2017 Health Care Disparities Report for Minnesota Health Care Programs

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2 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams (Fr care delivered in 2016) Reprt Preparatin Directed by: Anne M. Snwden, MPH, CPHQ Directr f Perfrmance Measurement, Validatin & Reprting, MNCM Key Cntributrs: Kevan Edwards, PhD Research Directr, Health Care Research and Quality, DHS Mark Fresman, PhD Supervisr, Health Care Research and Quality, DHS Lindsey Ziegler, MPH Prject Specialist/Data Analyst, MNCM Direct Questins r Cmments t: Anne M. Snwden snwden@mncm.rg Mark Fresman, PhD mark.fresman@state.mn.us MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

3 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Please see the next page MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 3

4 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table f Cntents I. Executive Summary... 5 II. Intrductin III. Statewide Difference between MHCP and Other Purchasers f Health Care Services IV. Measures with Specificatin Changes i. Childhd Immunizatin Status (Cmb 10) V. Measures with an Increase in MHCP Rate i. Mderate Increase Cntrlling High Bld Pressure ii. Small Increase Clrectal Cancer Screening VI. Measures with a Decrease in MHCP Rate i. Small Decrease Chlamydia Screening in Wmen Depressin Remissin at Six Mnths Apprpriate Testing fr Children with Upper Respiratry Infectin (URI) Breast Cancer Screening ii. Mderate Decrease Optimal Diabetes Care Optimal Asthma Cntrl Adult Ages iii. Large Decrease Optimal Vascular Care Optimal Asthma Cntrl Children Ages VII. Medical Grup/Clinic Level Perfrmance Results VIII. Examinatin f Statewide MHCP Rates by Race and Hispanic Ethnicity IX. Examinatin f Statewide MHCP Rates by DHS Regin X. Cnclusin XI. Acknwledgements XII. List f Medical Grups Reprted XIII. Appendices XIV. Appendix 1: Data Surces and Data Cllectin XV. Appendix 2: Methds XVI. Appendix 3: Medical Grup/Clinic Perfrmance Rate Tables XVII. Appendix 4: Medical Grup Perfrmance Over Time (Three Years) XVIII. Appendix 5: Purchaser Perfrmance Rate Differences XIX. Appendix 6: Glssary XX. Appendix 7: Measure Definitins XXI. Appendix 8: References MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

5 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Executive Summary The 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams prvides health care perfrmance rates fr patients enrlled in the managed care cmpnent f these prgrams. Minnesta Health Care Prgrams (MHCP) includes Medical Assistance and MinnestaCare, which are bth funded by state and federal gvernments and administered by health plans. The reprt als explres the differences in perfrmance rates between patients enrlled in MHCP and patients enrlled in managed care prgrams f Other Purchasers (private insurance r Medicare managed care prgrams) at a statewide and medical grup level. Fr six measures (Optimal Diabetes Care, Optimal Vascular Care, Depressin Remissin at Six Mnths, Optimal Asthma Cntrl - Children Ages 5-17, Optimal Asthma Cntrl - Adults Ages 18-50, and Clrectal Cancer Screening), it als cmpares these rates at the clinic level. When cmpared with the verall ppulatin f Minnesta, patients enrlled in MHCP are f lwer sciecnmic status and represent a disprprtinate number f persns f clr, American Indian r Alaskan Natives, persns with disabilities, and elderly adults. In additin, these patients ften experience significant persnal challenges that create barriers t receiving apprpriate health care. In many cases, the cmplexity f the health care system is a barrier t receiving ptimal care. As a result, MHCP patients may nt receive care that meets best practices as ften as patients insured by Other Purchasers. 123 The Minnesta Department f Human Services (DHS) selected the fllwing 11 measures fr this reprt based n their relevance t patients enrlled in MHCP. The measures are listed in rder in which they appear thrughut the reprt. Childhd Immunizatin Status (Cmb 10)*^ Cntrlling High Bld Pressure* Clrectal Cancer Screening Chlamydia Screening in Wmen* Depressin Remissin at Six Mnths Apprpriate Treatment fr Children with Upper Respiratry Infectin (URI)* Breast Cancer Screening* Optimal Diabetes Care Optimal Asthma Cntrl Adults Ages Optimal Vascular Care Optimal Asthma Cntrl Children Ages 5-17 *Healthcare Effectiveness Data and Infrmatin Set (HEDIS) measures ^Measure specificatin changes Key Findings Tw f the ten cmparable MHCP statewide measures have imprved since last year (Cntrlling High Bld Pressure and Clrectal Cancer Screening). These imprvements were statistically significant (see Table ES3). Cntrlling High Bld Pressure had the largest gains in MHCP rates. Eight measures (Apprpriate Treatment fr Children with URI, Breast Cancer Screening, Chlamydia Screening in Wmen, Depressin Remissin at Six Mnths, Optimal Asthma Cntrl Adults, Optimal Asthma Cntrl Children, Optimal Diabetes Care, and Optimal Vascular Care) declined frm last year; f these, nly Chlamydia Screening in Wmen did nt have a statistically significant decline. Fr five measures, the criteria fr including patients in the measure denminatr changed in 2017 (Clrectal Cancer Screening, Optimal Diabetes Care, Optimal Asthma Cntrl Adults, Optimal Asthma Cntrl Children, and Optimal Vascular Care). This change may have cntributed t the change in statewide rates fr these measures. 1 American Health Insurance Plans (2006). Addressing Disparities in Health. Available at HealthAndMedicine/DiversityAndCulturalCmpetency. 2 Rbert Wd Jhnsn Fundatin (2010). Quality & Equality in U.S. Health Care: A Message Handbk. 3 Snwden AM, Kunerth V, Carlsn, AM, McRae JA, Vetta E. Addressing Health Care Disparities Using Public Reprting. American Jurnal f Medical Quality, July/August 2012: MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 5

