this document is made available electronically by the minnesota … · 2015. 3. 24. · repo...

This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp

This page intentionally left blank.

MN Community Measurement 2008 Health Care Quality Report December 2008

© MN Community Measurement 2008. All rights reserved. May be used by participating provider groups as defined in the Medical Group Data Sharing Agreement.

1© MN Community Measurement 2008. All rights reserved. May be used by participating provider groups as defined in the Medical Group Data Sharing Agreement.


December 2008

This report marks the fifth anniversary of public reporting on health care quality by MNCommunity Measurement (MNCM) – a milestone that provides an opportunity to assess ourprogress toward achieving the high performance standards we have adopted as a health carecommunity. We are pleased to report that over the last five years we have observed increasinglevels of participation in public reporting by health care clinicians, as well as improved outcomesfor patients as evidenced by increases in measurement results.

With the wealth of data we have collected, we are beginning to embark on deeper analysesto further inform health care quality improvement in Minnesota. For example, in 2008MNCM released our first Health Care Disparities Report, which examined medical groupperformance on eight quality measures for patients publicly insured through MinnesotaHealth Care Programs. In this report, you’ll find new analyses that highlight the medicalgroups that have been high performers since we began public reporting, as well as thoseclinics and medical groups that have shown the greatest improvement for each measure.

Our direct data submission (DDS) process continues to grow and expand. In 2008, we doubledthe number of medical groups participating in DDS to more than 60, representing more than300 clinics statewide. And our Reporting Advisory Committee has established a list of otherpriority measures to move into the DDS process over the next few years.

As we continue to grow, the need to align our measures with other efforts across the communityis critical. We see this happening in pay-for-performance programs, for instance, as purchasersand health plans move toward using our measures to identify and reward high-performingmedical groups and clinics.

Over the next few years, we plan to develop new measures that are relevant to consumersand meet the needs of the marketplace. Next year, we will report a new patient experiencemeasure that will complement our clinical measures and help to engage consumers in usingquality measures in their health care decision making. We will also be developing standardsfor collecting race, ethnicity and primary language data through DDS to help identify andreduce disparities in care.

We strive to be a community-wide asset that will benefit all stakeholders. With newopportunities emerging from recent health care reform legislation, MNCM looks forward topartnering with others in the community to further align and raise the value of this work.As we talk with clinical leaders in the community, they tell us that public reporting is encouragingthem to find ways to get better results for their patients. These stories are inspiring and wehope they reflect your experience as well. Your feedback is always appreciated.

Brian Anderson, MD Board Chair Jim Chase, President

Report Prepared by:Anne M. Snowden, MPH, CPHQ

Director of Performance Measurement and Reporting, MNCM

Key Contributors:

Cheryl Barber, MS, MPHData Analyst, MNCM

Angeline Carlson, PhDDirector of Research, Data Intelligence Consultants

Michelle B. Ferrari, MPHProject Manager, MNCM

Elizabeth HoelscherAdministrative Assistant, MNCM

Diane Mayberry, MHA, RN, CPHQDirector of Program Development, MNCM

Deb OlsonHR and Administrative Manager, MNCM

Direct Questions or Comments to:

Anne M. Snowden(612) 455-2911

[email protected]


MN Community Measurement2008 Health Care Quality Report

(2007 Dates of Service)

2 © MN Community Measurement 2008. All rights reserved. May be used by participating provider groups as defined in the Medical Group Data Sharing Agreement.

© MN Community Measurement 2008. All rights reserved. May be used by participating provider groups as defined in the Medical Group Data Sharing Agreement. 3


I. EXECUTIVE SUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

II. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

III. CHANGES IN THE REPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

IV. DATA SOURCES AND DATA COLLECTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

V. MEASURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

VI. METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

VII. RESULTS BY MEASURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Optimal Diabetes Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Optimal Vascular Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Controlling High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Use of Appropriate Medications for People with Asthma . . . . . . 52

Treatment for Children with Upper Respiratory Infection . . . . . . 58Testing for Children with Pharyngitis . . . . . . . . . . . . . . . . . . . . . . . 64

Breast Cancer Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Cervical Cancer Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Colorectal Cancer Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Cancer Screening Combined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86Chlamydia Screening in Women . . . . . . . . . . . . . . . . . . . . . . . . . . . 90Childhood Immunizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

VIII. SUMMARY OF STATEWIDE RESULTS BY MEASURE . . . . . . . . . . . . . . . . . . 100

IX. HIGHEST PERFORMERS BY TYPE OF MEDICAL GROUP IN 2008 . . . . . . . 102

X. MEDICAL GROUP PERFORMANCE VARIATION . . . . . . . . . . . . . . . . . . . . . . . . 104

XI. CONSISTENTLY HIGH PERFORMING MEDICAL GROUPS OVER 5 YEARS . . . . 105

XII. FUTURE PLANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

XIII. ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

XIV. LIST OF MEDICAL GROUPS AND CLINICS REPORTED . . . . . . . . . . . . . . . . . 108

Table of Contents

“Living with Illness” measures

“Getting Better” measures

“Staying Healthy” measures

2008 Health Care Quality Report



Executive Summary

Over the past five years, MNCM has focused on public reporting of health care performancethroughout Minnesota and border communities. During this period, we have expanded the number ofmeasures, retired some measures, and updated measures to align with current evidence-based guidelines.The number of medical groups reported has also increased during this time. What hasn’t changed isour mission to accelerate the improvement of health by public reporting of health care information.

The 2008 Health Care Quality Report was designed and produced by MN Community Measurement(MNCM) to present statewide clinic and medical group performance on 12 measures of healthcare quality. To celebrate our fifth public report, we have highlighted progress we’ve made as acommunity to improve health care.

Key FindingsIn the five years that we have been measuring Optimal Diabetes Care, the number of people achievingoptimal care has almost tripled. This year almost 10,000 more people across Minnesota with diabeteswill be meeting these aggressive treatment goals. And we know from research that this will meanthousands more people will avoid the serious complications of diabetes – strokes, heart attacks,amputations and vision problems.

For the Cancer Screening Combined measure, the statewide rate surpassed 50 percent for the firsttime with a 5 percentage point improvement. This translates to 18,000 more patients statewidescreened for breast, cervical and colorectal cancer.

Other Key Findings• Statewide results are up for most measures.Just three measures – Controlling HighBlood Pressure, Asthma Care and CervicalCancer Screening – remained steady sincereport year 2007.

• More medical groups demonstratedabove-average rates on our measures.

• The number of medical groups and clinicsthat participated in our Direct DataSubmission process has more than doubled– from 28 in report year 2007 to 62 inreport year 2008.

• The number of medical groups reportedfrom health plan data has increased from128 in report year 2007 to 143 in reportyear 2008, and more groups are reportedon for more measures.

• Practice variation between medical group andclinic performance continues; opportunitiesfor improvement exist.

• Some primary care, Obstetrics andGynecology (OB/GYN), Urgent /

Convenience Care and Cardiology clinicsachieved above-average rates more frequentlythan other medical groups.

• There have been some big improvements inmedical group and clinic performance sincereport year 2007 and over a five-year period.

• Since report year 2004, only one medicalgroup–HealthPartners Clinics – has shownconsistently high performance acrossfour measures (Optimal Diabetes Care,Breast Cancer Screening, Cervical CancerScreening and Chlamydia Screening).

• Four medical groups – Aspen MedicalGroup (now a part of Allina MedicalGroup), Camden Physicians, CentraCareHealth System, and Park Nicollet HealthServices – have shown consistently highperformance on three of these four measures.

• Childhood Immunization rates haveincreased by more than 1.5 times sincereport year 2006 from 52 percent to77.5 percent.



17.1%

13.0%

32.6%

32.3%

65.4%

91.7%

85.8%

84.5%

76.5%

77.9%

62.8%

54.4%

43.6%

77.5%

3.6

2.5

N/A

N/A

0.1

0.4

1.4

3.8

1.0

0.3

3.1

5.1

2.8

3.1

3.6 (2 years)

9.1 (5 years)

N/A

N/A

0.1 (2 years)

17.9 (5 years)

0.1 (3 years)

2.7 (3 years)

1.2 (5 years)

0.1 (5 years)

4.5 (3 years)

6.8 (3 years)

14.5 (5 years)

25.5 (3 years)

PercentagePoint

ChangeOver Time

Quality Measure 2008 StatewideAverage

(2007 Dates ofServices)

Percentage PointChange

Statewide2007 vs. 2008

MN Community MeasurementStatewide Results Comparisons to Previous Years

Executive Summary

* These statewide averages are weighted (see methods). N/A = Measurement specifications changed so comparisons cannot be made.

“Living with Illness” measuresOptimal Diabetes Care*

(Clinic level results)

Optimal Diabetes Care*(Medical group level results)

Optimal Vascular Care*(Clinic level results)

Optimal Vascular Care*(Medical group level results)

Controlling High Blood Pressure*(Medical group level results)

Asthma Care (Ages 5-56)(Medical group level results)

“Getting Better” measuresAppropriate Treatment for Children with URI

(Medical group level results)

Appropriate Testing for Children with Pharyngitis(Medical group level results)


Breast Cancer Screening (Mammograms)(Medical group level results)

Cervical Cancer Screening (Pap tests)(Medical group level results)

Colorectal Cancer Screening*(Medical group level results)

Cancer Screening Combined*– Ages 51-80 (breast, cervical, colorectal)(Medical group level results)

Chlamydia Screening (Ages 16-25)(Medical group level results)

Childhood Immunizations*(Medical group level results)

© MN Community Measurement 2008. All rights reserved. May be used by participating provider groups as defined in the Medical Group Data Sharing Agreement.6


Executive Summary

Future Plans

From the beginning, MNCM has been dedicatedto reporting credible and comparable healthcare quality information on medical groupsand clinics. Today, many organizations viewMNCM as a community asset. Our results arebeing used by health plans and purchasers fortheir pay-for-performance programs. Medicalgroups and clinics are using the results tochange systems that support their qualityimprovement efforts. Other organizations areusing the results to provide consumers withinformation about the cost and quality of carefrom a medical group or clinic. And the resultsare used by state agencies, the media and othersto inform the public about health care qualityin our communities.

This report represents our initial effort to lookat MNCM data in new ways and we plan tocontinue investigating important questionsusing our data. The results will help us meetour mission to accelerate the improvementof health by publicly reporting health careinformation. We will be sharing our findingsin future reports.

Our future looks bright. Our Board of Directorsis committed to seeing that this work continuesto serve our community and add value towardimproving our health care system.For more information, contact Anne Snowden,MN Community Measurement,at [email protected].



Statewide public reporting efforts in Minnesota began when local health plans realized that bycombining their data they would have enough information to make comparisons on health careperformance at a medical group level. This community effort was originally managed andcoordinated by the Minnesota Council of Health Plans, and for two years, the results were sharedonly with the medical groups. In 2004, the results were made public for the first time. The releaseof the first public report led to the formation of an independent, 501(c)(3) organization calledMN Community Measurement (MNCM).

MNCM has since focused on public reporting of health care performance measurements throughoutMinnesota and border communities. MNCM uses measures that physicians agree are importantto their patients. Our measures cover conditions that affect a large number of patients and havea significant impact on cost and quality of life for patients. Our results prove that medical groupscan improve the quality of care for their patients. Public disclosure of these results allows physiciansto learn from others. And while it is true that a large portion of the responsibility for achievinggood results on selected measures lies with the patient, the data show that some physicians andcare teams are better at getting those results than others.

Our public reports have been used in positive ways to impact the care of patients. Clinicians andmembers of care teams have shared with us the ways in which they believe our measures andresults have contributed to system changes that have ultimately improved patients’ lives.

Here’s one example:

We don’t hear these stories every day, so we don’t always know how public reporting contributesto better health outcomes. Have we solved all of the challenges of measurement and public reporting?No, but this fifth annual report demonstrates that we are making progress. In this report,you’ll find new analyses that highlight medical groups that have been high performers since webegan public reporting, as well as those groups that have shown the greatest improvement.With the wealth of data we have collected, we are beginning to embark on deeper analyses tofurther inform health care quality improvement in Minnesota and border communities.

Introduction

My clinic leadership made a decision to focus on breast, cervical and colorectal cancer screeningwhen MNCM announced its new Cancer Screening Combined measure. We knew that the resultswould be reported publicly and that our medical group would be compared to our peers, and so weinstituted system changes to make sure that patients received these cancer screenings. These changesincluded reminders from physicians and clinic staff to patients about the importance of regular cancerscreenings. One of my patients came in for a mammogram after receiving a reminder and an earlystage breast cancer was detected. Her breast cancer was caught early and it made a difference in theoutcome. Had we not taken advantage of every opportunity – phone, mail and direct contact withher – I am convinced that she would not have had a mammogram. These system changes and thecommitment to carry them out made a difference in this patient’s life.


Measurement Changes

•

•

•

•

•

•

Report Changes

•

•

•

•

•

•


Changes in the 2008 Report

Retired the Optimal Coronary ArteryDisease (CAD) measure (clinic level results)and introduced Optimal Vascular Care(clinic level results) as a new measure.

Changed the blood pressure level for OptimalVascular Care measure (medical group levelresults). Last year, there were two bloodpressure targets: less than 140/90 for patientswith vascular care and less than 130/80 forpatients with vascular care and diabetes.This year, there is one blood pressure targetof less than 130/80 for all patients.

Reported Optimal Diabetes Care andOptimal Vascular Care measures clinic levelresults for those medical groups thatparticipated in the Direct Data Submission(DDS) process. If a medical group did notparticipate in DDS, we reported a medicalgroup level rate for these measures.

Added codes to identify Negative CompetingDiagnosis criteria for the Treatment forChildren with Upper Respiratory Infectionmeasure. This resulted in a major decreasein the denominators at the statewide andmedical group level, so some medical groupsmay no longer be reported for this measure.

Changed descriptions of age ranges for somemeasures (Cervical Cancer Screening,Colorectal Cancer Screening, andCancer Screening Combined) to reflect theage during the measurement period.

Suppressed some medical group rates for theChlamydia Screening in Women measuredue to continued technical coding issues.

Increased the total number of medicalgroups reported from 128 to 143.

Added more detailed descriptions to thefollowing sections: Data Sources and DataCollection; Measures; and Methods.

Added a Performance Highlights sectionafter every measure to direct attention tothe top performers in 2008, top performersover five years of public reporting, and tonote the groups that have achieved thebiggest improvements.

Added statewide results comparisons fromprevious years.

Added a section on Top Performers in 2008by Medical Group Type.

Added a section on Consistently High-Performing Medical Groups over five years.


Clinic Level

The clinic level results in this report were derivedfrom data submitted from medical groups onbehalf of individual clinics within their group.Medical groups submitted all data elementsspecified by MNCM through a Web-based portal.Each medical group was given the opportunityto report on a clinic’s total patient populationor a representative sample of the clinic’s entirepatient population. If a medical group electedto submit through this process, it was requiredto submit data for all clinics within the medicalgroup. In 2008, data were voluntarily submittedby 62 medical groups representing over 321clinic sites – double the number that agreed toparticipate in the previous year.

Supplying data to MNCM through the directdata submission (DDS) process is appealing tomost medical groups. DDS results reflect abroader representation of a medical group’spatient base not just their patients insuredthrough managed care. In addition, the DDSprocess allows MNCM to report results at theclinic level – a level that is more understandableto consumers and helps individual clinics betteridentify opportunities for improvement.Lastly, DDS results are available sooner thanresults collected through the health plan datacollection process. These clinic level results are alsodisplayed at the aggregated medical group level.

An extensive validation process using theNational Committee for Quality Assurance’s(NCQA) “8 and 30” File Sampling Procedure,developed in 1996 in consultation with JohnsHopkins University ensured that DDS resultswere reliable, complete and consistent.The audits were conducted by abstractors whoare independent of the medical groups andtrained by MNCM. Here is a summary of the“8 and 30” procedure MNCM follows:

•

•

•

•

•

•

•

•


Data Sources and Data Collection

MNCM randomly selected 33 medicalrecords (3 charts that were oversampled)for each clinic site.

Reviewers examined the first eight recordsof the clinic’s sample to verify compliancewith the submission instructions and thatthe data submitted matched the sourcedata. Compliance was defined as follows:

High (90-100%) - zero to three errors/areas out of complianceMedium (60-89%) – four to 12 errors/areas out of complianceLow (<60%) – more than 12 errors/areas found to be out of compliance

If all of the first eight records reviewed were incompliance, the clinic was in high compliance(90-100% of charts in compliance) and nofurther chart review was necessary.

If the first clinic site is in high complianceand the data submission process for all clinicsites within the medical group is identical,further review could be abbreviated at thediscretion of the reviewers.

If the clinic site was not in high compliance,the reviewers will continue to review theremaining 22 charts.

If after review of all 30 charts the clinic wasnot in high compliance on all factors, theMNCM auditors and clinic staff developeda mutually agreed-upon remedy or correctiveaction plan.

Clinic sites that were not in high compli-ance or had not been in high compliancein a previous MNCM audit were held tomore rigorous denominator certificationand on-site validation process.

The final report was completed after issueswere resolved and results finalized.

(continued on page 10)



Data Sources and Data Collection

Medical Group LevelThe medical group level data used for this reportwere derived from administrative claims fromhealth plans and/or medical record review.The data set reflects patients enrolled in managedcare plans including commercial HMO/POS/PPOproducts, Medicare Cost and Medicare Risk prod-ucts, Private Medicare fee-for-service products, andMinnesota Health Care Programs (PrepaidMedical Assistance including dual eligibles,MinnesotaCare, General Assistance Medical Care).These data do not include patients who are unin-sured, patients who self pay, or patients who areserved by Medicaid/Medicare fee-for-service.These data were collected by the health plans usingthe Healthcare Effectiveness Data and InformationSet,Volume2,HEDIS®2008:Technical Specifications(2007 dates of service). The data collection andreporting cycle was consistent with the annualHEDIS cycle. HEDIS is produced and maintainedby the National Committee for Quality Assurance(NCQA). The following 10 organizationscollected data for purposes of public reporting:

•••••••

••

•

Each health plan utilized an extensive validationprocess to ensure quality measures following thestandards described inVolume5,HEDISComplianceAudit®: Standards, Policies and Procedures:

•

•

•

•

•

•

To ensure further data integrity, validation checkswere instituted at multiple levels during the dataaggregation process before results were published:

•

•

•

•

•

•

Blue Cross and Blue Shield of MinnesotaFirstPlan of MinnesotaHealthPartnersMedicaMetropolitan Health PlanPreferredOnePrimeWest Health System

(county-based purchaser)Sanford Health PlanSouth Country Health Alliance

(county-based purchaser)UCare

All data files were submitted toMNCommunityMeasurement’s aggregation vendor for aggrega-tion and validation. Files were checked forproper formatting, missing and invalid values,and to confirm accurate record counts.Preliminary health plan rates were calculatedand returned to each health plan for validation.

