qcare: minnesota’s quality care and rewarding excellence initiative august 2, 2007 scott leitz,...
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QCare: Minnesota’s Quality Care and Rewarding Excellence Initiative
August 2, 2007Scott Leitz, Assistant CommissionerMinnesota Department of Health
What is QCare?
QCare: Quality Care and Rewarding Excellence
An initiative to build on and leverage community standards and initiatives in Minnesota to achieve a rapid improvement in the health outcomes
Sets goals and standards for health care performance and quality outcomes
Identify, reward superior quality health care
QCare rationale
…between the health care that we have now and the health care that we could have lies not just a gap, but a chasm.
– Crossing the Quality Chasm: A New Health Care System for the 21st Century
Wide and persistent differences in quality of care
Percentage of Adults Receiving Recommended Care, U.S.
0%
20%
40%
60%
80%
100%
Overall Cancer BP Diabetes UTI Alcohol
Source: McGlynn, New England Journal of Medicine.
Percent of Minnesotans with diabetes receiving optimal care
4% 6% 10%
0%
20%
40%
60%
80%
100%
2004 2005 2006
Source: Minnesota Community Measurement.
Overall Goals
QCare Goals:– Dramatically improve health care
quality by 2010– Save lives and improve health – Achieve cost savings as health care
quality and delivery improves• Back of envelope cost savings
analysis
QCare development
QCare Council– Developed as part of NGA policy academy– 10 member team:
• Providers overall guidance and governance for QCare• State agencies (Health, Medicaid, State Employee
Insurance)• Private sector
– Hospital, health plan, physician, employer leaders
• Key Legislators
Framework and preliminary goals
QCare in a Nutshell
Agree on best care Measure outcomes commonly Report transparently Establish stretch goals for improvement Align rewards and incentives to support
improvement Provide supports to providers,
employers in achieving goals
Build on Existing Iniatives: “Align the boxes”
Institute for Clinical Systems Improvement (ICSI)– Guideline development
Minnesota Community Measurement– Measurement of performance at clinic level
CMS and MN Hospital Association reporting for hospitals; adverse health event reporting
Leadership in both the public and private sector Smart Buy Alliance
– State government purchasers, BHCAG, Chamber of Commerce, unions
www.minnesotahealthinfo.org Others
Q-Care Rapid Transformation
Significantly improve in key areas
–Preventive care–Diabetes–Cardiovascular–Hospital-based care
QCare Governor’s Executive Order
In July, 2006, Governor Pawlenty issued an executive order
…The Commissioner[s] of Human Services and …Employee Relations are directed to adopt and apply the QCare standards and align payments and incentives for all state purchased health care
To the extent permitted by law, apply QCare standards to all state purchased health care
Contracts with health plans and providers must include incentives and requirements for reporting costs and quality, and for meeting targets and goals, improvements in key areas, and greater accountability
QCare Goals
Diabetes Measure Baseline 2010
QCareOptimal care –
5 Targets achieved (for A1c blood
sugar level, LDL, blood pressure,
daily aspirin use, no tobacco use)
6% 80%
QCare Goals
Cardiovascular
Measure Baseline 2010 QCare
Optimal care –
5 Targets achieved [LDL (generally and
for persons with diabetes), blood pressure, daily aspirin use, no tobacco use]
38% 90%
QCare Goals
Hospital Care
Measure Baseline 2010 QCare
Heart Attack Care 91.6% 100%
Heart Failure Care 84.7% 100%
Pneumonia Care 67.7% 100%
Leapfrog reporting
42% 100%
Adverse events 105 50
QCare Goals
Preventive CareMeasure Baseline 2010
QCareChild Immunizations 68%
90%
Adolescent Immunizations 39%
Well Child Visits 59%
Breast Cancer Screening 74%
Cervical Cancer Screening 78%
Chlamydia Screening Women
32%
Implementation and Next Steps
State Public Programs– Medicaid: Preventive Care Incentives (Health
plans and patients)– Bridges to Excellence: diabetes and heart
• State employee insurance, Medicaid
Smart Buy Alliance– BTE participation
Supports– E-Health, Administrative uniformity
Expanding Measures– Asthma, Depression
Additional Partnerships
Challenges and Lessons Learned
Still lots of boxesPublic/private partnerships remain a
challenge “Stretch goals” are not always well-receivedNot a lot of agreement or consensus on how
to provide supportsEven with the best attempts at coordination
and alignment, groups will still go off on their own
Contact Information
Scott LeitzAssistant CommissionerMinnesota Department of Health