6 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Of the seven measures with three r mre years f cmparable data, three have imprved ver time (See Table ES3). All three increases were statistically significant. Clrectal Cancer Screening (eight percentage pint increase) Apprpriate Testing fr Children with URI (six percentage pint increase) Cntrlling High Bld Pressure (tw percentage pint increase) The Apprpriate Treatment fr Children with URI measure cntinues t have the highest MHCP rate at 93 percent, fllwed by Cntrlling High Bld Pressure at 72 percent. The measure with the lwest MHCP rate was Depressin Remissin at Six Mnths at five percent. Nine f the 11 statewide perfrmance rates fr MHCP patients were significantly lwer than fr patients insured by Other Purchasers. Tw measures Apprpriate Treatment fr Children with URI and Chlamydia Screening in Wmen shwed a significantly higher perfrmance rate fr MHCP patients than Other Purchaser patients (see Table ES4). The largest gaps between MHCP and Other Purchaser patients ccurred n fur measures (see Table ES4), and Childhd Immunizatin Status Cmb 10 had the largest gap: Childhd Immunizatin Status Cmb 10 (23 percentage pints) Breast Cancer Screening (20 percentage pints) Clrectal Cancer Screening (19 percentage pints) Optimal Vascular Care (19 percentage pints) Statewide gaps in perfrmance rates between MHCP and Other Purchasers have narrwed ver time fr six measures. Fur f these changes were statistically significant (indicated by an asterisk): Chlamydia Screening in Wmen (ver nine years)* Cntrlling High Bld Pressure (ver three years)* Optimal Asthma Cntrl Children Ages 5-17 (ver three years) Optimal Asthma Cntrl Adults Ages (ver three years)* Optimal Diabetes Care (ver tw years) Clrectal Cancer Screening (ver seven years)* MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

7 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Differences exist between racial grups within the MHCP patient ppulatin fr all five HEDIS measures (Table ES1). Table ES1: Summary f Findings by Racial Grup American Indian r Alaskan Native patients had rates significantly belw the MHCP statewide average fr three measures. Asian patients had rates significantly abve the MHCP statewide average fr three measures (Apprpriate Treatment fr Children with URI, Childhd Immunizatin Status and Chlamydia Screening fr Wmen) and belw average fr ne measure. Black r African American patients had rates significantly belw average fr three measures and abve average fr tw measures (Apprpriate Treatment fr Children with URI and Chlamydia Screening fr Wmen). White patients had abve average rates fr ne measure (Breast Cancer Screening) and belw average rates fr three measures. Statistically significant differences exist between Hispanic and Nn-Hispanic patients within the MHCP patient ppulatin fr three f the five HEDIS measures (Table ES2). Table ES2: Summary f Findings by Ethnic Grup Hispanic patients had health care perfrmance rates that were significantly higher than Nn-Hispanic patients in three measures Chlamydia Screening in Wmen, Breast Cancer Screening, and Childhd Immunizatin Status (Cmb 10). Nn-Hispanic patients did nt have a perfrmance rate significantly higher than the statewide MHCP rate in any measures MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 7

8 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Differences exist between gegraphical regins fr the MHCP patient ppulatin fr all f the Direct Data Submissin (DDS) measures. The Nrthwest regin had the lwest rate fr fur measures (Optimal Diabetes Care; Optimal Vascular Care; Optimal Asthma Cntrl Children Ages 5-17; and Optimal Asthma Cntrl Adults Ages 18-50) and these rates were significantly belw the MHCP statewide rate. This regin did nt have the highest screening rate fr any measures. The Nrtheast regin had the highest rate fr tw measures (Depressin Remissin at Six Mnths and Clrectal Cancer Screening) and these rates were significantly abve the MHCP statewide rate. This regin did nt have the lwest rate fr any measure. The Metr regin had the highest rate fr three measures (Optimal Vascular Care; Optimal Asthma Cntrl Children Ages 5-17; and Optimal Asthma Cntrl Adults Ages 18-50). The rates fr Optimal Vascular Care; Optimal Diabetes Care; Optimal Asthma Cntrl Children Ages 5-17; and Optimal Asthma Cntrl Adults Ages were significantly abve the MHCP statewide rate. This regin had the lwest rate fr Clrectal Cancer Screening, which was significantly belw the MHCP statewide rate. The Suthern regin had the lwest rate fr ne measure (Depressin Remissin at Six Mnths), which was significantly belw the MHCP statewide rate. The rates fr the Optimal Asthma Cntrl Adults Ages and Clrectal Cancer Screening measures were significantly abve the MHCP statewide rate. This regin had the highest rate fr ne measure (Optimal Diabetes Care). There was ne measure that had measure specificatin changes: Childhd Immunizatin Status (Cmb 10). Due t these changes, n trending data is available MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