Once these checks were finalized, the data fileswere aggregated. The aggregated data file wasthen checked for accurate record counts, andpreliminary MNCM rates were calculated.

The preliminary rates were carefullyreviewed by MNCM staff and the dataaggregation vendor. Particular attentionwas paid to trending and medical groupswith extremely low or high rates and/ornotable changes from the previous year.

After these checks were finalized, preliminaryrates were sent to medical groups for reviewand comment.

MNCM investigates any data concerns withthe data aggregation statistical team todetermine if the issues were related to thesubmitted data.

Publication of the final written report wascompleted after issues were resolved andresults finalized.

Health plan data were audited by an NCQA-certified HEDIS auditor.

Medical group level data validation includedtraining that is based on NCQA standardsfor every measure. Abstractors were testedon charts using inter-rater reliability exercisesthat must achieve a specified level of compliance.

NCQA vendors audited a specified percentageof charts per abstractor that required a speci-fied level of compliance (usually 90-100%).

If an abstractor was below the specified com-pliance level, further training was requireduntil the abstractor reached an acceptable levelof compliance specified by the health plan.

Some health plans required a second tier ofauditing, in which internal staff who weremedical record reviewers audited the samecharts again.

Most health plans had built-in data checks ontheir entry-screens for the data abstraction tool.



The measures in this 2008 Health Care Quality Report were recommended by MNCM’sReporting Advisory Committee and approved by our Board of Directors. Over the years, wehave expanded measures, retired some, and updated others to align with current evidence-basedguidelines. These changes are reflected in Table 1.

Measures


11

Medical Group Level Reporting (Data Source: Health Plans)

Appropriate Testing for Children with PharyngitisAppropriate Treatment for Children with Upper Respiratory InfectionChildhood Immunization (Combo 3)Childhood Immunization (Combo 2)Adolescent ImmunizationWell Child VisitsUse of Appropriate Medications for People with AsthmaBreast Cancer ScreeningCervical Cancer ScreeningColorectal Cancer ScreeningCancer Screening Combined (Breast, Cervical, Colorectal)Chlamydia Screening in WomenControlling High Blood Pressure (<140/90 mmHg)Optimal Diabetes Care (Old Targets)**Optimal Diabetes Care (New Targets)Optimal Vascular CareDepression Treatment-Acute Phase Medication ManagementDepression Treatment-Continuous Phase Medication Management

Total Medical Groups

Clinic Level Reporting (Data Source: Medical Groups)Optimal Diabetes CareOptimal Coronary Artery Disease (CAD) CareOptimal Vascular Care

Total Clinics (# Medical Groups/# Clinics)

Report Year2004 2005 2006 2007 2008

Table 1 - Clinical Performance Measures

*Blood Pressure <=140/90 mmHg**Optimal Diabetes Care (Old Targets): HbA1c <=8, Blood Pressure <130/85 mmHg, LDL-C <130 mg/dl, Aspirin Use, Tobacco Free

***HbA1c <7

XXX

XXXXXXX

X***X

143

X

X

62/321

XXX

XXXXXXX

X

128

XXX

28/191

XXXX

XXXXXXXX*XX

XX

104

XXXXXX

XX*XX

XX

54

XXXXXX

XX*XX

XX

51



Measures

12

With the development of the DDS process, we now have two reporting levels for measures – cliniclevel and medical group level. The newer clinic level measures are those calculated from medical groupdata submitted through the DDS process. The traditional medical group level results are calculatedusing health plan data – claims only or claims plus chart review – depending on the measure.

Measures are summarized in categories based on health care emphasis. In some cases the measuresassess how well medical groups care for patients with chronic conditions and are referred to as“Living with Illness” measures. Another category includes measures that reflect how well medicalgroups care for patients with common acute illnesses and are referred to as “Getting Better”measures. A third category includes measures that reflect how well medical groups keep individualshealthy and identify disease at an early stage when it can be treated most effectively. These measuresare referred to as “Staying Healthy” measures.

Clinic Level

The two clinic level measures in this report relied on data specifications published in the 2008 DirectData Submission Guide and are aligned with clinical guidelines established by the Institute forClinical Systems Improvement (ICSI). Specifications for clinic level results have been developedfor two measures – Optimal Diabetes Care and Optimal Vascular Care. Both of these measuresare Living with Illness measures.


• •


Optimal Vascular Care – Measures thepercentage of patients with vasculardisease ages 18-75 who reached all fourtreatment goals to reduce modifiable riskfactors. The treatment goals include bloodpressure less than 130/80 mmHg, LDL-Cless than 100 mg/dl, daily aspirin use anddocumented tobacco-free status.

Optimal Diabetes Care – Measures thepercentage of patients with diabetes(Types 1 and 2) ages 18-75 who reachedall five treatment goals to reduce the riskof cardiovascular diseases. The treatmentgoals include hemoglobin A1c (A1c) lessthan 7, blood pressure less than 130/80mmHg, LDL-C less than 100 mg/dl, dailyaspirin use (ages 41-75) and documentedtobacco-free status.



•

•

•

•

• •

Medical Group Level

The 12 medical group level measures in this report relied on NCQA’s HEDIS specifications, whichare aligned with ICSI’s clinical guidelines. HEDIS is a national set of standardized performancemeasures originally designed for the managed care industry. These measures have been adapted foruse by MNCM to track the performance of medical groups. These measures fall into all threecategories – Living with Illness, Getting Better and Staying Healthy.

Measures



Optimal Diabetes Care – Measures the per-centage of patients with diabetes (Type 1 andType 2) ages 18-75 who reached all five treat-ment goals to reduce the risk of cardiovasculardiseases. These treatment goals include hemo-globin A1c (A1c) less than 7, blood pressureless than 130/80 mmHg, LDL-C less than100 mg/dl, daily aspirin use (ages 41-75) anddocumented tobacco-free status.

Optimal Vascular Care – Measures thepercentage of patients with vascular diseaseages 18-75 who reached all four treatmentgoals to reduce modifiable risk factors.The treatment goals include blood pressureless than 130/80 mmHg, LDL-C less than100 mg/dl, daily aspirin use and documentedtobacco-free status.

Controlling High Blood Pressure –Measuresthe percentage of patients ages 18-85 witha diagnosis of hypertension whose bloodpressure was adequately controlled at lessthan 140/90 mmHg during the measurementyear. The representative blood pressure isthe most recent blood pressure readingduring the measurement year (as long asthe blood pressure occurred after thediagnosis of hypertension was made).

Use of Appropriate Medications for Peoplewith Asthma – Measures the percentageof patients ages 5-56 with persistent asthmain the measurement year and prior yearwho were appropriately prescribedmedication during the measurement year.

Appropriate Treatment for Children withUpper Respiratory Infection – Measuresthe percentage of children ages threemonths to 18 years with a diagnosis ofupper respiratory infection (URI) whowere not given an antibiotic prescriptionwithin three days of the episode period(July 1 of prior year to June 30 ofmeasurement year).

Appropriate Testing for Children withPharyngitis – Measures the percentage ofchildren ages 2-18 with pharyngitis (sorethroats) who were given an antibiotic anda group A streptococcus (strep) test for theepisode period (July 1 of prior year toJune 30 of measurement year).


Note: Vascular disease includes the following, as defined inthe HEDIS 2008 specifications for the measure CholesterolManagement for Patients With Cardiovascular Conditions(CMC): Acute Myocardial Infarction (AMI), coronary arterybypass graft (CABG), percutaneous transluminal coronaryangioplasty (PTCA) or ischemic vascular disease (IVD)

13



•

•

•

•

•

•

Measures

Breast Cancer Screening – Measures thepercentage of women ages 52-69 who hada mammogram during the measurementyear or prior year.

Cervical Cancer Screening – Measures thepercentage of women ages 24-64 whoreceived one or more Pap tests to screenfor cervical cancer in the measurementyear or the two years prior.

Colorectal Cancer Screening – Measuresthe percentage of adults ages 51-80 who hadappropriate screening for colorectal cancerin the measurement year and prior year.

Cancer Screening Combined – Measuresthe percentage of adults ages 51-80 whoreceived appropriate cancer screeningservices (breast, cervical, colorectal).A patient must be up-to-date for all threecomponents to be considered up-to-datefor this measure. This measure uses thesame denominator as the Colorectal CancerScreening measure. For this combinedmeasure, males receive an automatic “pass”for the breast and cervical cancer screeningcomponents.

Chlamydia Screening – Measures the per-centage of sexually active women aged 16-25who had at least one test for chlamydiainfection during the measurement year.

Childhood Immunization Status (Combo 3)– Measures the percentage of children twoyears of age who had four DTaP/DT, threeIPV, one MMR, three H influenza type B,three Hepatitis B, one VZV, and fourpneumococcal conjugate vaccines withinthe HEDIS specified time period and bytheir second birthday.


14



Clinic Level

MNCM’s 2008 Direct Data Submission Guide(2008 DDS Guide) provided the measurementspecifications for two measures – OptimalDiabetes Care and Optimal Vascular Care.Medical groups could participate in DDS using eitherelectronic health records (EHR) or paper charts.

Eligible Population SpecificationsThe eligible populations for these measures wereidentified and pulled by each medical group onbehalf of their individual clinics utilizing theirbusiness practice management systems or EHR.The 2008 DDS Guide provided the standarddefinitions for the eligible population thatincluded age, timeframe for look back to identifythe clinic’s current patient panel, number ofvisits needed in the measurement timeframe,and appropriate diagnosis codes.

Patient Attribution to Medical GroupsMedical groups determined the attribution systemof patients to physicians and physicians to clinic.Each medical group’s patient attribution methodwas reviewed by MNCM as part of the fieldvalidation process.

Sampling from Total PopulationMedical groups had the option to submit fullpopulation data or a sample of 60 patients perclinic. For medical groups that chose to submita sample, the 2008 DDS Guide describedaccepted methods to select a systematic sample.For each measure, a minimum threshold of 30patients per clinic site was established forpurposes of public reporting.

Numerator SpecificationsFor clinic level measures, the numerator was thenumber of patients from the eligible populationor the sample who met measurement criteria.

Calculating RatesClinic level rates were calculated as 100 timesthe number who met the measurement specifi-cations divided by the number eligible for themeasure. Rates from measures using the totaleligible population were straightforward calcu-lations whereby the total eligible populationserved as the denominator. For clinics thatelected to sample their populations, the ratescalculated for the measures required weightingto account for the total eligible population.Rates and 95 percent confidence intervals werecalculated for each measure for each clinic.Clinic level rates were reported as percentages.Clinic level rates were first calculated for eachclinic and then an overall clinic rate averagewas calculated. The clinic average rate is usedwhen comparing a single clinic to the perform-ance of all clinics.

LimitationsBecause participation was voluntary, medicalgroups that participated in DDS do not representall medical groups that serve patients inMinnesota. Additionally, not every clinicwithin a given medical group was publiclyreported due to small numbers of patients.Although medical groups were required tosubmit data for all clinics within the group,some individual clinic sites did not meet theminimum thresholds for public reporting.

Methods

15




Medical Group Level

Measurement specifications for medical grouplevel results were calculated using NCQA’sHEDIS® 2008: Technical Specifications alongwith MNCM-specific numerator specificationsfor some measures. All medical groups inMinnesota are reported for medical group levelmeasures if they meet minimum reportingrequirements based on the number of patients.Medical Group inclusion in this report forthese measures is not voluntary.

Eligible Population SpecificationsThe eligible populations for the measures in thisreport were identified by each participatinghealth plan utilizing its respective administrativedatabases. NCQA’s HEDIS® 2008: TechnicalSpecifications provided the standard definitionsfor the eligible population, which includedpatients who satisfied all specified criteria,including age, continuous enrollment, benefit, andevent or anchor date enrollment requirements.

Medical group level measures were calculatedusing either an administrative method or ahybrid method. The measures that are calculatedusing the administrative method are whollyderived from health plan claims data, whilemeasures calculated using the hybrid method arederived from a combination of health planclaims data and medical record review data.Claims data tell us that a test of health servicewas performed, but not its value or outcome.Medical records are reviewed for selected measuresto determine a value or outcome. For example,a health plan claim will tell us that a cholesteroltest was administered, while a review of themedical record will tell us the test showed thepatients LDL, or bad cholesterol level, was lessthan 130 mg/dl. For administrative measures,the entire eligible population is the denominator.

A minimum threshold of 30 patients per medicalgroup was established for public reporting forthese measures. For hybrid measures, the eligiblepopulation serves as the sampling frame fromwhich to draw the denominator. For each hybridmeasure, a minimum threshold of 60 patientsper medical group was established for purposesof public reporting.

The following measures used the administrativemethod:

•

•

•

•

•

•

The following measures used the hybridmethod:

•

•

•

•

•

•

16


Appropriate Testing for Childrenwith Pharyngitis

Appropriate Treatment for Childrenwith Upper Respiratory Infection

Breast Cancer Screening

Cervical Cancer Screening

Chlamydia Screening

Use of Appropriate Medicationsfor People with Asthma

Cancer Screening Combined

Childhood Immunization Status (Combo 3)

Controlling High Blood Pressure

Colorectal Cancer Screening

Optimal Vascular Care

Optimal Diabetes Care

Methods



Patient Attribution to Medical GroupsHealth plans assigned patients to a medicalgroup using a frequency-based attribution logicand a standard medical group definition.Administrative billing codes identified thefrequency of patient visits to medical groupsduring the measurement year. Patients wereassigned to the medical group that they visitedmost frequently. Patients who visited two ormore medical groups with the same frequencywere attributed to the medical group visitedmost recently. MNCM, in collaboration withthe health plans and medical groups, establisheda standard definition of medical groups using acommon identifier, the tax identification number.This common identifier, updated annually, isnecessary for data aggregation from multiplehealth plans.

Sampling for Hybrid MeasuresAs noted previously, the hybrid method requiredeach participating health plan to identify the eligiblepopulation that met measurement specificationsusing its administrative databases. This populationof eligibles served as the sampling frame fromwhich to draw the denominator (the patients forwhommedical record review would be completed).The resource-intensive nature of medical recordreview necessitates a random sample of the eligiblepopulation. Medical record review was conductedfor all enrollees drawn for the sample.

MNCM used a two-stage, random samplingprocess. This strategy was designed withstatisticians to ensure reporting for the maximumnumber of medical groups while minimizing theimpact of weighting on the results. As in previousyears, NCQA served as the sampling vendor forall hybrid measures. The sampling procedurestarted with the health plans providing NCQAwith a data file containing a record for each eligiblepatient for each hybrid measure. The file

identified eligible patients that had been selectedfor the HEDIS sample by the plans. Additionalpatients were then selected by NCQA from theremaining eligible population to meet MNCMminimum reporting requirements.

Numerator SpecificationsFor administrative measures, the numerator is thenumber of patients from the eligible populationwho met measurement criteria. For hybridmeasures, the numerator is the number ofpatients from the sample who met measurementcriteria.

WeightingBecause data for hybrid measures were takenfrom a sample, the results were weighted toobtain accurate rates. This allowed for aggregationand unbiased reporting by medical group.Weighting is a cost-saving measure that enablesMNCM to draw a sample on which to estimatemedical group and statewide rates. Weighting isapplied to efficiently utilize health planresources for data collection on a randomlysampled population.

Weights were calculated for each samplingstratum (i.e. health plan/health plan product /medical group). A weight was equal to the totaleligible population for that stratum divided bythe total sample size. In calculating rates for apopulation – for example, a medical group orstatewide – the denominator was the sum of theweights for all patients in that population,and the numerator was the sum of the weightsfor patients in the population who met themeasurement specifications.

17


Methods



Calculating RatesRates were expressed as percentages. They werecalculated as 100 times the number who metthe measurement specifications divided by thenumber who were eligible for the measure.Rates calculated for measures using theadministrative method were straightforward.However, rates calculated for measures usingthe hybrid method required weighting becauseof the sampling procedures. Rates and 95-percent-asymmetrical confidence intervals werecalculated for each measure for each medicalgroup. Asymmetrical confidence intervals wereused to avoid confidence interval lower-boundvalues less than zero.

RatesRates were calculated at both a statewide leveland at a medical group level. Statewide ratesinclude those patients attributed to a medicalgroup AND those who could not be attributedto a medical group (i.e., all patients regardlessof medical group affiliation). Medical groupaverage rates include ONLY those patients whowere attributed to medical groups. This rate isused when comparing a single medical groupto the performance of all medical groups.The medical group average may be slightlyhigher than the statewide average, because itincluded patients who accessed care morefrequently.

LimitationsThe medical groups identified in this report donot fully represent all medical groups in Minnesota.This is because MNCM has established minimumthresholds for public reporting. Only medicalgroups that met these minimum reportingthresholds were included. At the same time,the medical groups that are included may not bereported for all medical group level measures.

The medical group level data reflect patientsinsured through a managed care delivery system.Because the data reflects patients with insurancecoverage, it does not include the uninsured,patients who self pay, or patients served by afee-for-service delivery system. Therefore, thedata will not represent a medical group’s entirepatient population.

Caution is recommended when makingcomparisons from year to year. Annual ratedifferences can occur due to natural variation,changes in measurement specifications, changesin data sources and other factors.

