Leadership in ActionMinnesota Bridges to Excellence

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Bringing Good Ideas to Minnesota through Collaboration

Multi-stakeholder community convening in 2005 – Learn about National Bridges to Excellence program

• Implemented by GE and Ford • Financial rewards for providers that improve quality in

diabetes and coronary care• Individual doctors must receive NCQA certification

Early adopter purchasers – Champions of Change Carlson Companies General Electric Honeywell 3M

Medtronic State of MN Employer Group Wells Fargo

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Minnesota Bridges to Excellence - Leverage Community Partnerships and Best Practices Institute for Clinical System Improvement (ICSI):

develops guidelines and drives physician consensus Minnesota Community Measurement (MCMN): measure

development, data aggregation, quality review, performance rates, public reporting for increased transparency

Health Plans: aligned measure specifications used by all payers for rewards

Guiding Coalition formed: – Employers, providers, health plans, MMA, ICSI, MNCM, Stratis

Health– Ensure collaboration, consensus and success of program

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Supporting High Quality Outcomes Program Goals:

– Improve the quality of care for patients– Raise the level of purchaser and consumer awareness about the variation

in the quality– Spark provider competition based on quality outcomes

Action Group– Manages and administers

• Performance Criteria• Clinic eligibility and reward calculation• Ongoing program development/enhancement• Community Dialogues• Provider Webcasts

Celebrate Excellence: Annual Recognition Reception

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MNBTE – Chronic Conditions

Optimal Diabetes Care Optimal Vascular Care(added in 2007)

Depression Care(added in 2009)

HgBA1c < 8 LDL < 100 Remission:

LDL < 100 Aspirin Daily Initial PHQ-9** of >9; follow-up PHQ-9 in 6

months < 5

Aspirin Daily* Non Smoker Or

Non Smoker Blood Pressure < 140/90 Response: (added in 2012)

Blood Pressure <140/90 Initial PHQ-9** of >9; follow-up PHQ-9 in 6 months 50% better

* Only if risk of cardiovascular disease is present – then all adults age 18-75** PHQ-9 depression assessment questionnaire

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Innovations 2007

– Require Direct Data Submission to MNCM to reward at clinic-level based on clinical data

– DHS Managed Medicaid joins program– Work with health plans to ensure alignment of measure specifications

2008 – 2009 – More purchasers join – 14 Champions of Change

• Resource Training & Solutions, Southwest/West Service Cooperative, Target, US Bank, University of Minnesota

– MNBTE serves as model for State of Minnesota Quality Incentive Payment System (QIPS)

2009– Early adopter of depression care rewards using ICSI-developed remission

measure for DIAMOND program

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And More Innovations 2010

– Add improvement rewards (ODC/OVC), encouraging all clinics to improve outcomes– QIPS becomes operational for State Employee Group and DHS

• Action Group manages – ensures private/public market alignment

2011– Depression care improvement rewards added– Launched study to determine next opportunities

• Supply sensitive care and overuse identified

2012– Learning collaborative established: Phase I – Low back pain and spine surgery– Value Statement developed outlining purchaser expectations. – Health plans, care systems and innovators meet with Champions to discuss new

programs, care redesign and other efforts to improve outcomes and efficiency.

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MNBTE – Historical Picture

Diabetes Vascular Disease Depression

2006 Minimum: 10%9 Medical Groups

2007 Minimum: 20%37 clinics – achievement

Minimum: 50% (CAD-2007)64 clinics – achievement

2008 Minimum: 25%62 clinics – achievement

Minimum: 40% (Vascular)76 clinics – achievement

2009 Minimum: 35%17 clinics – achievement

Minimum: 50%36 clinics – achievement

Minimum: 5%17 clinics

2010 Minimum: 41%44 clinics – achievement 20 clinics – improvement

Minimum: 55%45 clinics – achievement45 clinics – improvement

Minimum: 10%10 clinics - achievement

2011 Minimum: 48%94 clinics – achievement82 clinics – improvement

Minimum: 55%48 clinics – achievement *41 clinics – improvement *

Minimum: 10%27 clinics – achievement 3 clinics – improvement

2012 Minimum: 51%45 clinics – achievement 104 clinics – improvement

Minimum: 58%102 clinics – achievement 98 clinics – improvement

Minimum Remission: 13%Minimum Response: 18%Xx clinics remissionXx clinics response

Champions of Change: $2,500,000 in financial Incentives

* QIPS rewards additional 300+ clinics – lower minimum threshold

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Today we recognize the Champions of Change for their leadership in rewarding providers for improved health outcomes for all Minnesotans

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Thank You!