9 Statewide Rate Cmparisns t Previus Years 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table ES3 displays the MHCP statewide results fr reprt year 2017 (2016 dates f service) and cmpares the 2017 reprt results t previus years. See the definitins listed belw fr measure categries. Measure Specificatin Changes since 2016 Measures in this categry had specificatin changes in the previus year. Due t this, n trend data is available. Large Increase and Large Decrease These categries include measures that displayed a MHCP rate change whse abslute value was greater than five percentage pints frm 2016 t Mderate Increase and Mderate Decrease These categries include measures that displayed a MHCP rate change whse abslute value was greater than ne percentage pint and less than r equal t five percentage pints frm 2016 t Small Increase and Small Decrease These categries include measures that displayed a MHCP rate change whse abslute value was less than r equal t ne percentage pint frm 2016 t Table ES3: Summary f MHCP Statewide Rates fr 2017 Reprt Year Cmpared t Previus Years 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 9

10 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Summary f Statewide Purchaser Rate Differences Table ES4 displays differences in the quality measures fr patients enrlled in MHCP cmpared t patients enrlled with Other Purchasers. The difference in rates was calculated by subtracting the MHCP rate frm the Other Purchasers rate. In the furth clumn frm the left, labeled Rate Difference (2017) (Other purchasers-mhcp), a psitive number indicates the Other Purchasers rate was higher than the MHCP rate; therefre, Other Purchasers patients received were mre likely t achieve that measure. Cnversely, a negative number indicates the MHCP rate was higher than the Other Purchasers rate; therefre, MHCP patients were mre likely t achieve that measure. Table ES4: Summary f Statewide Purchaser Rate Differences MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

11 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Summary f Medical Grup Perfrmance Over Time Table ES5 lists 14 medical grups with cnsistently high perfrmance n tw r mre quality measures ver three years f the seven quality measures that can be cmpared. It als lists 18 medical grups with cnsistent imprvement n tw r mre quality measures ver three years f the seven quality measures that can be cmpared. Table ES5: Medical Grups with Cnsistently High Perfrmance r Cnsistent Imprvement 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 11

12 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Intrductin A wrthy gal fr ur natinal health care system is quality care fr all patients. Despite that, significant evidence shws widespread disparities exist in health care acrss the cuntry. Health care quality, cst and patient utcmes vary by factrs such as where patients live, which dctrs r clinics prvide their health care, their sciecnmic status, and their race and ethnicity. There is grwing evidence that lw-incme patients face barriers t btaining high-quality health care. In sme cases, the barriers are actually increasing. 4 An imprtant aspect f imprving accuntability fr health care utcmes is establishing a mechanism fr nging measurement. The 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams is prduced by MN Cmmunity Measurement (MNCM) in cllabratin with the Minnesta Department f Human Services (DHS). It summarizes health care quality perfrmance results f patients enrlled in Minnesta Health Care Prgrams (MHCP) and makes cmparisns t the results f ther patients. The measures in this reprt are presented at statewide, medical grup and, in sme cases, clinic levels. This is the nly public reprt that medical grups and clinics can use t identify health care perfrmance rates fr their patients enrlled in state-funded public prgrams, as well as cmpare thse rates with ther medical grups and clinics. All patients whse care is reviewed in this reprt are enrlled in managed care prgrams, either thrugh MHCP r ther payers. Backgrund Due t the at-risk nature f the MHCP patient ppulatin, the Minnesta State Legislature directed DHS in 2005 t establish a perfrmance reprting and quality imprvement system fr medical grups and clinics prviding health care services t patients enrlled in the managed care cmpnent f MHCP. The inaugural Health Care Disparities Reprt, released in 2007, was the first in the natin t include lcal level infrmatin that was actinable fr medical grups and clinics. Befre this reprt became available, natinal and state level reprts f differences in care were either dismissed as being the result f patient factrs and issues utside f medical grup cntrl, r because f the perceptin that disparities existed elsewhere. This reprt supplies cmparable, transparent perfrmance data t medical grups and clinics; which allws them t reflect n the disparities within their systems and identify areas fr imprvement. Overview f Perfrmance Measures This reprt includes 11 health care quality perfrmance measures selected by DHS based n their relevance t patients enrlled in MHCP. Six f the measures were develped by MN Cmmunity Measurement (MNCM); the ther five were develped by the Natinal Cmmittee fr Quality Assurance (NCQA) and are knwn as Healthcare Effectiveness Data and Infrmatin Set (HEDIS) measures. Mst perfrmance measures included in this reprt have been endrsed by the Natinal Quality Frum (NQF) and are aligned with clinical guidelines. Fr mre infrmatin n methds, see Appendix 2. Additinally, the reprt features MHCP perfrmance rates fr HEDIS measures by race and Hispanic ethnicity using infrmatin self-reprted by patients at the time f their MHCP enrllment. These results are reprted at a statewide level. The results shw differences in rates amng MHCP patients by race and Hispanic ethnicity. Future Cmmitment DHS and MNCM are cmmitted t analyzing MHCP health care perfrmance rates at medical grup and clinic levels t inspire imprvement. We are pleased that this reprt cntinues t generate interest frm the media, plicymakers, and 4 Lavizz-Murey, R. (2008). Racial disparities in health care quality shuld mean equality. Healthcare Financial Management, January 2008: MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