18

Methods



(2007 Dates of Service)

Results by Measure


Optimal Diabetes Care (Clinic Level Results)

* Statewide averages (above) include those patients attributed to a medical group AND those who could not be attributed to a medical group.Note: Caution is needed when making comparisons from year to year.


This measures the percentage of patients withdiabetes (Type I and Type II) 18 - 75 whoreached all of the following five treatment goalsto reduce cardiovascular risk:

• Hemoglobin A1c (HBA1c) less than 7• Blood pressure less than 130/80 mmHg• LDL-cholesterol less than 100 mg/dl• Daily aspirin use, ages 41-75• Documented tobacco-free status

This composite rate is calculated using anall-or-none method. Credit is given for achievingthis measure when all five components are met.The data collected for this measure are reporteddirectly to MNCM by medical groups and clinicsfrom electronic health records or paper-basedmedical charts.

TotalEligible95% CI

Optimal Diabetes Care 16.8%-17.3%17.1% 15,772 83,034 130,019

StatewideAverage*(Weighted)



100%90%80%70%60%50%40%30%20%10%0%


2007 Report 2008 Report

14% 17%

Numerator(Patients whomettreatment goals)

Denominator( Patients sampled)




Fairview Oxboro ClinicFairview RidgeValley ClinicQuello Clinic - Eden PrairieFairview Ridges ClinicFairview Mesaba Clinic - Mountain IronFHSM - Inver Grove HeightsFairview Hugo ClinicFairview Eagan ClinicFairview Crosstown ClinicFairview North Branch ClinicAllina Medical Clinic - LitchfieldFairview Highland Park ClinicFairview Lakeville ClinicMankato Clinic - North MankatoRichfield Medical GroupFairview CedarRidge ClinicFairview Uptown ClinicAllina Medical Clinic - IslesFamily Practice Medical Center of WillmarFairview Northeast ClinicAALFA Family ClinicFHSM - Afton RoadFHSM - Banning Avenue OfficeFHSM - North St. Paul ClinicHealthEast - MaplewoodAllina Medical Clinic - West Health CampusAllina Medical Clinic - BuffaloHealthPartners - Inver Grove HeightsFairview Chisago Lakes ClinicFairview Lino Lakes ClinicFHSM - Woodlane Family PracticeMankato Clinic - MapletonFairview EdenCenter ClinicFairview Red Wing Medical CenterHealthEast - OakdaleSt. Cloud Medical Group - SouthWWMA - Ellsworth Medical ClinicMeritCare - Island ParkMeritCare - Black DuckFairview Elk River ClinicMeritCare - North FargoAllina Medical Clinic - Coon RapidsFrance Avenue Family PhysiciansAllina Medical Clinic - Elk RiverAllina Medical Clinic - The Doctors UptownHealthPartners - ComoAllina Medical Clinic - FarmingtonAllina Medical Clinic - CokatoCamden Physicians - PlymouthFHSM - Gorman ClinicFHSM - ShoreviewHealthEast - Midway

1,174204629476060102470345305336288736860607223184448431976060606028645031328924160108454734606060248894222252,63433723115873223912060606060

n*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 17% Lower Confidence Level/Upper Confidence Level

FHSM - Family HealthServices MinnesotaHCMC - Hennepin County Medical CenterHP - HealthPartnersHFA - Hennepin Faculty Associates

AMC - Allina Medical ClinicACMC - Affilliated Community Medical CentersCPMG - Columbia Park Medical GroupFCHS - Fremont Community Health Services

MNCOME - Minnesota Center for Obesity,Metabolism, and Endocrinology

NMC - North Memorial ClinicSCMG - St. Cloud Medical Group

SMDC - St. Mary’s/Duluth ClinicUMP - University of Minnesota

PhysiciansWWMA - Western Wisconsin

Medical Associates

Endocrinology *n= sample size

Living

with

Illne

ss



Optimal Diabetes Care (Clinic Level Results) – continued

Fairview Hiawatha ClinicAllina Medical Clinic - Forest LakeFairview Milaca ClinicAllina Medical Clinic - AnnandaleFairview Lakes Medical CenterHealthPartners - Apple ValleyFairview Jonathan ClinicFHSM - White Bear OfficeInnovis Health - LisbonAllina Medical Clinic - West St. PaulFairview Rush City ClinicAllina Medical Clinic - RamseyAllina Medical Clinic - EaganHealthEast - WoodburyCentraCare - MelroseFHSM - Maplewood OfficeHealthEast - Vadnais HeightsAllina Medical Clinic - ShoreviewFairview Princeton ClinicACMC - Granite Falls ClinicHealthPartners - Arden HillsMeritCare - Twin ValleyMeritCare - Desk 35MeritCare - MahnomenWinona Clinic - WinonaMankato Clinic - Daniel’s Health CenterHutchinson Medical CenterPark Nicollet Clinic - Maple GroveACMC - Redwood Falls ClinicAllina Medical Clinic - Maple GroveACMC - New London ClinicHealthPartners - Health Center for WomenMNCOMEHealthEast - Cottage GroveSouthdale Internal MedicineSCMG - Cold Spring Medical ClinicWWMA - New Richmond ClinicMankato Clinic -Wickersham CampusApple Valley Medical ClinicAllina Medical Clinic - WoodburyBurnsville Family PhysiciansAllina Medical Clinic - ShakopeeFairview Zimmerman ClinicHealthPartners - WestHealthPartners - WoodburyAllina Medical Clinic - Nicollet MallPark Nicollet Clinic - St. Louis Park Int. Med.Allina Medical Clinic - ChamplinAllina Medical Clinic - WoodlakeHealthPartners - White Bear LakeFHSM - Vadnais Heights OfficeInnovis Health - Moorhead

492405253104928406141606066222647035212060606035666916643757682711207720035640726212918012060606060701,0115982433151873998204281,0334246883976060

n*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 17%







Medical Associates

Lower Confidence Level/Upper Confidence LevelEndocrinology *n= sample size




Innovis Health - South UniversityWWMA - Spring Valley Medical ClinicMeritCare - Southpointe Family MedicineSt. Mary’s/Duluth Clinic - HaywardMeritCare - Southpointe Internal MedicineQuello Clinic - LakevilleSteven Saliterman, MDPark Nicollet Clinic - MinnetonkaAllina Medical Clinic - Cottage GroveAllina Medical Clinic - EdinaMeritCare - PerhamQuello Clinic - SavageSt. Mary’s/Duluth Clinic - SpoonerFairview Red Wing Downtown ClinicSt. Mary’s/Duluth Clinic - HermantownPark Nicollet Clinic - Prairie CenterAllina Medical Clinic - North BranchFairview Maple Grove Medical CenterCentraCare - Diabetes CenterHealthEast - Rice StreetMayo Clinic - Baldwin BuildingHealthPartners - Coon RapidsWWMA - River Falls Medical ClinicHealthPartners - BloomingtonSMDC- General Internal MedicineHealthPartners - RiversideAMC - United Medical SpecialtiesPark Nicollet Clinic -Carlson/MinnetonkaMeritCare - Bemidji Internal MedicineAllina Medical Clinic - HastingsFamily Medicine of WinonaACMC - Marshall ClinicFairview Red Wing Ellsworth ClinicFHSM - Larpenteur OfficeFHSM - Maryland ClinicFHSM - Woodbury OfficeHealthEast - RoselawnInnovis Health - Thief River FallsUMP - Phalen ClinicHealthPartners - RiverWay AnokaPark Nicollet Clinic - WayzataMeritCare-South Moorhead Internal MedicinePark Nicollet - St. Louis Park Fam. Med.ACMC - Willmar ClinicHealthPartners - Brooklyn CenterMeritCare - JamestownAllina Medical Clinic - NorthfieldPark Nicollet Clinic - BrookdaleNorth Memorial Clinic -Minnetonka PhysiciansPark Nicollet Clinic - Golden ValleyFairview Red Wing Zumbrota ClinicHealthPartners - RiverWay Andover

606038649562834841166457284284143393170606263433860606062010658413238071,179660673559374738716060606060607233743326341,2797643784271,314129502163504

n*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 17%







Medical Associates

Living

with

Illne

ss





CPMG - Fridley Plaza ClinicQuello Clinic - Centennial LakesStevens Community Medical CenterWinona Clinic - LewistonPark Nicollet Clinic - CreeksideACMC - Benson ClinicSt. Mary’s/Duluth Clinic - ElyCamden Physicians - Maple GroveCamden Physicians - MinneapolisCentraCare - Heartland St. CloudCentraCare - Heartland St. JosephCentraCare - Internal Medicine PlazaHealthPartners - North Suburban Lino LakesInnovis Health - NorthportNMC - Brooklyn Park PhysiciansAMC - Cambridge Medical CenterPark Nicollet Clinic - BloomingtonSt. Mary’s/Duluth Clinic - SuperiorAllina Medical Clinic - MoraMeritCare - MayvilleACMC - Litchfield ClinicMankato Clinic - Blue EarthMeritCare - HillsboroHealthPartners - Health Specialty CenterHealthPartners - MaplewoodPark Nicollet Clinic - ChanhassenPark Nicollet Clinic - BurnsvilleMankato Clinic - Main StreetSt. Mary’s/Duluth Clinic - International FallsPark Nicollet Clinic - PlymouthCPMG - Columbia Park ClinicAspen Medical Group - MaplewoodFHSM - Highland Family PhysiciansHealthEast - Downtown St. PaulHealthPartners Central Minnesota ClinicsInnovis Health - JamestownNorthwest Family Physicians - Rogers OfficeSCMG - Clearwater Medical ClinicUMP - Smiley’s ClinicFairview Mesaba Clinic - NashwukPark Nicollet Clinic - EaganMeritCare - South Moorhead Family MedicineNorth Clinic -WestHealth Office in PlymouthSt. Mary’s/Duluth Clinic - AshlandHealthPartners - MidwayCPMG - Andover Park ClinicMeritCare - East Grand ForksPark Nicollet Clinic - MinneapolisGlencoe Regional Health ServicesQuello Clinic - BurnsvilleStillwater Medical Group - Curve Crest ClinicAllina Medical Clinic - Faribault

12041365521892494116060606060606060961574929432115204901049175574751,0441324784201206060606060606060304932446167936110312772712047773553

n*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 17%







Medical Associates





Park Nicollet Clinic - ShakopeePark Nicollet Clinic - HopkinsSt. Mary’s/Duluth Clinic - HibbingHealthPartners - St. PaulSt. Mary’s/Duluth Clinic - LakesideMeritCare - WalkerWWMA - Hudson PhysiciansHealthEast - Macalester/GrovelandInnovis Health - FosstonInnovis Health - WahpetonInnovis Health - WalkerSilver Lake Clinic - ShoreviewSilver Lake Clinic - St. AnthonyUnited Family Practice Health CenterUMP - Primary Care CenterSt. Mary’s/Duluth Clinic - AuroraPark Nicollet Clinic - Prior LakeMeritCare - WahpetonAllina Medical Clinic - HinkleyMeritCare - Detroit LakesHealthPartners - RiverWay Elk RiverHP - Center for International HealthSt. Mary’s/Duluth Clinic - WestMeritCare - Bemidji Family MedicineSt. Mary’s/Duluth Clinic - Deer RiverCPMG - Blaine ClinicMulticare Associates - Fridley Medical CenterRenville County Hospital and Clinics - HectorSt. Mary’s/Duluth Clinic - ChisholmMeritCare - Valley CityAspen Medical Group - BloomingtonCentraCare - Long PrairieHealthPartners - North Suburban RosevilleInnovis Health - West AcresInnovis Health - West FargoLakeview Clinic - ChaskaNMC - Golden Valley PhysiciansNMC - Northeast Family PhysiciansNorthwest Family Physicans - Plymouth OfficeNorthwest Family Physicians - Crystal OfficeSt. Cloud Medical Group - NorthwestUMP - Medicine 6 Clinic, EndocrineNMC - Plymouth Internal MedicineMeritCare - Bemidji NorthNorth Clinic - Maple Grove OfficeMankato Clinic - Lake CrystalFairview Mesaba Clinic - HibbingCentraCare - Internal Medicine River CampusConsultants Internal MedicineHFA - Internal Medicine ClinicRiverside Family PhysiciansHealthEast - Salud Integral

56356864879533311112060606060606060602601663501324413352647375093341128477772726060606060606060606060606110262921206060606036

n*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 17%







Medical Associates

Living

with

Illne

ss





St. Mary’s/Duluth Clinic - VirginiaMeritCare - West FargoMeritCare - EndocrinologyHFA - Hennepin Center for Senior CareNorth Memorial Clinic - Elk River PhysiciansAlexandria ClinicCPMG - Brooklyn Park ClinicFamily Medical Center - Little FallsAspen Medical Group - White Bear LakeFCHS - Central Avenue ClinicInnovis Health - Detroit LakesLakeview Clinic - WaconiaCarlos Fernandez MD ClinicLakeville Integrative Medicine ClinicPark Nicollet Clinic - Endocrine P3800NorthPoint Health & Wellness CenterNorth Clinic - Oakdale Office in RobbinsdaleMeritCare - Pelican RapidsMeritCare - Cass LakeRenville County Hospital and Clinics - RenvilleAspen Medical Group - Bandana SquareAspen Medical Group - HighlandAspen Medical Group - Inver Grove HeightsCentraCare - Heartland BeckerCentraCare - Heartland Family MedicineHFA - HCMC Family Medical CenterHFA - Hennepin Care South ClinicHFA - HCMC Internal Medicine ClinicHFA - Hennepin Family Care East Lake ClinicInnovis Health - Valley CityLakeview Medical ClinicNew Spirit Women’s ClinicStillwater Medical Group - Somerset ClinicNorth Clinic - Osseo OfficeMeritCare - New York MillsEdina Sports Health & WellnessMeritCare - HawleyCommunity-University Health Care CenterFremont Community Health ServicesHFA - Hennepin Care North ClinicInnovis Health - Park RapidsLakeview Clinic - WatertownUMP - Bethesda ClinicMulticare Associates - Blaine Medical CenterRenville County Hospital and Clinics - OliviaAspen Medical Group - HopkinsLakeview Clinic - NorwoodUMP - Broadway Family MedicineAspen Medical Group - East Lake Street

67950327951104120120120606060603030

2,73861627949546060606060606060606060606162153181476060606060604110860606060

n*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 17%







Medical Associates




High Performers in 2008

Clinic level results showed that an average of 17 percent of patients with diabetes met all fiverequired components included in this measure. Fairview Oxboro Clinic set the benchmark of 48percent of diabetes patients in full compliance with all five diabetes-care components. There were77 of 321 clinics with rates and confidence intervals fully above the clinic level average. The highperforming clinics are listed below in alphabetical order under the heading of their medical groupname:

High Performers over Five YearsNot applicable.

Biggest ImprovementsThe greatest improvement since report year 2007 in Optimal Diabetes Care (clinic level results) wasmade by Allina Medical Clinic - Litchfield with a 24 percentage point increase.

Performance Highlights – Clinic Level Results

AALFA Family ClinicAffiliated Community MedicalCenters

• Granite Falls Clinic• Redwood Falls Clinic

Allina Medical Clinic• Annandale• Buffalo• Cokato• Coon Rapids• Eagan• Elk River• Farmington• Forest Lake• Isles• Litchfield• Maple Grove• Ramsey• Shoreview• The Doctors Uptown• West Health Campus• West St. Paul• Woodbury• Woodlake

Apple Valley Medical ClinicCamden Physicians

• PlymouthFairview Health Services

• CedarRidge Clinic• Chisago Lakes Clinic• Crosstown Clinic• Eagan Clinic

• EdenCenter Clinic• Elk River Clinic• Hiawatha Clinic• Highland Park Clinic• Hugo Clinic• Jonathan Clinic• Lakes Medical Center• Lakeville Clinic• Lino Lakes Clinic• Milaca Clinic• North Branch Clinic• Northeast Clinic• Oxboro Clinic• Princeton Clinic• Red Wing Medical Center• Ridges Clinic• RidgeValley Clinic• Rush City Clinic• Uptown Clinic

Fairview Mesaba Clinic• Mountain Iron

Family HealthServices Minnesota• Afton Road• Banning Avenue Office• Gorman Clinic• Inver Grove Heights• North St. Paul Clinic• Shoreview• Woodlane Family Practice

Family Practice Medical Centerof Willmar

France Avenue Family Physicians

HealthEast• Maplewood• Midway• Oakdale

HealthPartners Medical Group• Apple Valley• Arden Hills• Como• Inver Grove Heights• West• Woodbury

Mankato Clinic• Mapleton• North Mankato

Merit Care• Black Duck• Desk 35• Island Park• North Fargo

Park Nicollet Health Services• Maple Grove• St. Louis Park

Internal MedicineQuello Clinic

• Eden PrairieRichfield Medical GroupSt. Cloud Medical Group

• SouthWestern Wisconsin MedicalAssociates

Living

with

Illne

ss



Optimal Diabetes Care (Clinic Level Results by Medical Group)

Richfield Medical GroupFamily Practice Medical Center of WillmarFairview Health ServicesAALFA Family ClinicFrance Avenue Family PhysiciansFamily HealthServices MinnesotaAllina Medical ClinicWinona ClinicHutchinson Medical CenterHealthEastMNCOMESouthdale Internal MedicineApple Valley Medical ClinicBurnsville Family PhysiciansMankato ClinicSteven Saliterman, MDCamden PhysiciansMayo ClinicSt. Cloud Medical GroupHealthPartners Medical GroupAffiliated Community Medical CentersFamily Medicine of WinonaQuello ClinicWestern Wisconsin Medical AssociatesFairview Mesaba ClinicMeritCareStevens Community Medical CenterSt. Mary’s/Duluth Clinic Health SystemPark Nicollet Health ServicesInnovis HealthCentraCare Health SystemHealthPartners Central Minnesota ClinicsColumbia Park Medical GroupGlencoe Regional Health ServicesStillwater Medical GroupNorth Memorial ClinicSilver Lake ClinicUnited Family Practice Health CenterNorthwest Family PhysiciansUniversity of Minnesota PhysiciansConsultants Internal MedicineRiverside Family PhysiciansMulticare AssociatesAlexandria ClinicNorth ClinicFamily Medical CenterCarlos Fernandez MD ClinicLakeville Integrative Medicine ClinicAspen Medical GroupNorthPoint Health & Wellness CenterRenville County Hospital and ClinicsLakeview ClinicHennepin Faculty AssociatesFremont Community Health ServicesLakeview Medical ClinicNew Spirit Women's ClinicEdina Sports Health & WellnessCommunity-University Health Care Center

6044810,6659733784014,729172200696120601,011243637411806024011,03531723741,4434062107,62465

8,38213,26084054079575120134474120601803606060125120247146303048061239240415131606018160

n*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Clinic Average 17%

MNCOME - Minnesota Center for Obesity, Metabolism, and Endocrinology Lower Confidence Level/Upper Confidence LevelEndocrinology *n= sample size




Clinic level results by medical group showed that an average of 17 percent of patients with diabetesmet all five required components included in this measure. Fairview Health Services, FamilyPractice Medical Center of Willmar, and Richfield Medical Group set the benchmark of 33 percentof diabetes patients in full compliance with all five diabetes care components. There were 10 of58 medical groups with rates and confidence intervals fully above the medical group level average.The high performing medical groups are listed below:

High Performers over Five Years

Not applicable.

