Tracking Reform
Quality Improvement
New Peer Grouping Timeline
The Minnesota Department of Health has updated its timeline for provider peer grouping in the state. Physicians are expected to get their first look at their peer grouping results for total care in late summer. Condition-specific results are expected to be available in the fall of 2011.
Peer grouping is an effort to compare the cost and quality of care provided by clinics and hospitals. The initiative is initially focusing on total cost of care as well as care for these six conditions: diabetes, coronary artery disease, pneumonia, asthma, congestive heart failure, and total knee replacement.
Providers originally were told they would receive their scores in June of 2010 and that those scores would be released to the public in September.
The MMA initiated legislation in 2010 to modify the peer grouping program to ensure the use of valid and reliable data and to adopt a more reasonable timeline. The 2010 legislation set October 15 as the target date to disseminate results, but the health department missed that deadline largely because of delays in claims data submission by payers and data clean up.
According to the current timeline, payers and the state are required to begin using the peer grouping results in the development of new networks or incentives within 12 months of publication. As such, it is unlikely that any use of the data by payers will occur before 2013.
Statewide Quality Reports Released, New Measures Added
The Minnesota Department of Health released its first statewide report on health care quality in November. The report, which will be done annually, lays the foundation for provider peer grouping, which will compare providers on both risk-adjusted quality and cost.
The report, which was made available online at the Minnesota Department of Health website, includes data on the extent to which physician clinics provided optimal diabetes care and optimal vascular care in 2009. It also includes clinic data about asthma care, preventive screening rates, and the appropriate use of antibiotics based on 2008 HEDIS data collected by health plans.
Starting this year, Minnesota clinics will be evaluated on three new quality measures—depression care, asthma care, and colon cancer screening.
In addition, all clinics will be required to register with MN Community Measurement (www.mncm.org) and complete a health information technology survey. The MMA has created a brochure that clinics can use to educate their staff about the law’s 2011 requirements. To learn more, go to www.mnmed.org/measure.
Federal Reform
Federal Judge Rules against Individual Mandate
U.S. District Court Judge Henry Hudson ruled in December that the federal government does not have the authority to require individuals to purchase health insurance, since doing so would be an unprecedented expansion of federal power that is not authorized under Congress’s right to regulate interstate commerce. Hudson did note that the portions of the law that are not based on the requirement that individuals have insurance are legal and can proceed.
Other courts in Michigan and Virginia have ruled in favor of the constitutionality of this provision of the Patient Protection and Affordable Care Act.
Health Care Homes
Minnesota Chosen for Federal Health Care Home Demo
Minnesota is one of eight states that the Centers for Medicare and Medicaid Services has chosen to be part of the Multi-Payer Advanced Primary Care Practice Demonstration.
This initiative is intended to show whether having health professionals work in a more integrated fashion and receive coordinated care payments from Medicare, Medicaid, and private health plans leads to greater effectiveness and efficiency. The demonstration is expected to ultimately include as many as 1,200 medical homes and 1 million Medicare recipients nationwide.