaining data from health plansFebruaryHealth plans provide dataMN Community Measurement completes attribution and sends to Medstat MarchMedstat invoices employersEmployers fund rewardsAprilMedstat cuts checks to providersProvider Webcast announcing rewards MayBHCAG Annual Summit Pay for Performance

  • ChallengesPastROI not solid (enough)Getting attention of employersRole of competing health plansLack of knowledge about what worksFutureDebate about what needs to common across plansHow to include Medicaid and State employeesHow to incorporate specialty care Sustained funding for ongoing development

  • Lessons Learned: Think Nationally; Act LocallyNational health care problems can turn into action by considering local health care market, resources, economics, and culture Build on existing initiatives and local strengthsNational quality standards (or higher)Local reporting (for now)Payment from local and national payers

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