Biggest Improvements

The greatest improvements since report year 2007 in Optimal Diabetes Care were made byFamily Practice Medical Center of Willmar, Fairview Health Services, Allina Medical Clinic andMayo Clinic with each achieving greater than a 10 percentage point increase.

Performance Highlights – Clinic Level Results by Medical Group

• Fairview Health Services• Family Practice Medical Center of Willmar• Richfield Medical Group• AALFA Family Clinic• France Avenue Family Physicians• Family HealthServices Minnesota• Allina Medical Clinic• HealthEast• Apple Valley Medical Clinic• HealthPartners Medical Group

Living

with

Illne

ss


Optimal Diabetes Care^ (Medical Group Level Results)


This measures the percentage of patients withdiabetes (Type I and Type II) 18 - 75 whoreached all of the following five treatment goalsto reduce the risk of cardiovascular diseases:

• Hemoglobin A1c (A1c) less than 7• Blood pressure less than 130/80 mmHg• LDL-C less than 100 mg/dl• Daily aspirin use (ages 41-75)• Documented tobacco-free status

This rate is calculated using an all-or-nonemethod. Credit is given for achieving thismeasure when all five components are met.Data collected for this measure are fromhealth plan claims and medical record review.


TotalEligible

Denominator( Patients sampled)95% CI

Optimal Diabetes Care 12.3%-13.7%13.0% 969 9,429 66,069




100%90%80%70%60%50%40%30%20%10%0%

Optimal Diabetes Care (Medical Group Level Results)

2004 Report 2005 Report 2006 Report 2007 Report 2008 Report

^ Note: Medical groups that did not participate in direct datasubmission (DDS) are presented for this measure if they metminimum sampling thresholds (see methodology).

4% 6% 10% 10% 13%


Endocrinology Lower Confidence Level /Upper Confidence Level



Minnesota Rural Health CooperativeEdina Family PhysiciansCrossroads Medical CentersOlmsted Medical CenterAllina Health SystemBrainerd Medical CenterNorthstar PhysiciansMayo Health SystemNeighborhood Health Care NetworkBuffalo ClinicBloomington Lake ClinicSanford ClinicGundersen ClinicMark P. Stesin, MDRiverwood Aitkin ClinicCentral Lakes Medical ClinicGrand Itasca ClinicFergus Falls Medical GroupSuperiorHealth CenterRegina Medical CenterSt. Luke’s ClinicsAltru Health SystemAvera Health/Avera Tri-StateEndocrinology Clinic Of Mpls.

101626286101801362442018895847462688663896763111738863

Optimal Diabetes Care (Medical Group Level Results) n*

Medical Group Average 13%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

*n= sample size

Living

with

Illne

ss




Medical group level results showed that an average of 13 percent of patients with diabetes metall five required components included in this measure. Among the groups reported at the medicalgroup level for Optimal Diabetes Care, Minnesota Rural Health Cooperative set the benchmarkof 21 percent of diabetes patients in full compliance with all five diabetes care components.Out of the 23 medical groups reported, Minnesota Rural Health Cooperative was the one groupthat had a rate and confidence intervals fully above the medical group level average for patients.(This group did not participate in the direct data submission process for this measure).

High Performers over Five Years

Throughout five years of public reporting, the following medical groups achieved consistently highperformance for Optimal Diabetes Care.

Biggest Improvements

The greatest improvement since report year 2007 in Optimal Diabetes Care (medical group level)was made by Minnesota Rural Health Cooperative with a 13 percentage point increase.

The greatest improvements over the last five years in Optimal Diabetes Care were made byHealthPartners Clinics and Affiliated Community Medical Centers each with an increase of14 percentage points since report year 2004.

Note: The high performers and biggest improvements over the last five years for this measure included all medical groups that were reported atthe medical group level using health plan data. (For this report, a policy decision was made to only report one Optimal Diabetes Care rate permedical group. If a medical group participated in DDS, MNCM only reported their DDS diabetes rate. In other words, they are not includedin the previous chart. If a medical group did not participate in DDS, MNCM listed them in the previous chart if minimum thresholds were met.)

Although most of the medical groups listed above are not represented in the previous chart because they participated in DDS, they are notedhere because health plan data was necessary to calculate the high performers and biggest improvers over five years.

Performance Highlights – Medical Group Level Results

• HealthPartners Clinics• Fairview Health Services• Camden Physicians• Park Nicollet Health Services• Family HealthServices Minnesota




Living

with

Illne

ss


Optimal Vascular Care (Clinic Level Results)


This measures the percentage of patients ages18-75 who have vascular disease and havereached all of the following four treatmentgoals to reduce the risk of cardiovascular disease:

• Blood pressure less than 130/80 mmHg• LDL-C less than 100 mg/dl• Daily aspirin use• Documented tobacco-free status

This composite rate is calculated using an all-or-nonemethod. Credit is given for achieving this measurewhen all four components are met. The datacollected for this measure are reported directly toMNCM by medical groups and clinics from electronichealth records or paper-based medical charts.

95% CI

Optimal Vascular Care 32.4%-33.4%32.6% 11,997 36,126 54,708




No trend chart since measurement specifications changed from last year

TotalEligible



* Statewide averages (above) include those patients attributed to a medical group AND those who could not be attributed to a medical group.

35


Optimal Vascular Care (Clinic Level Results)

Fairview RidgeValley ClinicFHSM - Afton RoadHealthPartners - ComoFairview Oxboro ClinicFairview Ridges ClinicFHSM - Gorman ClinicFHSM - Maplewood OfficeHealthPartners - Arden HillsFHSM - White Bear OfficeFairview Uptown ClinicFairview Eagan ClinicFairview Chisago Lakes ClinicHealthPartners - MaplewoodHealthPartners - Inver Grove HeightsFairview North Branch ClinicFHSM - Vadnais Heights OfficeHealthEast - MidwayFairview Milaca ClinicPark Nicollet Clinic - Prairie CenterHealthPartners - WestFHSM - Inver Grove HeightsQuello Clinic - SavageQuello Clinic - Eden PrairiePark Nicollet Clinic - MinnetonkaPark Nicollet Clinic - EaganFairview Crosstown ClinicSPHC - Lakeview Heart CenterHealthPartners - BloomingtonFHSM - Woodbury OfficeFHSM - Woodlane Family PracticeFairview Highland Park ClinicAllina Medical Clinic - ShoreviewFHSM - Banning Avenue OfficeHealthPartners - Apple ValleyInnovis Health - South UniversitySt. Paul Heart Clinic - DowntownUMP - Primary Care CenterPark Nicollet Clinic - CarlsonHealthPartners - WoodburyPark Nicollet Clinic - Maple GroveCamden Physicians - PlymouthMankato Clinic - North MankatoSouthdale Internal MedicineWinona Clinic - WinonaPark Nicollet Clinic - St. Louis Park Int. Med.FHSM - ShoreviewFairview Rush City Clinic

1061403743572971541392321144215010218012710399605273138210423855130175601877637107791171576060602822807760606010438765112

n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lower Confidence Level/Upper Confidence Level

Clinic Average 33%

HCMC - Hennepin County Medical CenterHFA - Hennepin Faculty AssociatesMNCOME-Minnesota Center for Obesity,

Metabolism, and EndocrinologyNMC - North Memorial ClinicSCMG - St. Cloud Medical Group

AMC - Allina Medical ClinicACMC - Affilliated Community Medical CentersCPMG - Columbia Park Medical GroupFHSM - Family HealthServices MinnesotaHP - HealthPartners

SMDC - St. Mary’s/Duluth ClinicSPHC - St. Paul Heart ClinicUMP - University of Minnesota PhysiciansWSCHS - West Side Community Health ServicesWWMA - Western Wisconsin Medical Associates

Cardiology *n = sample size

Living

with

Illne

ss

36


Optimal Vascular Care (Clinic Level Results) – continued

SCMG - Clearwater Medical ClinicAllina Medical Clinic - Nicollet MallHealthEast - WoodburyHealthPartners - White Bear LakeFairview CedarRidge ClinicHealthPartners - North Suburban RosevilleAllina Medical Clinic - Forest LakePark Nicollet - St. Louis Park Fam. Med.WWMA - River Falls Medical ClinicAllina Medical Clinic - LitchfieldFairview Elk River ClinicFairview Jonathan ClinicPark Nicollet Clinic - HopkinsMankato Clinic - Wickersham CampusCamden Physicians - MinneapolisHealthEast - OakdaleHP - North Suburban Lino LakesFHSM - North St. Paul ClinicAllina Medical Clinic - West Health CampusHealthPartners - RiversideHealthPartners - St. PaulNMC - Brooklyn Park PhysiciansHealthPartners - Coon RapidsFairview Red Wing Medical CenterPark Nicollet Clinic - BurnsvilleFHSM - Larpenteur OfficeAllina Medical Clinic - BuffaloCPMG - Andover Park ClinicAspen Medical Group - HighlandCentraCare - Internal Medicine PlazaHealthEast - MaplewoodRichfield Medical GroupWWMA - Ellsworth Medical ClinicFrance Avenue Family PhysiciansHealthPartners - Brooklyn CenterFairview Lino Lakes ClinicFairview EdenCenter ClinicFamily Practice Medical Center of WillmarMankato Clinic - Main StreetAllina Medical Clinic - Coon RapidsPark Nicollet Clinic - Golden ValleyFairview Lakes Medical CenterAllina Medical Clinic - The Doctors UptownHealthEast - Downtown St. PaulMayo Clinic - Baldwin BuildingSt. Paul Heart Clinic - MaplewoodWWMA - New Richmond Clinic

4916012015813260148233120135113521617260606088150135242692543772351242156560606060608123068971921167712204667660606060

n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 33%







37



Allina Medical Clinic - HastingsMulticare Associates - Blaine Medical CenterNorth Clinic - Maple Grove OfficeAMC - United Medical SpecialtiesPark Nicollet Clinic - WayzataAllina Medical Clinic - Elk RiverAllina Medical Clinic - WoodlakeACMC - Marshall ClinicFHSM - Maryland ClinicCamden Physicians - Maple GroveCentraCare -Central Minnesota Heart CenterSt. Cloud Medical Group - NorthwestFairview Northeast ClinicApple Valley Medical ClinicHealthPartners - RiverWay AndoverPark Nicollet Clinic - BloomingtonMeritCare - Bemidji Internal MedicinePark Nicollet Clinic - ShakopeeSt. Mary’s/Duluth Clinic - HaywardMeritCare - Desk 35Park Nicollet Clinic - BrookdaleQuello Clinic - Centennial LakesHealthPartners - Health Specialty CenterQuello Clinic - LakevilleAllina Medical Clinic - NorthfieldHealthPartners - RiverWay Elk RiverMeritCare - North FargoFHSM - Highland Family PhysiciansHealthEast - Cottage GroveInnovis Health - LisbonMeritCare - Preventive CardiologyACMC - Redwood Falls ClinicWWMA - Hudson PhysiciansPark Nicollet Clinic - PlymouthHealthPartners - MidwayFairview Princeton ClinicHealthPartners - RiverWay AnokaPark Nicollet Clinic - ChanhassenAllina Medical Clinic - ChamplinHutchinson Medical CenterAllina Medical Clinic - RamseyAllina Medical Clinic - EaganHP - Center for International HealthAllina Medical Clinic - West St. PaulAllina Medical Clinic - Maple GroveCentraCare - Internal Medicine River CampusCentraCare - Melrose

1876647861717337517710060606012331821719140014830145627417438416699909084606026612785140104240191161931831757244258606060

n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 33%







Living

with

Illne

ss

38



Innovis Health - Thief River FallsAllina Medical Clinic - WoodburyMeritCare - Island ParkPark Nicollet Clinic - Prior LakeAllina Medical Clinic - ShakopeeCPMG - Brooklyn Park ClinicNorth Clinic - Osseo OfficeMeritCare - Southpointe Internal MedicineAllina Medical Clinic - IslesACMC - Benson ClinicAspen Medical Group - MaplewoodSilver Lake Clinic - ShoreviewMeritCare - Black DuckSt. Mary’s/Duluth Clinic - LakesideAMC - Cambridge Medical CenterMeritCare-South Moorhead Internal MedicineLakeview Clinic - ChaskaHealthEast - RoselawnFairview Hiawatha ClinicAllina Medical Clinic - FarmingtonFairview Red Wing Downtown ClinicPark Nicollet Clinic - CreeksideWWMA - Spring Valley Medical ClinicSMDC - General Internal MedicineBurnsville Family PhysiciansConsultants Internal MedicineSMDC - HermantownACMC - Willmar ClinicSt. Mary’s/Duluth Clinic - HibbingAllina Medical Clinic - MoraAllina Medical Clinic - FaribaultMeritCare - PerhamQuello Clinic - BurnsvilleHealthEast - Vadnais HeightsMNCOMECentraCare - Long PrairieLakeview Clinic - WaconiaNorthwest Family Physicians - Crystal OfficeUMP - Outpatient Cardiovascular CenterAllina Medical Clinic - EdinaInnovis Health - West AcresSt. Mary’s/Duluth Clinic - SpoonerNorth Clinic - Oakdale Office in RobbinsdaleNorth Clinic - WestHealth Office in PlymouthMeritCare - WahpetonPark Nicollet Clinic - MinneapolisSt. Mary’s/Duluth Clinic - Ashland

601711225510710775416596660604017733818554341334179554299281603391593161131352141335212060606060188342166161199111452

n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 33%






Cardiology *n = sample sizeEndocrinology

39



Stillwater Medical Group - Curve Crest ClinicHealthPartners - Health Center for WomenCentraCare - Heartland St. JosephStillwater Medical Group - Somerset ClinicMeritCare - West FargoMeritCare - Bemidji Family MedicineFamily Medicine of WinonaMeritCare - Southpointe Family MedicineSt. Mary's/Duluth Clinic - ElyCPMG - Fridley Plaza ClinicGlencoe Regional Health ServicesSt. Cloud Medical Group - SouthCPMG - Blaine ClinicSt. Mary’s/Duluth Clinic - SuperiorMeritCare - South Moorhead Family MedicineMeritCare - MahnomenSteven Saliterman, MDSMDC - International FallsCPMG - Columbia Park ClinicRidgeview Westonka ClinicMeritCare - JamestownLakeview Clinic - NorwoodSt. Mary's/Duluth Clinic - WestACMC- Litchfield ClinicMeritCare - Detroit LakesFairview Red Wing Zumbrota ClinicFairview Zimmerman ClinicFairview Mesaba Clinic - HibbingMeritCare - East Grand ForksAlexandria ClinicMeritCare - Valley CityUMP - Smiley's ClinicAspen Medical Group - East Lake StreetAspen Medical Group - Inver Grove HeightsCentraCare - Heartland Family MedicineInnovis Health - Park RapidsMeritCare - WalkerMeritCare - MayvilleSt. Mary’s/Duluth Clinic - VirginiaAllina Medical Clinic - Cottage GroveMeritCare - HillsboroMeritCare - New York MillsInnovis Health - FosstonFamily Medical Center - Little FallsAspen Medical Group - BloomingtonHealthEast - Rice StreetHealthPartners Central Minnesota Clinics

7350545820021211120324012072605247315149492271201252515540469311574410210212016532606060606074368154678344120606060

n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 33%







Living

with

Illne

ss

40



Innovis Health - Detroit LakesWSCHS - East Side Family ClinicLakeview Medical ClinicMeritCare - HawleyNMC - Plymouth Internal MedicineNMC- Elk River PhysiciansNMC - Golden Valley PhysiciansInnovis Health - WalkerNMC - Northeast Family PhysiciansAspen Medical Group - Bandana SquareAspen Medical Group - White Bear LakeCentraCare - Heartland St. CloudHFA - Internal Medicine ClinicSt. Mary’s/Duluth Clinic - Deer RiverSt. Mary’s/Duluth Clinic - AuroraNorthwest Family Physicans - Plymouth OfficeNMC - Minnetonka PhysiciansWSCHS - La ClinicaMulticare Associates - Fridley Medical CenterHFA - Hennepin Care North ClinicCommunity-University Health Care CenterInnovis Health - WahpetonMeritCare - Bemidji NorthNorthwest Family Physicians - Rogers OfficeUMP - Phalen ClinicBrainerd Medical CenterAspen Medical Group - HopkinsEdina Sports Health & WellnessLakeview Clinic - WatertownHFA - HCMC Family Medical CenterHFA - Hennepin Care South ClinicRidgeview Chanhassen ClinicFremont Community Health ServicesUMP - Bethesda ClinicSilver Lake Clinic - St. AnthonySt. Mary’s/Duluth Clinic - ChisholmCentraCare - Heartland BeckerInnovis Health - JamestownHFA - HCMC Internal Medicine ClinicMeritCare - Pelican RapidsHFA - Hennepin Center for Senior CareUMP - Broadway Family MedicineRidgeview Excelsior Clinic

60303131736364323860606060191149607943564438535360471215441556146784041603553376036436036

n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 33%

Lower Confidence Level/Upper Confidence LevelCardiology *n = sample size








Clinic level results showed that an average of 33 percent of patients with vascular disease met allfour required components included in this measure. Fairview RidgeValley Clinic set the benchmarkof 62 percent of vascular disease patients in full compliance with all four vascular care components.There were 57 of 335 clinics with rates and confidence intervals fully above the clinic level average.The high performing clinics are listed below in alphabetical order under the heading of theirmedical group name:


Biggest ImprovementsNot applicable because measurement specification changed in 2008.