13 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams researchers. We are even mre encuraged that the infrmatin is being used by health care stakehlders t imprve care fr vulnerable patients. Our missin is t accelerate the imprvement f health by publicly reprting health care infrmatin. Our visin is t drive change that imprves health, patient experience, cst and equity f care fr everyne in ur cmmunity. Fr Mre Infrmatin Fr additinal infrmatin, please cntact Anne Snwden at snwden@mncm.rg r Mark Fresman at mark.fresman@state.mn.us MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 13

14 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Please see the next page MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

15 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Statewide Differences between MHCP and Other Purchasers f Health Care Services This sectin presents rates fr the 11 measures selected by DHS fr this reprt. Measures with specificatin changes in 2017 are described first. Next, measures with trend data are rganized int three sectins based n the size f the change in results frm last year s MHCP statewide rates. Each measure is briefly described and statewide results by purchaser are displayed fr each year that the measure has been active. Additinally, trending results fr MHCP and Other Purchasers are included. Next, medical grup perfrmance rates fr MHCP patients are highlighted, including lists f medical grups with the highest perfrmance and medical grups that made the largest imprvements since Additinally, clinic perfrmance highlights are included fr six measures: Optimal Diabetes Care, Optimal Vascular Care, Depressin Remissin at Six Mnths, Optimal Asthma Cntrl - Children Ages 5-17, Optimal Asthma Cntrl - Adults Ages 18-50, and Clrectal Cancer Screening. Finally, medical grup perfrmance ver time is reprted with an analysis f medical grup purchaser rate differences. Please nte that the Childhd Immunizatin Status (Cmb 10) measure is nt included in this analysis due t measure specificatin changes in Backgrund Please nte that the significance level is defined as p<0.05. Detailed medical grup perfrmance data are presented in three appendices: Appendix 3: Clinic Level and Medical Grup Perfrmance Rate Tables Appendix 4: Medical Grup Perfrmance ver Time (Three Years) Appendix 5: Purchaser Perfrmance Rate Differences 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 15

16 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Measure with Specificatin Changes frm 2016 t 2017 Childhd Immunizatin Status (Cmb 10) Infants and tddlers are especially vulnerable t infectius diseases, due t their develping immune systems. Vaccines can help prevent many diseases and their serius side effects. Immunizatin f infants and tddlers is recmmended by the American Academy f Pediatrics (AAP). The Childhd Immunizatin Status (Cmb 10) measure evaluates the percentage f children wh had the fllwing vaccines by their secnd birthday: Fur DTaP Three IPV (pli) One MMR Three H influenza type B Three Hepatitis B One VZV (chicken px) Fur pneumcccal cnjugate One hepatitis A Tw r three rtavirus Tw influenza The data fr this measure are cllected frm health plan claims, the Minnesta Immunizatin Infrmatin Cnnectin (MIIC) registry and medical recrd review. (See Glssary) Fr Childhd Immunizatin Status in 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. The MHCP statewide rate fr childhd immunizatins was 36 percent; the rate fr Other Purchasers was 60 percent. Table 1 displays statewide rates fr each purchaser since measure implementatin. Table 1: Statewide Rates fr Childhd Immunizatin Status (Cmb 10) This measure has the largest purchaser gap f all 11 measures included in this reprt MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

17 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Please see the next page MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 17

