|Minnesota Medical Groups Bridge Disparities Gap
Despite a nationwide disparity in quality of care
provided to Medicaid patients compared to those with other insurance,
some Minnesota medical groups have been able to deliver comparable care
on certain health measures, according to the Health Care Disparities
Report by MN Community Measurement.
"We are pleased to see that some clinics have already
bridged the disparities gap. This sets the bar for others," said Brian
Osberg, Minnesota state assistant human services commissioner for
healthcare. "This is the beginning of a long-term commitment by the
state to track healthcare disparities and fosterquality improvement
initiatives that will eventually eliminate them."
The report is the first in the nation to provide a
large-scale comparison by medical group of the care for public program
patients in managed care and that for patients with other insurance.
The 2005 Legislature mandated the Department of Human
Services (DHS) to establish a performance reporting system for medical
groups serving patients covered by Minnesota Health Care Programs. MN
Community Measurement, a nonprofit healthcare quality measurement
organization, prepared the report.
Fairview Health Services achieved comparable rates on
optimal diabetes care for both public and commercially insured
patients. The 18.93 percent of public patients receiving optimal care
was less than 1 percent behind their commercial rate of 19.7 percent.
"What’s most remarkable is that they accomplished it for one of
the more difficult, chronic conditions," Osberg said. Both rates also
significantly surpassed the statewide average of 11.42 percent for
Columbia Park Medical Group also attained comparable
rates for diabetes care of public, 11.14 percent, and commercial
patients, 11.52 percent. Allina’s rate for public patients, 11.37
percent, exceeded their commercial rate, 9.45 percent, the report said.
Using health plan claims and medical records data, MN
Community Measurement looked at the appropriateness and effectiveness
of care delivered by clinics in 2006 for eight measures:
children’s sore throats and colds, childhood immunizations,
asthma, diabetes and three adult cancer screening exams.
On many measures, quality of care provided to public
program patients fell behind that provided to others. Jim Chase,
executive director of MN Community Measurement, said, "As a whole,
Minnesota medical groups are significantly less successful at achieving
quality of care outcomes for people on public programs. We found this
to be the case in seven of eight measures."
The difference was most striking for breast cancer
screening. Just 57.6 percent of women aged 52 to 69 with public
insurance had a mammogram within the prior two years, compared to 77.1
percent of those with other insurance – a difference of 19.5
The lag in quality for children with public coverage was
also significant. There was a 12.9 percentage point difference in the
rate of appropriate treatment for children’s colds and a 10.1
percentage point difference in the rate of 2-year-olds having
Only one measure – screening for Chlamydia
provided to women aged 16 to 25 – showed a higher rate for public
program patients, 47.9 percent compared to 37.7 percent for others, the
"We observed considerable performance variation between
medical groups, which we also find with the commercially insured
population," Chase said. "Where you go makes a difference, no matter
what type of insurance you have. We believe this report will help
direct medical practices’ quality improvement resources and
encourage the sharing of best practices for serving public program
Looking only at rates of care for public program patients, six medical groups were above average on at least four measures:
- HealthPartners Medical Group – above average on seven of eight measures
- Children’s Physician Network – above average on four of five children’s measures
- Park Nicollet – above average on six of eight measures
- Aspen Medical Group (now a part of Allina Clinics) – above average on five of eight measures
- CentraCare Health System and Mayo Clinic – both above average on four of eight measures
The report provides an additional tool for DHS to use in
fostering quality improvement within Minnesota Health Care Programs.
Other efforts underway include pay-for-performance initiatives and
other incentives in DHS’ contracts with managed care
Address: MN Community Measurement, Broadway Place E #455, 34334 Broadway St. NE, Minneapolis, MN 55413; (612) 455-2911, www.mnhealthcare.org.