Performance Highlights – Clinic Level Results

Allina Medical Clinic• Coon Rapids• Forest Lake• Litchfield• Nicollet Mall• Shoreview

Fairview Health Services• CedarRidge Clinic• Chisago Lakes Clinic• Crosstown Clinic• Eagan Clinic• Highland Park Clinic• Hugo Clinic• Lakes Medical Center•Milaca Clinic• North Branch Clinic• Oxboro Clinic• Red Wing Medical Center• Ridges Clinic• RidgeValley Clinic• Rush City Clinic• Uptown Clinic

Family HealthServicesMinnesota

• Afton Road• Banning Avenue Office• Gorman Clinic• Inver Grove Heights•Maplewood Office• Vadnais Heights Office•White Bear Office•Woodbury Office

HealthEast• Midway•Woodbury

HealthPartners MedicalGroup

• Apple Valley• Arden Hills• Bloomington• Como• Coon Rapids• Inver Grove Heights•Maplewood• St. Paul•West•White Bear Lake•Woodbury

Innovis Health• South University

Park Nicollet Health Services• Burnsville• Carlson• Eagan• Hopkins•Maple Grove•Minnetonka• Prairie Center• St. Louis Park FamilyMedicine

• St. Louis ParkInternal Medicine

Quello Clinic• Savage

St. Paul Heart• Downtown• Lakeview Heart Center

University of MinnesotaPhysicians

• Primary Care CenterWinona Clinic

• Winona

Living

with

Illne

ss



Optimal Vascular Care (Clinic Level Results by Medical Group)

Family HealthServices MinnesotaSouthdale Internal MedicineWinona ClinicFairview Health ServicesHealthPartners Medical GroupSt. Paul HeartCamden PhysiciansMankato ClinicPark Nicollet Health ServicesRichfield Medical GroupFrance Avenue Family PhysiciansFamily Practice Medical Center of WillmarMayo ClinicHealthEastApple Valley Medical ClinicWestern Wisconsin Medical AssociatesQuello ClinicAllina Medical ClinicSt. Cloud Medical GroupHutchinson Medical CenterCentraCare Health SystemAffiliated Community Medical CentersInnovis HealthBurnsville Family PhysiciansConsultants Internal MedicineNorth ClinicUniversity of Minnesota PhysiciansMeritCareColumbia Park Medical GroupMulticare AssociatesMNCOMEStillwater Medical GroupSt. Mary’s/Duluth Clinic Health SystemFamily Medicine of WinonaGlencoe Regional Health ServicesSteven Saliterman, MDLakeview ClinicNorth Memorial ClinicAspen Medical GroupAlexandria ClinicNorthwest Family PhysiciansFairview Mesaba ClinicFamily Medical CenterLakeview Medical ClinicSilver Lake ClinicRenville County Hospital and ClinicsWestside Community Health CenterRidgeview ClinicsCommunity-University Health Care CenterBrainerd Medical CenterEdina Sports Health & WellnessFremont Community Health ServicesHennepin Faculty Associates

1,547601063,6603,8941801803193,1766081192605933183675534,59519618352762556681602443004,5204641231201314,8801117249224386474120180122143311203773280381214165332

n*

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Clinic Average 33%

Lower Confidence Level/Upper Confidence Level *n= sample sizeMNCOME - Minnesota Center for Obesity, Metabolism, and Endocrinology Cardiology




Clinic level results by medical group showed that an average of 33 percent of patients with vasculardisease met all four required components included in this measure. Family HealthServices Minnesotaset the benchmark of 46 percent of vascular patients in full compliance with all four vascularcare components. There were 10 of 53 medical groups with rates and confidence intervals fullyabove the medical group level average. The high-performing medical groups are listed below:


Biggest ImprovementsNot applicable.

Performance Highlights – Clinic Level Results by Medical Group

• Family HealthServices Minnesota• Fairview Health Services• Winona Clinic• HealthPartners Medical Group• St. Paul Heart• Camden Physicians• Mankato Clinic• Park Nicollet Health Services• HealthEast• Allina Medical Clinic

Living

with

Illne

ss


Optimal Vascular Care^ (Medical Group Level)


This measures the percentage of patients ages18-75 who have vascular disease and havereached all of the following four treatmentgoals to reduce the risk of cardiovascular disease:

• Blood pressure less than 130/80 mmHg• LDL-C less than 100 mg/dl• Daily aspirin use• Documented tobacco-free status

This composite rate is calculated using an all-or-nonemethod. Credit is given for achieving this measurewhen all four components are met. Data collectedfor this measure are from health plan claims andmedical record review.

95% CI

Optimal Vascular Care 30.9%-33.6%32.3% 1,257 4,575 15,905




No trend chart since measurement specifications changed from last year

^ Note: Medical groups that did not participate in direct datasubmission (DDS) are presented for this measure if they metminimum sampling thresholds (see methodology).

TotalEligible






Allina Health SystemMetropolitan Cardiology ConsultantsMinnesota Heart ClinicOlmsted Medical CenterBuffalo ClinicMinneapolis Heart InstitiuteNorthstar PhysiciansSt. Luke’s ClinicsMayo Health SystemMinnesota Rural Health Cooperative

70606867656670729270

Optimal Vascular Care (Medical Group Level Results) n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Cardiology Lower Confidence Level /Upper Confidence Level *n= sample size

Living

with

Illne

ss




Medical group level results showed that an average of 33 percent of patients with vascular diseasemet all four required components included in this measure. Among the groups reported at themedical group level for Optimal Vascular Care, Allina Health System set the benchmark of 59percent of vascular disease patients in full compliance with all four vascular care components.Two of 10 medical groups had rates and confidence intervals fully above the medical group averagefor patients. These groups did not participate in the direct data submission process for this measure:


Biggest ImprovementsNot applicable because measurement specification changed in 2008.


• Allina Health System• Metropolitan Cardiology Consultants




Living

with

Illne

ss


Controlling High Blood Pressure (Medical Group Level Results)



This measures the percentage of patients ages18-85 with a diagnosis of hypertension, orhigh blood pressure, whose blood pressurewas adequately controlled at less than140/90 mmHg during the measurement year.The representative blood pressure is the mostrecent blood pressure reading during themeasurement year (as long as the blood pressureoccurred after the diagnosis of hypertensionwas made).

Data collected for this measure are from health planclaims and medical record review.

95% CI

BP < 140/90 mmHg 64.4%-66.3%65.4% 6,529 10,324 130,831




TotalEligible



100%90%80%70%60%50%40%30%20%10%0%

Controlling High Blood Pressure (Medical Group Level Results)

2007 Report 2008 Report

65% 65%



Affiliated Community Medical CentersNorthwest Family PhysiciansFamily HealthServices MinnesotaOlmsted Medical CenterHealthPartners ClinicsAlexandria ClinicFairview Health ServicesInnovis HealthPark Nicollet Health ServicesAllina Medical ClinicHealthEastBloomington Lake ClinicUnited Family Practice Health CenterMayo ClinicMulticare Associates of the Twin CitiesSt. Cloud Medical GroupSt. Mary’s/Duluth Clinic Health SystemMankato ClinicCentral Lakes Medical ClinicRidgeview ClinicsColumbia Park Medical GroupBuffalo ClinicNorthstar PhysiciansNorth ClinicFergus Falls Medical GroupMayo Health SystemMeritCareSt. Luke’s ClinicsStillwater Medical GroupQuello ClinicCamden PhysiciansBroadway Medical CenterAspen Medical GroupAllina Health SystemBrainerd Medical CenterNorth Memorial ClinicSilver Lake ClinicHennepin CountySanford ClinicEdina Family PhysiciansNeighborhood Health Care NetworkWestern Wisconsin Medical AssociatesUniversity of Minnesota PhysiciansCentraCare Health SystemMinnesota Rural Health CooperativeLakeview ClinicFairview MesabaHutchinson Medical CenterAvera Health/Avera Tri-StateSuperiorHealth Center

1286518682

1,26971472121411712171628470676523973666914065183927326913811765766996201839710864507231661886521511115967658711270

Controlling High Blood Pressure (Medical Group Level Results) n*

Living

with

Illne

ss

Lower Confidence Level /Upper Confidence Level

Medical Group Average 66%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

*n= sample size




Medical group level results showed that an average of 66 percent of patients with high blood pressureappropriately controlled. Affiliated Community Medical Centers, Northwest Family Physicians andFamily HealthServices Minnesota set the benchmark of 80 percent of patients with controlled highblood pressure. Nine of 50 medical groups had rates and confidence intervals that were fully abovethe medical group average.


Biggest ImprovementsThe greatest improvements since report year 2007 in Controlling High Blood Pressure (medical grouplevel) were made by St. Cloud Medical Group, Bloomington Lake Clinic and Northwest FamilyPhysicians, with each achieving greater than a 22 percentage point increase.


• Affiliated Community Medical Centers• Northwest Family Physicians• Family HealthServices Minnesota• Olmsted Medical Center• HealthPartners Clinics• Alexandria Clinic• Fairview Health Services• Park Nicollet Health Services• Allina Medical Clinic




Living

with

Illne

ss


100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Use of Appropriate Medications for People with Asthma (Ages 5-56)

74% 76%

92%91%91%



Use of Appropriate Medications for People with Asthma (Ages 5-56)(Medical Group Level Results)

This measures the percentage of patients ages5-56 with persistent asthma who were appro-priately prescribed medication.

The data for this measure are collected from healthplan claims.

Asthma

Asthma


NumeratorStatewideAverage* Denominator

91.3% - 92.0%91.7% 17,405 18,991

95% CI




Edina Sports Health & WellnessBurnsville Family PhysiciansMetropolitan Pediatric SpecialistsGundersen ClinicChildren’s Physician NetworkHutchinson Medical CenterRegina Medical CenterNorthwest Family PhysiciansGrand Itasca ClinicAffiliated Community Medical CentersBloomington Lake ClinicFamily Medicine of WinonaStillwater Medical GroupAlexandria ClinicCentraCare Health SystemSt. Cloud Medical GroupApple Valley Medical ClinicAllina Health SystemBroadway Medical CenterCamden PhysiciansBrainerd Medical CenterFrance Avenue Family PhysiciansColumbia Park Medical GroupSt. Croix Regional Medical CenterFairview Health ServicesWestern Wisconsin Medical AssociatesSilver Lake ClinicMayo Health SystemAvera Health /Avera Tri-StateNorth Memorial ClinicHealthPartners ClinicsPark Nicollet Health ServicesAllina Medical Clinic

313011071

1,4683735101672566330250732592107992351041003216745

1,106131834101081301,8141,2301,560

Use of Appropriate Medications for People with Asthma – Ages 5-56 (Medical Group Level Results) n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lower Confidence Level /Upper Confidence Level *n = sample size

Living

with

Illne

ss



Family Practice Medical Center of WillmarMankato ClinicMinnesota Rural Health CooperativeMayo ClinicMulticare Associates of the Twin CitiesFamily HealthServices MinnesotaFamily Medical Center - Little Falls and PierzHealthPartners Central Minnesota ClinicsHennepin CountyUniversity of Minnesota PhysiciansAspen Medical GroupLakeview ClinicInnovis HealthRidgeview ClinicsBuffalo ClinicQuello ClinicCentral Lakes Medical ClinicHealthEastEdina Family PhysiciansCrossroads Medical CentersSt. Mary’s/Duluth Clinic Health SystemFergus Falls Medical GroupAltru Health SystemSanford ClinicMeritCareOlmsted Medical CenterNorth ClinicSuperiorHealth CenterSt. Luke’s ClinicsNeighborhood Health Care NetworkNorthstar PhysiciansWinona ClinicFairview MesabaUnited Family Practice Health Center

48189220104104401561101621803871851951021631323032768583674414516632914813749110139145733236

Use of Appropriate Medications for People with Asthma – Ages 5-56 (Medical Group Level Results)–continued n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%




St. Cloud Medical GroupBuffalo ClinicCentraCare Health SystemMetropolitan Pediatric SpecialistsLakeview ClinicAffiliated Community Medical CentersChildren’s Physician NetworkStillwater Medical GroupMankato ClinicWestern Wisconsin Medical AssociatesMulticare Associates of the Twin CitiesMayo Health SystemMinnesota Rural Health CooperativeFamily HealthServices MinnesotaHealthEastHealthPartners ClinicsHennepin CountyAvera Health /Avera Tri-StateColumbia Park Medical GroupAllina Medical ClinicSanford ClinicAspen Medical GroupOlmsted Medical CenterPark Nicollet Health ServicesFairview Health ServicesMeritCareSt. Mary’s/Duluth Clinic Health SystemAltru Health SystemUniversity of Minnesota PhysiciansInnovis HealthMayo ClinicNeighborhood Health Care NetworkNorthstar Physicians

93591251027080

1,32271683430143846310153372535231063926026629496132526156346138

Use of Appropriate Medications for Children with Asthma – Ages 5-17 (Medical Group Level Results) n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Living

with

Illne

ss



Gundersen ClinicChildren’s Physician NetworkAffiliated Community Medical CentersNorthwest Family PhysiciansStillwater Medical GroupBloomington Lake ClinicGrand Itasca ClinicCamden PhysiciansMayo ClinicApple Valley Medical ClinicSilver Lake ClinicFairview Health ServicesCrossroads Medical CentersFrance Avenue Family PhysiciansAlexandria ClinicColumbia Park Medical GroupNorth Memorial ClinicAllina Health SystemCentraCare Health SystemPark Nicollet Health ServicesHealthPartners Central Minnesota ClinicsSt. Croix Regional Medical CenterWestern Wisconsin Medical AssociatesBrainerd Medical CenterEdina Family PhysiciansSt. Cloud Medical GroupHealthPartners ClinicsAllina Medical ClinicMayo Health SystemAvera Health/Avera Tri-StateUniversity of Minnesota PhysiciansInnovis HealthFamily HealthServices MinnesotaQuello ClinicFamily Practice Medical Center of WillmarAspen Medical GroupMulticare Associates of the Twin CitiesMinnesota Rural Health CooperativeMankato ClinicRidgeview ClinicsHennepin CountySt. Mary’s/Duluth Clinic Health SystemHealthEastFamily Medical Center - Little Falls and PierzAltru Health SystemMeritCareSuperiorHealth CenterSt. Luke’s ClinicsLakeview ClinicNorthstar PhysiciansBuffalo ClinicNeighborhood Health Care NetworkSanford ClinicNorth ClinicOlmsted Medical CenterWinona Clinic

54146176811795050937067648124530441151106813496487379771591171,2811,250267551191393381043029574136121859023522639932333488115107104781031218850

Use of Appropriate Medications for Adults with Asthma – Ages 18 - 56 (Medical Group Level Results) n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%





Medical group level results showed that an average of 92 percent of patients with persistent asthmaages 5-56 were appropriately prescribed medication. Metropolitan Pediatric Specialists set thebenchmark of 99 percent. Six of 68 medical groups had rates and confidence intervals fullyabove the medical group average:


Biggest ImprovementsThe greatest improvement since report year 2007 in Appropriate Medication for People with Asthma(medical group level) was made by SuperiorHealth Center with a 12 percentage point increase.


• Metropolitan Pediatric Specialists• Gundersen Clinic• Children’s Physician Network• Affiliated Community Medical Centers• Stillwater Medical Group• CentraCare Health System

Living

with

Illne

ss


Appropriate Treatment for Children with Upper Respiratory Infection



85.5% - 86.1%85.8% 35,868 41,812

95% CI

Appropriate Treatment for Childrenwith Upper Respiratory Infection



This measures the percentage of children agesthree months to 18 years with a diagnosis ofupper respiratory infection (URI) who werenot given an antibiotic prescription withinthree days.

The data collected for this measure are fromhealth plan claims. Note: A higher rate indicatesappropriate treatment of children with URI(i.e., the proportion for whom antibiotics werenot prescribed).