18 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Mderate Increase in MHCP Rate frm 2016 t 2017 Cntrlling High Bld Pressure Hypertensin, r high bld pressure, is assciated with serius health effects, such as crnary heart disease, strke, and retinpathy. Cntrl f high bld pressure can substantially reduce the chance f cmplicatins and reduce the risk f develping ther cnditins. The Cntrlling High Bld Pressure measure evaluates the percentage f patients between ages with a diagnsis f hypertensin whse bld pressure was adequately cntrlled at less than 140/90 mmhg during the measurement year. The representative bld pressure, as defined by the Natinal Cmmittee fr Quality Assurance (NCQA), is the mst recent bld pressure reading during the measurement year, as lng as the reading ccurred after the diagnsis f hypertensin. Data cllected fr this measure are frm health plan claims and medical recrd review (See Glssary). The fllwing are the criteria fr being adequately cntrlled: Patients ages whse bld pressure was <140/90 mm Hg. Patients ages with a diagnsis f diabetes whse bld pressure was <140/90 mm Hg. Patients ages withut a diagnsis f diabetes whse bld pressure was <150/90 mm Hg. Frm 2016 t 2017, the percentage f MHCP adult patients whse bld pressure was under cntrl increased slightly frm 71% t 72% and this increase was statistically significant. In 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. See Figure 1 belw fr Cntrlling High Bld Pressure fr MHCP and Other Purchasers ver time. Figure 1: Statewide Rates fr Cntrlling High Bld Pressure Over Time MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

19 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Since 2015, the MHCP and Other Purchaser rates had similar increases each year; hwever, MHCP patients cntinue t have a significantly lwer rate f Cntrlling High Bld Pressure than patients insured by Other Purchasers. The statewide rate fr Cntrlling High Bld Pressure fr MHCP patients was 72 percent; the rate fr patients enrlled with Other Purchasers was 77 percent. Table 2 displays statewide rates fr each purchaser since measure implementatin. Table 2: Statewide Rates fr Cntrlling High Bld Pressure The difference between purchasers fr Cntrlling High Bld Pressure decreased by almst ne percentage pint frm 2016 t 2017, but this was nt statistically significant MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 19

20 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Small Increase in MHCP Rate frm 2016 t 2017 Clrectal Cancer Screening July 1, June 30, 2017 Dates f Service Of cancers that affect bth men and wmen, clrectal cancer is the secnd leading cause f cancer-related deaths in the United States and the third mst cmmn cancer in men and wmen. Clrectal cancer affects men and wmen f all racial and ethnic grups and is fund mst ften in peple aged 50 years r lder. Screening helps find clrectal cancer at an early state, when treatment ften leads t a cure. The Clrectal Cancer Screening measure evaluates the percentage f adults ages wh are up-t-date with the apprpriate screenings fr clrectal cancer. Apprpriate screenings fr clrectal cancer include: Guaiac-fecal ccult bld test (gfobt) r fecal immunchemical test (FIT) during the measurement year FIT-DNA test during the measurement year r the tw years prir Flexible sigmidscpy during the measurement year r the fur years prir CT clngraphy during the measurement year r the fur years prir Clnscpy during the measurement year r the nine years prir Medical grups and clinics reprt data directly t MNCM fr this measure based n electrnic health recrds r paperbased medical charts. (See Glssary) Frm 2016 t 2017, the Clrectal Cancer Screening rate fr MHCP patients increased by 0.6 percentage pints. This increase was statistically significant. Since 2011, the rate fr MHCP patients has increased by apprximately nine percentage pints, which is statistically significant. See Figure 2 belw fr Clrectal Cancer Screening rates fr MHCP and Other Purchasers ver time. Figure 2: Clrectal Cancer Screening Statewide Rates ver Time MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

21 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Since 2011, the MHCP and Other Purchaser rates had similar increases each year; hwever, MHCP patients cntinue t have a significantly lwer rate f Clrectal Cancer Screening than patients insured by Other Purchasers. The MHCP statewide rate fr Clrectal Cancer Screening is 56 percent; the rate fr Other Purchasers is 75 percent. Table 3 displays statewide rates fr each purchaser since measure implementatin. Table 3: Statewide Rates* fr Clrectal Cancer Screening The gap between purchasers has remained relatively cnsistent fr all seven years that the data have been reprted fr this measure. Since 2011, the gap has narrwed slightly and significantly MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 21

22 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Small Decrease in MHCP Rate frm 2016 t 2017 Chlamydia Screening in Wmen Chlamydia is the mst cmmn sexually transmitted disease in the US and can lead t serius health prblems, including infertility in wmen. Chlamydia mst ften has n symptms, and if symptms d appear, it may be several weeks after being infected. Screening fr chlamydia is recmmended by the US Preventive Services Task Frce. The Chlamydia Screening in Wmen measure evaluates the percentage f sexually active wmen ages wh had at least ne test fr chlamydia during the measurement year. The data fr this measure are cllected frm health plan claims. (See Glssary) In 2017, 56 percent f MHCP patients received apprpriate chlamydia screening, which is a ne percent decrease frm This difference is statistically significant. See Figure 3 fr apprpriate screening rates fr MHCP and Other Purchasers ver time. Figure 3: Statewide Rates fr Chlamydia Screening in Wmen ver Time Figure 3 als includes the 2017 Natinal HEDIS Medicaid and Cmmercial rates as benchmarks fr cmparisn. The statewide MHCP rate is the slightly less than the 2017 Natinal HEDIS benchmark (57 percent). The statewide Other Purchasers rate is abve the 2017 Natinal Cmmercial benchmark (48 percent) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