100%90%80%70%60%50%40%30%20%10%0%


2006 Report 2007 Report 2008 Report

86% 86%84%





Getting

Bette

r



University of Minnesota PhysiciansAALFAHennepin CountyGundersen ClinicPhysicians Urgent CareSilver Lake ClinicMille Lacs ClinicsUnited Clinics of Faribault CountyHealthPartners ClinicsNorth Memorial ClinicHealthEastGrand Itasca ClinicNorth ClinicExpress HealthcareHealthPartners Central Minnesota ClinicsCamden PhysiciansNeighborhood Health Care NetworkBuffalo ClinicChildren’s Physician NetworkMayo ClinicUnited Family Practice Health CenterAllina Health SystemWestHealth Urgent CareSuperiorHealth CenterMinuteClinicPark Nicollet Health ServicesQuello ClinicThe Doctor’s Office - Urgent CareLakeview ClinicMeritCareNorthwest Family PhysiciansAspen Medical GroupMetropolitan Pediatric SpecialistsColumbia Park Medical GroupStillwater Medical GroupFergus Falls Medical GroupChaska Urgent CareFairview Health ServicesFamily Practice Medical Center of WillmarAllina Medical ClinicHutchinson Medical CenterFamily HealthServices MinnesotaMulticare Associates of the Twin CitiesUnity Family Healthcare - AvonPriority Pediatrics Urgent CareMid Minnesota Family Medicine Center

4913422612572487146

2,4292674291621172112561203215144,92436987148154669552,1711391813168701394891,31532341216086

2,2381162,697189388201479354

Appropriate Treatment for Children with Upper Respiratory Infection (Medical Group Level Results) n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lower Confidence Level /Upper Confidence LevelUrgent /Convenience Care *n= sample size



Western Wisconsin Medical AssociatesRegina Medical CenterSanford ClinicOsceola Medical CenterAffiliated Community Medical CentersCatalyst Medical ClinicOlmsted Medical CenterRiverwood Aitkin ClinicSuburban Emergency AssociatesFoley Medical CenterInnovis HealthWinona Health Physicians ClinicMankato ClinicApple Valley Medical ClinicSt. Joseph’s Family ClinicsRidgeview ClinicsMaple Grove Urgent CareSt. Mary’s/Duluth Clinic Health SystemBrainerd Medical CenterBloomington Lake ClinicSt. Luke’s ClinicsFairview MesabaNorthstar PhysiciansWinona ClinicAlexandria ClinicMayo Health SystemCentraCare Health SystemCrossroads Medical CentersPaynesville Area Health Care SystemAltru Health SystemMinnesota Rural Health CooperativeTri-County Hospital Clinics - Wadena Medical CenterFamily Medical Center - Little Falls and PierzSt. Croix Regional Medical CenterSt. Cloud Medical GroupRiverview ClinicsLakewood Health SystemCentral Lakes Medical ClinicBroadway Medical CenterSouthern Metro Medical ClinicsEdina Family PhysiciansAvera Health/Avera Tri-StateFamily Medicine of WinonaDr. Bobby K. Yang Medical Clinic

2711125634073039514695631467307053919813543781422522041172441661801,5066826268395661138117972771161507928991505313331

Appropriate Treatment for Children with Upper Respiratory Infection (Medical Group Level Results) –continued n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Getting

Bette

r





Medical group level results showed an average of 86 percent of children ages three months to 18 years,with a diagnosis of URI, were appropriately managed without antibiotic. University of MinnesotaPhysicians set the benchmark of 97 percent. Twenty-six of 91 medical groups had rates andconfidence intervals fully above the medical group average:


Biggest ImprovementsThe greatest improvements since report year 2007 in Appropriate Treatment for Children with URI(medical group level) were made by Maple Grove Urgent Care and United Clinics of FaribaultCounty each with a 20 percentage point increase.


• University of Minnesota Physicians• Hennepin County• Gundersen Clinic• Physicians Urgent Care•Mille Lacs Clinics• HealthPartners Clinics• North Memorial Clinic• HealthEast• Grand Itasca Clinic• North Clinic• Express Healthcare• HealthPartners Central Minnesota Clinics• Camden Physicians

• Neighborhood Health Care Network• Buffalo Clinic• Children’s Physician Network•Mayo Clinic• Allina Health System•WestHealth Urgent Care•MinuteClinic• Park Nicollet Health Services• Lakeview Clinic•MeritCare•Metropoitan Pediatric Specialists• Fairview Health Services• Allina Medical Clinic




Getting

Bette

r



84.2% - 84.9%84.5% 29,607 35,026

95% CI

Appropriate Testing forChildren with Pharyngitis


Appropriate Testing for Children with Pharyngitis(Medical Group Level Results)

This measures the percentage of children ages 2-18with pharyngitis who were given an antibioticand a group A streptococcus (strep) test.

The data collected for this measure are fromhealth plan claims. Note: A higher rate representsbetter performance (i.e., appropriate testing).

100%90%80%70%60%50%40%30%20%10%0%

Appropriate Testing for Children with Pharyngitis


82% 81% 85%

Appropriate Testing for Children with Pharyngitis






Getting

Bette

r



MinuteClinicPriority Pediatrics Urgent CareSilver Lake ClinicMulticare Associates of the Twin CitiesSt. Francis Medical Clinic - Urgent CarePhysicians Urgent CareBaldwin Area Medical CenterExpress HealthcareMaple Grove Urgent CareColumbia Park Medical GroupWestHealth Urgent CareCamden PhysiciansStillwater Medical GroupChildren’s Physician NetworkThe Doctor’s Office - Urgent CareHealthPartners ClinicsFamily Practice Medical Center of WillmarNorthwest Family PhysiciansParkview Medical ClinicPark Nicollet Health ServicesFairview Health ServicesFoley Medical CenterUnity Family Healthcare - AvonUniversity of Minnesota PhysiciansBloomington Lake ClinicEdina Family PhysiciansHealthEastApple Valley Medical ClinicRegina Medical CenterNeighborhood Health Care NetworkChaska Urgent CareRidgeview ClinicsHealthPartners Central Minnesota ClinicsNorthstar PhysiciansSouthern Metro Medical ClinicsBuffalo ClinicCentraCare Health SystemQuello ClinicUnited Family Practice Health CenterCrossroads Medical CentersSt. Croix Regional Medical CenterWestern Wisconsin Medical AssociatesScenic Rivers Health ServicesAspen Medical GroupWinona ClinicSt. Joseph’s Family Clinics

1,64112170257499645267114446281625164,5421611,473762101301,8061,90994851115555465318164174109145238235126418445221421711192794434750106

Appropriate Testing for Children with Pharyngitis (Medical Group Level Results) n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lower Confidence Level /Upper Confidence LevelUrgent /Convenience Care *n = sample size



North ClinicFamily HealthServices MinnesotaPaynesville Area Health Care SystemAllina Medical ClinicCatalyst Medical ClinicCentral Lakes Medical ClinicGrand Itasca ClinicGundersen ClinicOlmsted Medical CenterMid Minnesota Family Medicine CenterAllina Health SystemLakeview ClinicSt. Cloud Medical GroupNorth Memorial ClinicRiverwood Aitkin ClinicSt. Luke’s ClinicsHennepin CountyFamily Medical Center - Little Falls and PierzSuburban Emergency AssociatesAlexandria ClinicAmery Regional Medical CenterTri-County Hospital Clinics - Wadena Medical CenterInnovis HealthHutchinson Medical CenterMille Lacs ClinicsLakewood Health SystemAffiliated Community Medical CentersMankato ClinicMayo ClinicSt. Mary’s/Duluth Clinic Health SystemMayo Health SystemMinnesota Rural Health CooperativeSanford ClinicMeritCareWinona Health Physicians ClinicBrainerd Medical CenterFergus Falls Medical GroupBroadway Medical CenterAltru Health SystemStevens Community Medical Center - MorrisAvera Health /Avera Tri-StateRiverview ClinicsFairview MesabaMetropolitan Pediatric SpecialistsDr. Bobby K. Yang Medical Clinic

8125980

2,096633714044301471803563141126915510978522055112442910377895654831263921,1055842435813327896103267463631149272173

Appropriate Testing for Children with Pharyngitis (Medical Group Level Results) – continued n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Getting

Bette

r





Medical group results showed that an average of 85 percent of children ages 2-18 years who werediagnosed with pharyngitis were appropriately dispensed an antibiotic and received a strep test.MinuteClinic and Priority Pediatrics Urgent Care set the benchmark of 99 percent. Thirty-sevenof 92 medical groups had rates and confidence intervals fully above the medical group average:


Biggest ImprovementsThe greatest improvement since report year 2007 in Appropriate Testing for Children with Pharyngitis(medical group level) was made by Riverwood Aitken Clinic with a 45 percentage point increase.


• MinuteClinic• Priority Pediatrics Urgent Care• Silver Lake Clinic•Multicare Associates of the Twin Cities• St. Francis Medical Clinic-Urgent Care• Physicians Urgent Care• Baldwin Area Medical Center• Express Healthcare•Maple Grove Urgent Care• Columbia Park Medical Group•WestHealth Urgent Care• Camden Physicians• Stillwater Medical Group• Children’s Physician Network• The Doctor’s Office-Urgent Care• HealthPartners Clinics• Family Practice Medical Center of Willmar• Northwest Family Physicians• Parkview Medical Clinic

• Park Nicollet Health Services• Fairview Health Services• Foley Medical Center• Unity Family Healthcare-Avon• University of Minnesota Physicians• HealthEast• Apple Valley Medical Clinic• Regina Medical Center• Neighborhood Health Care Network• Chaska Urgent Care• Ridgeview Clinics• HealthPartners Central Minnesota Clinics• Northstar Physicians• Southern Metro Medical Clinics• Buffalo Clinic• CentraCare Health System• Quello Clinic• Allina Medical Clinic




Getting

Bette

r





76.3% - 76.7%76.5% 112,464 147,048

95% CI



Breast Cancer Screening (Medical Group Level Results)

100%90%80%70%60%50%40%30%20%10%0%



75% 74%74% 76% 76%

This measures the percentage of women ages52-69 who received a mammogram in the priortwo years.

The data for this measure are collected fromhealth plan claims.




Western OB/GYNPaul Larson OB/GYN ClinicSouthdale OB/GYN ConsultantsJohn A. Haugen AssociatesClinic Sofia OB/GYNHealthPartners Central Minnesota ClinicsPartners Obstetrics & GynecologyAssociated OB/GYNObstetrics & Gynecology AssociatesDiamond Women’s CenterEdina Family PhysiciansGrand Itasca ClinicOakdale Obstetrics and GynecologyComprehensive Healthcare For WomenMetropolitan OB & GYNStevens Community Medical Center - MorrisCatalyst Medical ClinicGundersen ClinicPark Nicollet Health ServicesHealthPartners ClinicsAllina Health SystemMayo ClinicNew Spirit Women’s ClinicFamily Practice Medical Center of WillmarMetropolitan Medical AssociatesWomen’s Health ConsultantsRiverwood Aitkin ClinicOB/GYN WestCentraCare Health SystemOlmsted Medical CenterFergus Falls Medical GroupMankato ClinicAspen Medical GroupAlexandria ClinicCamden PhysiciansCentral Lakes Medical ClinicAffiliated Community Medical CentersNorth ClinicSouthdale Internal Medicine

671821569773

1,0731353214311787256285371177260556

10,74518,0111,2961,082722462694617576

1,6118544371,6212,7525439903211,6781,607245

Breast Cancer Screening (Medical Group Level Results) n*

OB/GYN Lower Confidence Level /Upper Confidence Level


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

*n= sample size

Stay

ingHea

lthy



United Clinics of Faribault CountyObstetrics, Gynecology & InfertilityBrainerd Medical CenterSanford ClinicSt. Luke’s ClinicsBloomington Lake ClinicQuello ClinicBurnsville Family PhysiciansMeritCareEdina Sports Health & WellnessLakewood Health SystemLakeview ClinicPaynesville Area Health Care SystemParkview Medical ClinicWinona ClinicSt. Cloud Medical GroupNorthwest Family PhysiciansInnovis HealthCrossroads Medical CentersFairview Health ServicesHealthEastAltru Health SystemConsultants Internal MedicineWestern Wisconsin Medical AssociatesAllina Medical ClinicMayo Health SystemSt. Mary’s/Duluth Clinic Health SystemTri-County Hospital Clinics - Wadena Medical CenterHutchinson Medical CenterAvera Health/Avera Tri-StateGraceville Health Center ClinicHennepin CountyMinnesota Rural Health CooperativeSouthern Metro Medical ClinicsFamily Medical Center - Little Falls and PierzStillwater Medical GroupBuffalo ClinicMulticare Associates of the Twin Cities

57827821,4968685561,0683622,225290182967265964931,1408201,3544777,1742,867668306907

12,3933,5591,918190579735398761,4262013512,113740826

Breast Cancer Screening (Medical Group Level Results) – continued n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

OB/GYN Lower Confidence Level /Upper Confidence Level *n= sample size



Apple Valley Medical ClinicScenic Rivers Health ServicesFoley Medical CenterSt. Joseph’s Family ClinicsAmery Regional Medical CenterRegina Medical CenterSilver Lake ClinicBroadway Medical CenterFamily HealthServices MinnesotaRichfield Medical GroupNorthstar PhysiciansFrance Avenue Family PhysiciansSt. Croix Regional Medical CenterBaldwin Area Medical CenterMille Lacs ClinicsNorth Memorial ClinicSuperiorHealth CenterUnity Family Healthcare - AvonFairview MesabaRidgeview ClinicsUniversity Of Minnesota PhysiciansColumbia Park Medical GroupWinona Health Physicians ClinicRiverside Family PhysiciansOsceola Medical CenterLakewood Health Center ClinicFamily Medicine of WinonaRiverview ClinicsAALFAUnited Family Practice Health CenterHealing Spirit ClinicKittson Memorial ClinicNeighborhood Health Care NetworkCedar Riverside People’s Center

818109812461922236683194,2252519472572561281511,050336811787701,0001,32881133111381588772295387243036

Breast Cancer Screening (Medical Group Level Results) – continued n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Stay

ingHea

lthy




Medical group level results showed that an average of 82 percent of women ages 52-69 had amammogram. Western OB/GYN set the benchmark of 100 percent. Twenty-five of 115 medicalgroups had rates and confidence intervals fully above the medical group average:

High Performers over Five YearsThroughout five years of public reporting, the following medical groups achieved consistently highperformance for Breast Cancer Screening:

Biggest ImprovementsThe greatest improvement since report year 2007 in Breast Cancer Screening was made bySouthern Metro Medical Clinics with a 14 percentage point increase.

The greatest improvement since report year 2004 in Breast Cancer Screening was made by WinonaClinic with a 34 percentage point increase.


• Western OB/GYN• Paul Larson OB/GYN Clinic• Southdale OB/GYN Consultants• John A. Haugen Associates• Clinic Sofia OB/GYN•HealthPartners Central Minnesota Clinics• Partners Obstetrics & Gynecology• Obstetrics & Gynecology Associates• Diamond Women’s Center• Edina Family Physicians• Grand Itasca Clinic• Gundersen Clinic• Park Nicollet Health Services

• HealthPartners Clinics• Allina Health System•Mayo Clinic• Family Practice Medical Center of Willmar•Metropolitan Medical Associates• CentraCare Health System• Olmsted Medical Center• Fergus Falls Medical Group•Mankato Clinic• Aspen Medical Group• Camden Physicians• Affiliated Community Medical Centers• North Clinic

• Aspen Medical Group• Camden Physicians• CentraCare Health System• HealthPartners Central Minnesota Clinics•Mankato Clinic• North Clinic• Olmsted Medical Center• Park Nicollet Health Services

• Affiliated Community Medical Centers• Central Lakes Medical Clinic• HealthPartners Clinics• Brainerd Medical Center• Grand Itasca Clinic• Gundersen Clinic•MeritCare•Mayo Clinic


Stay

ingHea

lthy





77.7% - 78.0%77.9% 254,000 326,203

95% CI



Cervical Cancer Screening (Medical Group Level Results)

100%90%80%70%60%50%40%30%20%10%0%



78% 77%78% 78% 78%

This measures the percentage of women ages24-64 who received one or more Pap tests toscreen for cervical cancer in the measurementyear or the two years prior. For health planmembers publicly insured through MinnesotaHealth Care Programs, the continuousenrollment requirement is one year.







Adefris & Toppin Women’s SpecialistsSouthdale OB/GYN ConsultantsDiamond Women's CenterObstetrics, Gynecology & InfertilityAssociated OB/GYNJohn A. Haugen AssociatesClinic Sofia OB/GYNObstetrics & Gynecology AssociatesOB/GYN WestMetropolitan OB & GYNPaul Larson OB/GYN ClinicWestern OB/GYNPartners Obstetrics & GynecologyAdvanced Specialty Care For WomenWomen’s Health ConsultantsOakdale Obstetrics and GynecologyComprehensive Healthcare For WomenNorthland OB-GYN AssociatesSteven Saliterman, MDEdina Family PhysiciansBurnsville Family PhysiciansFamily Practice Medical Center of WillmarEdina Sports Health & WellnessCatalyst Medical ClinicCentraCare Health SystemPark Nicollet Health ServicesQuello ClinicCrossroads Medical CentersMankato ClinicSt. Cloud Medical GroupFrance Avenue Family PhysiciansSanford ClinicConsultants Internal MedicineAffiliated Community Medical CentersSilver Lake ClinicStevens Community Medical Center - MorrisSouthdale Internal MedicineNorth ClinicAllina Health SystemBloomington Lake ClinicGraceville Health Center ClinicOsceola Medical CenterFairview Health Services

146655418428864932047455024635393066417426849416616630

1,3526225865701403,79121,7952,2341,0653,9912,8024983,6263674,5301,2611882613,0472,21392871283

15,394

Cervical Cancer Screening (Medical Group Level Results) n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Stay

ingHea

lthy



Lakeview ClinicAlexandria ClinicAspen Medical GroupBuffalo ClinicWinona ClinicChildren’s Physician NetworkFamily Medical Center - Little Falls and PierzHealthPartners ClinicsInnovis HealthAllina Medical ClinicCamden PhysiciansAvera Health/Avera Tri-StateWestern Wisconsin Medical AssociatesApple Valley Medical ClinicMeritCareLakewood Health SystemMayo ClinicCentral Lakes Medical ClinicHealthEastHealthPartners Central Minnesota ClinicsUniversity Of Minnesota PhysiciansNorth Memorial ClinicRidgeview ClinicsAltru Health SystemParkview Medical ClinicNorthwest Family PhysiciansRiverwood Aitkin ClinicRiverview ClinicsGundersen ClinicMulticare Associates of the Twin CitiesFairview MesabaColumbia Park Medical GroupOlmsted Medical CenterPaynesville Area Health Care SystemUnity Family Healthcare - AvonStillwater Medical GroupBrainerd Medical CenterBaldwin Area Medical CenterMinnesota Rural Health CooperativeGrand Itasca ClinicMille Lacs ClinicsTri-County Hospital Clinics - Wadena Medical CenterSt. Mary’s/Duluth Clinic Health System

2,1901,1585,2862,1851,09180665

36,2053,48527,1781,6901,8082,2461,6035,3824412,1575505,2182,1942,5981,8531,6531,8122471,6704122811,0791,6315852,7182,3396642034,2981,5262793,1911,1492404504,620

Cervical Cancer Screening (Medical Group Level Results) – continued n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%




Broadway Medical CenterFoley Medical CenterMetropolitan Medical AssociatesAALFARiverside Family PhysiciansFamily HealthServices MinnesotaFergus Falls Medical GroupSuperiorHealth CenterSt. Croix Regional Medical CenterRichfield Medical GroupFirst Care Medical ServicesUnited Family Practice Health CenterFamily Medicine of WinonaHennepin CountyNorthstar PhysiciansHealing Spirit ClinicLakewood Health Center ClinicAmery Regional Medical CenterScenic Rivers Health ServicesMayo Health SystemSouthern Metro Medical ClinicsNeighborhood Health Care NetworkUnited Clinics of Faribault CountyHutchinson Medical CenterSt. Luke’s ClinicsNew Spirit Women’s ClinicRegina Medical CenterSt. Joseph’s Family ClinicsWinona Health Physicians ClinicCedar Riverside People’s CenterKittson Memorial ClinicJohnson Street ClinicSt. Paul Family Medical CenterDr. Bobby K. Yang Medical Clinic

6991893262222217,4691,047782563313508163901,5892,27670913142157,9844351,7951401,2461,6431324824791611361354610066

Cervical Cancer Screening (Medical Group Level Results) – continued n*


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Stay

ingHea

lthy




Medical group level results showed that an average of 83 percent of women ages 24-64 had aPap test in the last three years. Adefris & Toppin Women’s Specialists and Southdale OB/GYNConsultants set the benchmark of 100 percent. Thirty-six of 128 medical groups had rates andconfidence intervals fully above the medical group average.

High Performers over Five YearsThroughout five years of public reporting, the following medical groups achieved consistently highperformance for Breast Cancer Screening:

Biggest ImprovementsThe greatest improvements since report year 2007 in Cervical Cancer Screening were made byDr. Bobby K. Yang Medical Clinic, Lakewood Health System, and Tri-County Hospital Clinics– Wadena Medical Center each with an 8 percentage point increase.

The greatest improvement since report year 2004 in Cervical Cancer Screening was made byFergus Falls Medical Group with a 22 percentage point increase.


• Adefris & ToppinWomen’s Specialists

• Southdale OB/GYNConsultants

• Diamonds Women’sCenter

• Obstetrics, Gynecology &Infertility

• Associated OB/GYN• John A. HaugenAssociates

• Clinic Sofia OB/GYN•Obstetrics & GynecologyAssociates

• OB/GYN West•Metropolitan OB & GYN• Paul Larson OB/GYNClinic

•Western OB/GYN

• Partners Obstetrics &Gynecology

• Advanced Specialty CareFor Women

•Women’s HealthConsultants

• Oakdale Obstetrics andGynecology

• ComprehensiveHealthcare For Women

• Northland OB-GYNAssociates

• Edina Family Physicians• Burnsville FamilyPhysicians

• Family Practice MedicalCenter of Willmar

• Edina Sports Health &Wellness

• CentraCare HealthSystem

• Park Nicollet HealthServices

• Quello Clinic• Crossroads MedicalCenters

•Mankato Clinic• St. Cloud Medical Group• Sanford Clinic• Affiliated CommunityMedical Centers

• Silver Lake Clinic• North Clinic• Allina Health System• Fairview Health Services• Aspen Medical Group• Health Partners Clinic

• CentraCare HealthSystem

• Crossroads MedicalCenters

•Mankato Clinic• Park Nicollet HealthServices

• Quello Clinic• Allina• Aspen Medical Group• Buffalo Clinic• HealthPartners Clinics• Family Practice MedicalCenter of Willmar

• Lakeview Clinic

• North Clinic• St. Cloud Medical Group• Affiliated CommunityMedical Centers

• Camden Physicians•MeritCare•Western WisconsinMedical Associates


Stay

ingHea

lthy




This measures the percentage of adults ages51-80 who had appropriate screening forcolorectal cancer.

Data for this measure are collected from healthplan claims and medical record review.

Numerator TotalEligible


61.8%- 63.9%62.8% 4,481 8,265 338,257Colorectal Cancer Screening


Colorectal Cancer Screening (Medical Group Level Results)

95% CIStatewideAverage*(Weighted)

100%90%80%70%60%50%40%30%20%10%0%



58% 60% 63%






CentraCare Health SystemSuperiorHealth CenterBrainerd Medical CenterCamden PhysiciansSt. Luke’s ClinicsAllina Health SystemAffiliated Community Medical CentersWinona ClinicHealthPartners Central Minnesota ClinicsMayo Health SystemMankato ClinicLakeview ClinicMayo ClinicMeritCareOlmsted Medical CenterWestern Wisconsin Medical AssociatesAlexandria ClinicNorth Memorial ClinicHealthPartners ClinicsSt. Cloud Medical GroupAllina Medical ClinicMulticare Associates of the Twin CitiesPark Nicollet Health ServicesNorth ClinicHutchinson Medical CenterApple Valley Medical ClinicFamily HealthServices MinnesotaInnovis HealthNorthstar PhysiciansSt. Mary’s/Duluth Clinic Health SystemUniversity of Minnesota PhysiciansFairview Health ServicesBuffalo ClinicFamily Medical Center - Little Falls and PierzMinnesota Rural Health CooperativeQuello ClinicStillwater Medical GroupHennepin CountyAspen Medical GroupHealthEastEdina Family PhysiciansNorthwest Family PhysiciansBloomington Lake ClinicColumbia Park Medical GroupUnited Family Practice Health CenterNeighborhood Health Care NetworkAvera Health/Avera Tri-StateAltru Health System

811531066914187926969170716976867569606892168487693008310469113802201691062806982136676928316810868696987699710368

Colorectal Cancer Screening (Medical Group Level Results) n*


Stay

ingHea

lthy

Lower Confidence Level /Upper Confidence Level *n= sample size




Medical group level results showed that an average of 67 percent of patients ages 51-80 had appropriatescreening for colorectal cancer. CentraCare Health System set the benchmark of 91 percent.Eleven of 48 medical groups had rates and confidence intervals fully above the medical group average:


Biggest ImprovementsThe greatest improvements since report year 2007 in Colorectal Cancer Screening (medical grouplevel) were made by Mayo Health System, Multicare Associates of the Twin Cities andCentraCare Health System each with more than a 25 percentage point increase.


• CentraCare Health System• SuperiorHealth Center• Brainerd Medical Center• Camden Physicians• St. Luke’s Clinics• Allina Health System• Affiliated Community Medical Centers• Winona Clinic• HealthPartners Central Minnesota Clinics• Mayo Health System• HealthPartners Clinics


Stay

ingHea

lthy




53.3%- 55.4%54.4% 4,082 8,265 338,257Cancer Screening Combined(Ages 51-80)

This measures the percentage of adults ages 51-80who received appropriate cancer screeningservices (breast, cervical, colorectal). A patientmust be up-to-date for all three components tobe considered up-to-date for this measure.

Data for this measure are collected from healthplan claims and medical record review.

(Note: This measure uses the same denominator as the ColorectalCancer Screening measure. For this combined measure, malesreceived an automatic “pass” for the breast and cervical cancerscreening components.)




Cancer Screening Combined (Ages 51-80) (Medical Group Level Results)


100%90%80%70%60%50%40%30%20%10%0%

Cancer Screening Combined (Ages 51-80)


47% 49% 54%

Cancer Screening Combined





CentraCare Health SystemSuperiorHealth CenterSt. Luke’s ClinicsBrainerd Medical CenterCamden PhysiciansMayo Health SystemMayo ClinicHealthPartners Central Minnesota ClinicsMankato ClinicAlexandria ClinicNorth Memorial ClinicAllina Health SystemSt. Cloud Medical GroupMulticare Associates of the Twin CitiesAffiliated Community Medical CentersWinona ClinicInnovis HealthOlmsted Medical CenterLakeview ClinicHealthPartners ClinicsApple Valley Medical ClinicAllina Medical ClinicMeritCarePark Nicollet Health ServicesNorthstar PhysiciansHutchinson Medical CenterFamily HealthServices MinnesotaSt. Mary’s/Duluth Clinic Health SystemFamily Medical Center - Little Falls and PierzFairview Health ServicesBuffalo ClinicQuello ClinicWestern Wisconsin Medical AssociatesNorth ClinicAspen Medical GroupColumbia Park Medical GroupNorthwest Family PhysiciansEdina Family PhysiciansStillwater Medical GroupUniversity of Minnesota PhysiciansBloomington Lake ClinicHealthEastMinnesota Rural Health CooperativeNeighborhood Health Care NetworkHennepin CountyAvera Health/Avera Tri-StateAltru Health SystemUnited Family Practice Health Center

811531411066917076697160688768699269807569921694878630022010411316982280696769831688769686910669108136972831036869

Cancer Screening Combined – Ages 51-80 (Medical Group Level Results) n*


Stay

ingHea

lthy





Medical group level results showed that an average of 59 percent of patients ages 51-80 had appropriatecancer screening services (breast, cervical and colorectal). CentraCare Health System set the benchmarkof 86 percent. Ten of 48 medical groups had rates and confidence intervals fully above the medicalgroup average:


Biggest ImprovementsThe greatest improvement since report year 2007 in Cancer Screening Combined was made byBrainerd Medical Center with a 51 percentage point increase.


• CentraCare Health System• SuperiorHealth Center• St. Luke’s Clinics• Brainerd Medical Center• Camden Physicians• Mayo Health System• Mayo Clinic• HealthPartners Central Minnesota Clinics• Mankato Clinic• HealthPartners Clinics


Stay

ingHea

lthy




Numerator Denominator95% CI


Chlamydia Screening in Women (Medical Group Level Results)

100%90%80%70%60%50%40%30%20%10%0%

Chlamydia Screening in Women


Note: Technical coding issues were identified for some medical groups so their chlamydia screening rates were suppressed in 2006, 2007 and 2008.


40%29% 32%

40% 44%

This measures the percentage of sexually activewomen aged 16-25 who had at least one testfor Chlamydia during the measurement year.





StatewideAverage*

43.2% - 44.0%43.6% 26,390 60,591


Stay

ingHea

lthy





Hennepin CountyUnited Family Practice Health CenterNorthland OB-GYN AssociatesHealthPartners ClinicsMid Minnesota Family Medicine CenterCamden PhysiciansAllina Medical ClinicWomen’s Health ConsultantsSt. Croix Regional Medical CenterNeighborhood Health Care NetworkFamily Practice Medical Center of WillmarFairview Health ServicesNorthwest Family PhysiciansHealthEastObstetrics, Gynecology & InfertilityWestern OB/GYNCrossroads Medical CentersGundersen ClinicCentraCare Health SystemAspen Medical GroupNorthstar PhysiciansRegina Medical CenterStillwater Medical GroupRidgeview ClinicsObstetrics & Gynecology AssociatesAffiliated Community Medical CentersAllina Health SystemSt. Cloud Medical GroupBuffalo ClinicFrance Avenue Family PhysiciansNorth Memorial ClinicLakeview ClinicMankato ClinicQuello ClinicOlmsted Medical CenterNorth ClinicOakdale Obstetrics and GynecologySilver Lake ClinicOB/GYN WestMille Lacs ClinicsCentral Lakes Medical ClinicMayo ClinicPark Nicollet Health ServicesSuperiorHealth CenterHutchinson Medical CenterSt. Mary’s/Duluth Clinic Health SystemWinona ClinicMulticare Associates of the Twin CitiesFoley Medical CenterPaul Larson OB/GYN Clinic

44615542

6,372432955,518421141,1861133,12830592162462021688459614031378213271179463227375376527545187139549347810922311457813534,0541442771,1182453635193

Chlamydia Screening in Women – Ages 16 -25 (Medical Group Level Results) n*





Edina Family PhysiciansColumbia Park Medical GroupFergus Falls Medical GroupWestern Wisconsin Medical AssociatesMetropolitan Pediatric SpecialistsPartners Obstetrics & GynecologySt. Luke’s ClinicsMayo Health SystemBurnsville Family PhysiciansSouthern Metro Medical ClinicsChildren’s Physician NetworkMinnesota Rural Health CooperativeInnovis HealthDr. Bobby K. Yang Medical ClinicParkview Medical ClinicDiamond Women’s CenterRiverview ClinicsFamily Medical Center - Little Falls And PierzComprehensive Healthcare For WomenBrainerd Medical CenterAmery Regional Medical CenterJohn A. Haugen AssociatesGrand Itasca ClinicMetropolitan OB & GYNApple Valley Medical ClinicUnity Family Healthcare - AvonLakewood Health SystemSt. Joseph’s Family ClinicsEdina Sports Health & WellnessBaldwin Area Medical CenterSanford ClinicPaynesville Area Health Care SystemRiverside Family PhysiciansBroadway Medical CenterWinona Health Physicians ClinicAltru Health SystemAlexandria ClinicRiverwood Aitkin ClinicAvera Health/Avera Tri-StateTri-County Hospital Clinics - Wadena Medical CenterFamily Medicine of WinonaCatalyst Medical ClinicStevens Community Medical Center - MorrisUnited Clinics of Faribault CountySt. Paul Family Medical CenterOsceola Medical Center

2085301845232111532741,8031161112,1996857013474404617730308113802159236852996711447905136311504448225682125105904155344671

Chlamydia Screening in Women – Ages 16 -25 (Medical Group Level Results) – continued n*


Stay

ingHea

lthy





Medical group level results showed that an average of 46 percent of sexually active women ages 16-25had a Chlamydia test.Hennepin County set the benchmark of 77 percent. Thirteen of 99 medical groupshad rates and confidence intervals fully above the medical group average:

High Performers over Five YearsThroughout five years of public reporting, the following medical groups achieved consistentlyhigh performance for Chlamydia Screening:

Biggest ImprovementsThe greatest improvement since report year 2007 in Chlamydia Screening was made by NorthlandOB/GYN Associates with a 37 percentage point increase.

The greatest improvement since report year 2004 in Chlamydia Screening was made by FamilyPractice Medical Center of Willmar with a 54 percentage point increase.


• Hennepin County• United Family Practice Health Center• Northland OB-GYN Associates• HealthPartners Clinic• Camden Physicians• Allina Medical Clinic• St. Croix Regional Medical Center• Neighborhood Health Care Network• Family Practice Medical Center of Willmar• Fairview Health Services• Northwest Family Physicians• HealthEast• Aspen Medical Group

• HealthPartners Clinic• Hennepin County• Neighborhood Health Care Network• Aspen Medical Group• Mayo Clinic• Northwest Family Physicians• CentraCare Health System• Lakeview Clinic


Stay

ingHea

lthy




This measures the percentage of children twoyears of age who had received all of the followingvaccines by their second birthdays:

• Four DTaP/DT• Three IPV• One MMR• Three H influenza type B• Three Hepatitis B• One VZV• Four pneumococcal conjugate

The data for this measure are collected fromhealth plan claims, the Minnesota ImmunizationInformation Connection registry (MIIC) andmedical record review.


Childhood Immunization (Combo 3) (Medical Group Level Results)

Childhood Immunization




76.4%- 78.5%77.5% 4,576 6,178 24,353Childhood Immunization


100%90%80%70%60%50%40%30%20%10%0%

Childhood Immunization (Combo 3)


52%

74% 77%




Alexandria ClinicCentraCare Health SystemAffiliated Community Medical CentersPark Nicollet Health ServicesHealthPartners ClinicsMankato ClinicSt. Mary’s/Duluth Clinic Health SystemAspen Medical GroupFergus Falls Medical GroupMulticare Associates of the Twin CitiesMeritCareChildren’s Physician NetworkHealthPartners Central Minnesota ClinicsAllina Medical ClinicSt. Cloud Medical GroupStillwater Medical GroupLakeview ClinicAvera Health/Avera Tri-StateUniversity of Minnesota PhysiciansHealthEastAltru Health SystemOlmsted Medical CenterMetropolitan Pediatric SpecialistsMayo Health SystemFairview Health ServicesNorthstar PhysiciansBrainerd Medical CenterColumbia Park Medical GroupFamily HealthServices MinnesotaSt. Luke’s ClinicsFairview MesabaMinnesota Rural Health CooperativeBuffalo ClinicMayo ClinicInnovis HealthHennepin CountySanford ClinicNeighborhood Health Care Network

611161102114031081398965769056473252100637211488988095118211241831178296666315199748614720899

Childhood Immunization – Combo 3 (Medical Group Level Results) n*


Stay

ingHea

lthy





Medical group level results showed that an average of 78 percent of children two years of age who wereup-to-date with all recommended immunizations by their second birthday. Alexandria Clinic set thebenchmark of 93 percent. Seven of 38 medical groups had rates and confidence intervals fully above themedical group average:


Biggest ImprovementsThe greatest improvement since report year 2007 in Childhood Immunization (medical grouplevel) was made by St. Luke’s Clinics with a 37 percentage point increase.


• Alexandria Clinic• CentraCare Health System• Affiliated Community Medical Centers• Park Nicollet Health Services• HealthPartners Clinics• Mankato Clinic• St. Mary’s /Duluth Clinic Health System


Stay

ingHea

lthy




Table 2 provides an overview of the statewideaverages by measure. It also includes thepercentage point change in the average ratesfrom report year 2007 to 2008 as well as thepercentage point change over time. Statewideresults are higher for most measures. Rates forthe Controlling High Blood Pressure, AsthmaCare and Cervical Cancer Screening measureshave remained steady since 2007. Althoughthe rate for the Asthma Care measure hasincreased over the years, significant changes tothe measurement specifications may havecontributed to this increase. The slowing pacein improvement for the Asthma Care measurecould be attributed, in part, to the high levelsof performance.

In the five years that we have been measuringOptimal Diabetes Care, we have seen the numberof patients achieving optimal care almosttriple. Compared to the 2007 Health CareQuality Report, almost 10,000 more peoplewith diabetes met these aggressive treatmentstandards. Research tells us that this greatlyreduces their risk of experiencing the seriouscomplications of diabetes – strokes, heartattacks, amputations and vision problems.