23 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams MHCP patients cntinue t have a significantly higher rate f chlamydia screening than patients enrlled with Other Purchasers. The MHCP rate decreased slightly frm 2016 t 2017, hwever, this difference was nt significant. The Other Purchaser rate als decreased slightly frm 2016 t The MHCP statewide rate fr chlamydia screening was 56 percent; the rate fr Other Purchasers was 48 percent. Table 4 displays statewide rates fr each purchaser since measure implementatin. Table 4: Statewide Rates fr Chlamydia Screening in Wmen Fr this measure, MHCP patients had a higher rate f apprpriate care than Other Purchaser patients. While the difference between purchasers decreased since 2013, the MHCP statewide rate has cnsistently been higher than the Other Purchaser statewide rate fr every year MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 23

24 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Depressin Remissin at Six Mnths February 1, January 31, 2017 Dates f Service Depressin is a serius mental illness and affects ver five percent f adult Americans n any given day. Depressin is cmmnly assciated with difficulty with perfrming daily activities. Treatment can help imprve the symptms f depressin. The Depressin Remissin at Six Mnths measure evaluates the percentage f patients with a diagnsis f majr depressin r dysthymia and an initial Patient Health Questinnaire-9 (PHQ-9) scre greater than nine wh are in remissin defined as a subsequent PHQ-9 scre (after six mnths f treatment) less than five. Medical grups and clinics reprt data directly t MNCM fr this measure based n electrnic health recrds r paperbased medical charts. (See Glssary) Frm 2016 t 2017, the percentage f MHCP patients whse depressin was in remissin at six mnths decreased by 0.3 percentage pints and this was statistically significant. In 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. See Figure 4 belw fr Depressin Remissin at Six Mnths fr MHCP and Other Purchasers ver time. Figure 4: Statewide Rates fr Depressin Remissin at Six Mnths Over Time MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

25 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Fr Depressin Remissin at Six Mnths in 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. The statewide rate fr Depressin Remissin at Six Mnths fr MHCP patients was five percent; the rate fr patients enrlled with Other Purchasers was nine percent. Table 5 displays the statewide rates fr each purchaser since measure implementatin. Table 5: Statewide Rates fr Depressin Remissin at Six Mnths 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 25

26 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Apprpriate Treatment fr Children with URI Upper respiratry infectins (URI), als knwn as the cmmn cld, are caused by viruses and nt bacteria. These infectins d nt require antibitics fr patients t feel better. Apprpriate use f antibitics are an imprtant strategy in reducing the spread f antibitic-resistance bacteria. The Apprpriate Treatment fr Children with Upper Respiratry Infectin (URI) measure evaluates the percentage f children ages three mnths t 18 years with a diagnsis f URI that were nt given an antibitic prescriptin within three days f the episde perid. The episde ccurred between July 1 f the prir year and June 30 f the measurement year. Apprpriate treatment is t nt prvide an antibitic, since mst URIs are caused by a virus (antibitics are nt an apprpriate treatment fr a virus). A higher rate indicates better perfrmance and apprpriate treatment. Data cllected fr this measure are frm health plan claims. (See Glssary) In 2017, 93 percent f MHCP children with URI received apprpriate treatment. This rate decreased by less than ne percentage pint frm 2016, and that decrease was statistically significant. Since measure implementatin, the rate fr MHCP children has increased by apprximately seven percentage pints, which is als statistically significant. See Figure 5 fr statewide rates fr MHCP and Other Purchasers ver time fr this measure. Figure 5: Apprpriate Treatment fr Children with URI Statewide Rates ver Time Figure 5 als displays the 2017 Natinal HEDIS Medicaid and Cmmercial rates as benchmarks fr cmparisn. The statewide MHCP and Other Purchasers rates are bth abve their respective Natinal HEDIS benchmarks. In ther wrds, Minnesta medical grups are mre successful in achieving this health care best practice with their patients, regardless f purchaser, than ther medical grups natinwide MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

27 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams MHCP patients and patients insured by Other Purchasers cntinued t have similar rates fr Apprpriate Treatment fr Children with URI, althugh the difference between them is statistically significant. The statewide MHCP rate fr this measure was 93 percent; the rate fr Other Purchasers was 89 percent. Table 6 displays statewide rates fr each purchaser since measure implementatin. Table 6: Statewide Rates fr Apprpriate Treatment fr Children with URI Fr this measure, MHCP patients had higher rates than patients insured by Other Purchasers. MHCP patients experienced lwer rates cmpared t Other Purchaser patients fr this measure frm 2006 t That pattern changed in 2009 and the MHCP rate has remained abve the Other Purchaser rate since then. The difference between purchasers has been statistically significant in ten f the twelve years that this measure has been evaluated; nly during 2009 and 2010 was the gap nt significant MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 27