For the Cancer Screening Combined measure,the rate surpassed the 50 percent marker forthe first time with a 5 percentage pointimprovement since the 2007 Health CareQuality Report. This means about 18,000more patients statewide were screened forbreast, cervical and colorectal cancer screening.This increase is likely due to an increase incolorectal cancer screening.

Chlamydia Screening rates increased by almost1.5 times since the 2004 Health Care QualityReport from 29 percent to 43.6 percent.However, this increase may be due to ourdecision to suppress the rates for some medicalgroups that use a particular procedure code thatis not recognized in the HEDIS specificationsfor this measure. Therefore, caution is advisedwhen interpreting this increase.

Among the notable quality improvements sincethe 2007 Health Care Quality Report, ChildhoodImmunization rates increased by almost 1.5 timessince report year 2006, the first year that Combo 3was measured.

Summary of Statewide Results




Summary of Statewide Results

Table 2: MN Community Measurement Statewide Results Comparisons to Previous Years


17.1%

13.0%

32.6%

32.3%

65.4%

91.7%

85.8%

84.5%

76.5%

77.9%

62.8%

54.4%

43.6%

77.5%

3.6

2.5

N/A

N/A

0.1

0.4

1.4

3.8

1.0

0.3

3.1

5.1

2.8

3.1

3.6 (2 years)

9.1 (5 years)

N/A

N/A

0.1 (2 years)

17.9 (5 years)

0.1 (3 years)

2.7 (3 years)

1.2 (5 years)

0.1 (5 years)

4.5 (3 years)

6.8 (3 years)

14.5 (5 years)

25.5 (3 years)

PercentagePoint

ChangeOver Time

Quality Measure 2008 StatewideAverage

(2007 Dates ofServices)

Percentage PointChange

Statewide2007 vs. 2008

* These statewide averages are weighted (see methods). N/A = Measurement specifications changed so comparisons cannot be made.

“Living with Illness” measuresOptimal Diabetes Care*

(Clinic level results)

Optimal Diabetes Care*(Medical group level results)

Optimal Vascular Care*(Clinic level results)

Optimal Vascular Care*(Medical group level results)

Controlling High Blood Pressure*(Medical group level results)

Asthma Care (Ages 5-56)(Medical group level results)

“Getting Better” measuresAppropriate Treatment for Children with URI

(Medical group level results)

Appropriate Testing for Children with Pharyngitis(Medical group level results)


Breast Cancer Screening (Mammograms)(Medical group level results)

Cervical Cancer Screening (Pap tests)(Medical group level results)

Colorectal Cancer Screening*(Medical group level results)

Cancer Screening Combined*– Ages 51-80 (breast, cervical, colorectal)(Medical group level results)

Chlamydia Screening (Ages 16-25)(Medical group level results)

Childhood Immunizations*(Medical group level results)


The following tables 3A-3D list the high performing medical groups by type based on measureson which they were reported. These groups had above-average rates on most measures.

Nine primary care medical groups achieved rates that were above average more frequently thanothers. Each of these medical groups achieved above-average rates on at least half of the measureson which they were reported.

Highest Performers in 2008 by Medical Group Type


Medical Group

HealthPartnersClinic

11 of 12

CentraCareHealth System

7 of 12

Park NicolletHealth Services

7 of 12

FairviewHealthServices

7 of 12

AffiliatedCommunityMedicalCenters

6 of 12

CamdenPhysicians

6 of 10

HealthPartnersCentralMinnesotaClinics

5 of 10

Family PracticeMedical Centerof Willmar

5 of 8

Children’sPhysicianNetwork

3 of 6

Asthma URI PharyngitisOptimalDiabetesCare

OptimalVascularCare

ControllingHighBP

ColorectalCancer

Screening

BreastCancer

Screening

CervicalCancer

Screening

CancerScreeningCombo

ChildhoodImmunization

Status

ChlamydiaScreening

• = Medical group rate and CI fully above average. = Data size too small to report. N/A = Measure not applicable.

Blank = Measure reported but rate was average or below average.

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

N/A

•

•

•

N/A

•

•

•

•

N/A

•

•

•

•

•

N/A

•

•

•

•

•

•

•

N/A

•

•

•

•

•

•

•

•

•

•

N/A

•

•

•

•

•

•

•

•

•

•

•

Table 3A: High Performing Medical Groups in 2008 – Primary Care


Highest Performers in 2008 by Medical Group Type


Four urgent/convenience care clinics achieved rates that were above average more frequently than others.Each of these clinics achieved above-average rates on the URI and Pharyngitis measures (Table 3B).

Two cardiology groups achieved rates that were above average more frequently than others.Each of these groups achieved above-average rates on the Optimal Vascular Care measure (Table 3C).

Nine OB/GYN groups achieved rates that were above average more frequently than others.Each of these medical groups achieved above-average rates on at least two of the three measureson which they were reported (Table 3D).

Table 3B: High Performing Medical Groups in 2008 – Urgent /Convenience Care

Table 3C: High Performing Medical Groups in 2008 – Cardiology

Medical Group

Metropolitan Cardiology Consultants - 1 of 1

St. Paul Heart - 1 of 1

OptimalVascular Care

••

• = Medical group rate and CI fully above average. = Data size too small to report.

• = Medical group rate and CI fully above average.

Table 3D: High Performing Medical Groups in 2008 – Obstetrics/Gyncology

Medical Group

Diamond Women’s Center - 2 of 3

John A. Haugen Associates - 2 of 3

Partners Obstetrics & Gynecology - 2 of 3

Paul Larson OB/GYN Clinic - 2 of 3

Western OB/GYN - 2 of 3

Clinic Sofia OB/GYN - 2 of 2

Northland OB-GYN Associates - 2 of 2

Southdale OB/GYN Consultants - 2 of 2

Obstetrics & Gynecology Associates - 2 of 2

Breast CancerScreening

Cervical CancerScreening

ChlamydiaScreening

••••••

••

•••••••••

•

Medical Group

Express Healthcare - 2 of 2

Minute Clinic - 2 of 2

Physicians Urgent Care - 2 of 2

West Health Urgent Care - 2 of 2

URI Pharyngitis

••••

••••



Medical Group Performance Variation in 2008


For all measures, we observed considerable variation across medical groups. For three measures,some medical groups achieved performance rates of 100 percent.

Asthma 5 - 56

Treatment for Childen URI

Testing for Children Pharyngitis



Childhood Immunizations



Cancer Screening Combination (50-80yrs)

Chlamydia Screening (16 -25yrs)

Optimal Vascular Care (DDS)*


Optimal Diabetes Care (DDS)*


All Measures - Practice Variation

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Medical Group Low/High Average

* Clinic Level Practice Variation


Consistently High Performing Medical Groups Over 5 Years


Five medical groups consistently achieved above-average rates on the four measures that werereported in each of the last five years by MNCM (Table 4). Three groups are urban multispecialtygroups; one is a family medicine group; and one is a multispecialty group from Greater Minnesota.HealthPartners Clinics has demonstrated the most consistently high performance over time.

Table 4: High-Performing Medical Groups for Five Years

Medical Group

HealthPartners Clinics - 4 of 4

Aspen Medical Group - 3 of 4

Camden Physicians - 3 of 4

CentraCare Health System - 3 of 4

Park Nicollet Health Services - 3 of 4

Breast CancerScreening

OptimalDiabetes Care

Cervical CancerScreening

ChlamydiaScreening

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•



From the beginning, MNCM has been dedicatedto reporting credible and comparable healthcare quality information on medical groupsand clinics. Today, many organizations viewMNCM as a community asset. Our results arebeing used by health plans and purchasers fortheir pay-for-performance programs. Medicalgroups and clinics are using the results tochange systems that support their qualityimprovement efforts. Other organizations areusing the results to provide consumers withinformation about the cost and quality of carefrom a medical group or clinic. And the data isused by state agencies and the media to informthe public about health care quality inMinnesota.

Our future looks bright. Our Board ofDirectors is committed to seeing that this workcontinues to serve our community and addvalue toward improving our health care system.Next year, for the first time, we will report aPatient Experience measure. It will provideinformation about consumers’ experiences withthe health care system. Our studies show usthat consumers value this information andwould use it to make decisions about theirhealth care. We will also report on a newdepression measure collected through our

Direct Data Submission process. This newmeasure was developed in collaboration withthe Institute for Clinical Systems Improvement(ICSI), health plans, the Minnesota Departmentof Human Services and several medical groups.It is based on evidence-based treatmentguidelines for depression care.

Next year will bring the development of twonew measures – an asthma composite measureand an orthopedic care measure. Additionally,our Reporting Advisory Committee hasidentified several existing measures that wouldbe suitable for the DDS process. The firstmeasure to transition to the DDS process willbe Colorectal Cancer Screening. ChildhoodImmunization Status and Controlling HighBlood Pressure will follow. MNCM will alsobe reconstructing our Web site to better engageconsumers in using our information.

This report, along with the 2007 Health CareDisparities Report, represents our initialefforts to look at MNCM data in new ways.The results will help us fulfill our mission toaccelerate the improvement of health by publiclyreporting health care information. We will besharing our findings in future reports.

Future Plans



Acknowledgements


The 2008 Health Care Quality Report is acollaborative effort led by MN CommunityMeasurement on behalf of the Minnesota healthcare community and the broader public. We wouldlike to acknowledge the contributions of allorganizations that shared their resources and theindividuals who shared their time and expertiseto make this report possible. We offer oursincerest thanks to:

The health plans and county-based purchasingorganizations that contributed data for this report:Blue Cross and Blue Shield of Minnesota, FirstPlanof Minnesota, HealthPartners, Medica, MetropolitanHealth Plan, PreferredOne, PrimeWest, Sanford HealthPlan, South Country Health Alliance and UCare.

The medical groups and clinics that submitteddata for this report: AALFA Family Clinic,Affiliated Community Medical Centers, AlexandriaClinic, Allina Medical Clinic, Apple Valley MedicalClinic, Aspen Medical Group, Brainerd MedicalCenter, Burnsville Family Physicians, CamdenPhysicians, Carlos Fernandez, MD Clinic,CentraCare Health System, Columbia ParkMedical Group, Community-University HealthCare Center, Consultants Internal Medicine,Edina Sports Health & Wellness, Fairview HealthServices, Fairview Mesaba Clinic, FamilyHealthServices Minnesota, Family Medical Center,Family Medicine of Winona, Family PracticeMedical Center of Willmar, France AvenueFamily Physicians, Fremont Community HealthServices, Glencoe Regional Health Services,HealthEast, HealthPartners Central MinnesotaClinics, HealthPartners Clinics, Hennepin FacultyAssociates, Hutchinson Medical Center, InnovisHealth, Lakeview Clinic, Lakeview Medical Clinic,Lakeville Integrative Medicine Clinic, MankatoClinic, Mayo Clinic, MeritCare, Minnesota Centerfor Obesity, Metabolism and Endocrinology(MNCOME), Multicare Associates, New SpiritWomen’s Clinic, North Clinic, North MemorialClinic, Northwest Family Physicians, NorthPoint

Health & Wellness Center, Park Nicollet HealthServices, Quello Clinic, Renville County Hospitaland Clinics, Richfield Medical Group, RidgeviewClinics, Riverside Family Physicians, Silver LakeClinic, Southdale Internal Medicine, St. CloudMedical Group, St. Mary’s/Duluth Clinic, St. PaulHeart, Steven Saliterman, MD, Stevens CommunityMedical Center, Stillwater Medical Group,United Family Practice Health Center, Universityof Minnesota Physicians, Western WisconsinMedical Associates, West Side CommunityHealth Services, Winona Clinic.

The Data Planning Group, delivering technicalguidance on data specifications and collection:Sarah Cook-Burton, Jennifer Dean, Jane Gendron,Jody Goken, Tatyana Kotlovskiy, Ann HerzogMorrison, Kathleen Hulting, Tracy Kueter, KarenOudekerk, Margareth Ranheim, Monica Simmer,Alex Tava, Diane Wehrle, Rachel Woods.

The Reporting Advisory Committee, providingexpertise in reporting policy and measureselection: Barry Bershow, Cara Broich,Craig Christianson, Sarah Cook-Burton,John Frederick, Jane Gendron, Betty Hanna,Doug Hiza, Nancy Jarvis, Chuck McKinzie,Terry Murray, Mark Nyman, Bruce Penner,Ann Robinow, David Tilstra, Linda Walling,Diane Wehrle, Paul Woods.

The MN Community Measurement Board ofDirectors, granting organizational oversightand leadership support: Brian Anderson,Donna Anderson, Jack Arland, Beth Averbeck,Pete Benner, Barry Bershow, Kent Bottles,Julie Brunner, Terry Cahill, Dann Chapman,Jim Chase, Patricia Dennis, Nancy Garrett,Pam Houg, Jennifer Lundblad, Cynthia MacDonald,Mark Nyman, Robert Meiches.

Additional thanks to the following individualswho provided consultation for this report:Angie Carlson, Jon Christianson,Becky Schierman, Leif Solberg.


AALFAAffiliated CommunityMedical CentersAlexandria ClinicAllina Health SystemAllina Medical ClinicAltru Health SystemAmery Regional Medical CenterApple Valley Medical CenterAspen Medical GroupAvera Health/Tri-StateBaldwin Area Medical CenterBloomington Lake ClinicBrainerd Medical CenterBroadway Medical CenterBuffalo ClinicBurnsville Family PhysiciansCamden PhysiciansCarlos Fernandez MD ClinicCatalyst Medical ClinicCedar Riverside People’s CenterCentraCare Health SystemCentral Lakes Medical ClinicChildren’s Physician NetworkColumbia Park Medical GroupCommunity-University HealthCare CenterConsultants Internal MedicineCrossroads Medical CentersDr. Bobby K. YangMedical ClinicEdina Family PhysiciansEdina Sports Health & WellnessFairview Health ServicesFairview MesabaFamily HealthServices MinnesotaFamily Medical Center– Little Falls And PierzFamily Medicine of WinonaFamily Practice Medical Centerof WillmarFergus Falls Medical GroupFirst Care Medical ServicesFoley Medical CenterFrance Avenue Family Physicians

Fremont CommunityHealth ServicesGlencoe RegionalHealth ServicesGraceville Health Center ClinicGrand Itasca ClinicGundersen ClinicHealing Spirit ClinicHealthEastHealthPartnersCentral Minnesota ClinicsHealthPartners ClinicsHennepin CountyHennepin Faculty AssociatesHutchinson Medical CenterInnovis HealthJohnson Street ClinicKittson Memorial ClinicLakeview ClinicLakeview Medical ClinicLakeville IntegrativeMedicine ClinicLakewood Health Center ClinicLakewood Health SystemMankato ClinicMayo ClinicMayo Health SystemMetropolitan Medical AssociatesMetropolitan Pediatric SpecialistsMeritCareMid Minnesota FamilyMedicine CenterMille Lacs ClinicsMinnesota Rural HealthCooperativeMulticare Associatesof the Twin CitiesNeighborhood Health CareNetworkNew Spirit Women’s ClinicNorth ClinicNorth Memorial ClinicNorthPointHealth & Wellness CenterNorthstar PhysiciansNorthwest Family Physicians

Olmsted Medical CenterOsceola Medical CenterPark Nicollet Health ServicesParkview Medical ClinicPaynesville AreaHealth Care SystemQuello ClinicRegina Medical CenterRenville County Hospitaland ClinicsRichfield Medical GroupRidgeview ClinicsRiverside Family PhysiciansRiverview ClinicsRiverwood Aitkin ClinicScenic Rivers Health ServicesSilver Lake ClinicSanford ClinicSouthdale Internal MedicineSouthern Metro Medical ClinicsSt. Cloud Medical GroupSt. Croix Regional Medical CenterSt. Joseph’s Family ClinicsSt. Luke’s ClinicsSt. Mary’s /Duluth ClinicHealth SystemSt. Paul Family Medical CenterSteven Saliterman, MDStevens Community Medical Center- MorrisStillwater Medical GroupSuperiorHealth CenterTri-County Hospital Clinics -Wadena Medical CenterUnited Clinics of Faribault CountyUnited Family PracticeHealth CenterUnity Family Healthcare - AvonUniversity of Minnesota PhysiciansWest Side CommunityHealth ServicesWestern WisconsinMedical AssociatesWinona Health Physicians ClinicWinona Clinic

Multispecialty and Primary Care Medical Groups Reported in 2008 - (114)


3 Endocrinology Clinics

4 Cardiology Clinics


Endocrinology Clinic of MplsMark P. Stesin, MD

MN Center for Obesity, Metabolism andEndocrinology (MNCOME)

Metropolitan Cardiology ConsultantsMinneapolis Heart Institute

Minnesota Heart ClinicSt. Paul Heart Clinic

18 Obstetrics /Gynecology Clinics

Other Types of Medical Groups Reported in 2008

Adefris & Toppin Women’s SpecialistsAdvanced Specialty Care for WomenAssociated OB/GYNClinic Sofia OB/GYNComprehensive Healthcare for WomenDiamond Women’s CenterJohn A. Haugen AssociatesMetropolitan OB & GYNNorthland OB-GYN Associates

OB/GYN WestOakdale Obstetrics and GynecologyObstetrics & Gynecology AssociatesObstetrics, Gynecology & InfertilityPartners Obstetrics & GynecologyPaul Larson OB/GYN ClinicSouthdale OB & GYN ConsultantsWestern OB/GYNWomen’s Health Consultants

11 Urgent /Convenience Care Clinics

Chaska Urgent CareExpress HealthcareMaple Grove Urgent CareMinuteClinicNow Care Medical CentersPhysicians Urgent Care

We wish to thank all medical groups and clinics in Minnesota andbordering communities for their continued commitment to quality improvement

as a means to provide the best care possible.

Priority Pediatrics Urgent CareSt. Francis Medical Clinic - Urgent CareSuburban Emergency AssociatesThe Doctor’s Office - Urgent CareWestHealth Urgent Care


MN Community MeasurementBroadway Place East, #4553433 Broadway Street NEMinneapolis, MN 55413

Email: [email protected]: 612-455-2911

this document is made available electronically by the minnesota … · 2015. 3. 24. · repo...

Documents