28 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Breast Cancer Screening Breast cancer is the secnd leading cause f cancer death in wmen, regardless f race r ethnicity. Screening can help imprve utcmes and reduce csts. The US Preventive Services Task Frce recmmends screening fr breast cancer in wmen aged 50 t 74 years. The Breast Cancer Screening measure evaluates the percentage f wmen ages wh received a mammgram during the prir tw years. The data fr this measure are cllected frm health plan claims. (See Glssary) Frm 2014 t 2017, the percentage f MHCP patients wh received a mammgram decreased by almst ne percentage pint, but this was nt statistically significant. In 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. See Figure 6 belw fr Breast Cancer Screening rates fr MHCP and Other Purchasers ver time. Figure 6: Statewide Rates fr Breast Cancer Screening Over Time MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

29 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams MHCP patients cntinue t have a significantly lwer Breast Cancer Screening rate than patients insured by Other Purchasers. This year, the statewide MHCP rate fr Breast Cancer Screening was 61 percent and the rate fr Other Purchasers was 78 percent. Table 7 displays statewide rates fr each purchaser since measure implementatin. Table 7: Statewide Rates fr Breast Cancer Screening The difference between purchasers fr Breast Cancer Screening widened by almst ne percentage pint frm 2016 t 2017, but this was nt statistically significant MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 29

30 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Mderate Decrease in MHCP Rate frm 2016 t 2017 Optimal Diabetes Care Accrding t the Centers fr Disease Cntrl and Preventin (CDC), ver 30 millin adults aged 18 and lder (12.2 percent f all U.S. adults) had diabetes in The percentage f adults with diabetes increases with age, reaching a high f 25 percent amng peple ver 65 years f age. Accrding t the American Diabetes Assciatin, diabetes care that includes emphasis n bld pressure, lipids, glucse, aspirin use and nn-use f tbacc will maximize health utcmes. The Optimal Diabetes Care measure evaluates the percentage f patients with diabetes (Type I and Type II) ages wh reached all five f the fllwing treatment gals t reduce cardivascular risk: Bld pressure less than 140/90 mmhg Hemglbin A1c (HBA1c) less than 8 On a statin medicatin, unless allwed cntraindicatins r exceptins are present Dcumented tbacc-free status Daily aspirin use fr patients with a c-mrbidity f Ischemic Vascular Disease (unless cntraindicated) Medical grups and clinics submitted data directly t MNCM fr this measure based n electrnic health recrds r paper-based medical charts. (See Glssary) Frm 2016 t 2017, the percentage f MHCP patients whse diabetes was ptimal decreased by ne percentage pint and this was statistically significant. In 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. See Figure 7 belw fr Optimal Diabetes Care fr MHCP and Other Purchasers ver time. Figure 7: Statewide Rates fr Optimal Diabetes Care Over Time MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

31 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Fr Optimal Diabetes Care in 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. The statewide rate fr Optimal Diabetes Care fr MHCP patients was 33 percent; the rate fr patients enrlled with Other Purchasers was 48 percent. Table 8 displays statewide rates fr each purchaser since measure implementatin. Table 8: Statewide Rates fr Optimal Diabetes Care 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 31

32 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Adults Ages Accrding t the CDC, abut 25 millin American have asthma. This is 7.6 percent f adults and 8.4 percent f children. Asthma has been increasing since the early 1980s in all age, sex and racial grups. The Optimal Asthma Cntrl measure evaluates the percentage f patients with persistent asthma wh attained all f the fllwing targets t cntrl their asthma: Evidence f well-cntrlled asthma using a validated asthma cntrl tl, Nt at risk fr elevated exacerbatin as evidenced by n patient-reprted emergency department visits and hspitalizatins due t asthma, This measure is segmented int tw age categries: children ages 5-17 and adults ages Medical grups and clinics reprt data directly t MNCM fr this measure based n electrnic health recrds r paperbased medical charts. (See Glssary) Frm 2016 t 2017, the percentage f MHCP adult patients whse asthma was under cntrl decreased by fur percentage pints and this was statistically significant. In 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. See Figure 8 belw fr Optimal Asthma Cntrl Adults Ages fr MHCP and Other Purchasers ver time. Figure 8: Statewide Rates fr Optimal Asthma Cntrl Adults Ages Over Time MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

33 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Fr Optimal Asthma Cntrl Adults Ages in 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. The statewide rate fr Optimal Asthma Cntrl Adults Ages fr MHCP patients was 41 percent; the rate fr patients enrlled with Other Purchasers was 53 percent. Table 9 displays statewide rates fr each purchaser since measure implementatin. Table 9: Statewide Rates fr Optimal Asthma Cntrl Adults Ages Every year has displayed a statistically significant difference between purchasers; hwever, the gap has narrwed significantly since MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 33

34 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Large Decrease in MHCP Rate frm 2016 t 2017 Optimal Vascular Care Cardivascular disease (CVD) is the leading cause f death fr men and wmen in the United States. Cnsidering the verall tll f cardivascular disease, measures that assess clinical care perfrmance are vital t reducing the negative impacts f CVD. The Optimal Vascular Care measure evaluates the percentage f patients ages with a diagnsis f vascular disease wh have reached all fur f the fllwing treatment gals t reduce cardivascular risk: Bld pressure less than 140/90 mmhg On a statin medicatin, unless allwed cntraindicatins r exceptins are present Dcumented tbacc-free status Daily aspirin use Medical grups and clinics submitted data directly t MNCM fr this measure based n electrnic health recrds r paper-based medical charts. (See Glssary) Frm 2016 t 2017, the percentage f MHCP patients whse vascular disease was ptimal decreased by seven percentage pints and this was statistically significant. In 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. See Figure 9 belw fr Optimal Vascular Care fr MHCP and Other Purchasers ver time. Figure 9: Statewide Rates fr Optimal Vascular Care Over Time MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

35 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Fr Optimal Vascular Care in 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. The statewide rate fr Optimal Vascular Care fr MHCP patients was 45 percent; the rate fr patients enrlled with Other Purchasers was 64 percent. Table 10 displays statewide rates fr each purchaser since measure implementatin. Table 10: Statewide Rates fr Optimal Vascular Care 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 35

36 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Children Ages 5-17 Accrding t the CDC, abut 25 millin American have asthma. This is 7.6 percent f adults and 8.4 percent f children. Asthma has been increasing since the early 1980s in all age, sex, and racial grups. The Optimal Asthma Cntrl measure evaluates the percentage f patients with persistent asthma wh attained all f the fllwing targets t cntrl their asthma: Evidence f well-cntrlled asthma using a validated asthma cntrl tl, Nt at risk fr elevated exacerbatin as evidenced by n patient-reprted emergency department visits and hspitalizatins due t asthma This measure is segmented int tw age categries: children ages 5-17 and adults ages Medical grups and clinics reprt data directly t MNCM fr this measure based n electrnic health recrds r paperbased medical charts. (See Glssary) Frm 2016 t 2017, the percentage f MHCP patients whse asthma was under cntrl decreased by seven percentage pints and this was statistically significant. In 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. See Figure 10 belw fr Optimal Asthma Cntrl Children Ages 5-17 fr MHCP and Other Purchasers ver time. Figure 10: Statewide Rates fr Optimal Asthma Cntrl Children Ages 5-17 Over Time MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

37 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Fr Optimal Asthma Cntrl Children Ages 5-17 in 2017, MHCP patients had a significantly lwer rate than Other Purchaser patients. The statewide rate fr Optimal Asthma Cntrl Children Ages 5-17 fr MHCP patients was 51 percent; the rate fr patients enrlled with Other Purchasers was 61 percent. Table 11 displays statewide rates fr each purchaser since measure implementatin Table 11: Statewide Rates fr Optimal Asthma Cntrl Children Ages 5-17 The difference between purchasers fr Optimal Asthma Cntrl Children Ages 5-17 narrwed by ver tw percentage pints frm 2016 t 2017, which is statistically significant. Hwever, this difference did nt change significantly frm 2015 t MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 37

38 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Medical Grup/Clinic Level Perfrmance Results Childhd Immunizatin Status (Cmb 10) by Medical Grup Fr the 2017 reprt year, 22 medical grups were reprtable fr the Childhd Immunizatin Status (Cmb 10) measure because they had at least 60 patients in their sample a large enugh sample t ensure a reasnable level f cnfidence in the reprted rate. These 22 medical grups accunted fr 2,176 f the 3,163 MHCP patients (69 percent) wh were eligible fr this measure statewide, and the 22 reprtable medical grups accunted fr 22 percent f medical grups prviding care t MHCP patients in Minnesta identified thrugh health plan claims data fr this measure. The mst successful medical grup fr this measure, HealthEast Clinics, achieved best practice with 59 percent f their MHCP patients; while the least successful, St. Luke's Clinics had n patients wh achieved best practice. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Eight medical grups had rates and cnfidence intervals greater than the statewide medical grup average (39 percent) fr MHCP patients. These medical grups are listed belw in rder f highest t lwest perfrmance. HealthEast Clinics Mankat Clinic, Ltd. May Clinic Health System-Owatnna May Clinic HealthPartners Clinics Sanfrd Health - Siux Falls Regin CentraCare Health Allina Health Largest Imprvement frm 2016 t 2017 The measure specificatin was revised this year t Cmb 10, which includes three additinal vaccines: pneumcccal cnjugate (PCV), rtavirus, and influenza. Due t this change, n trend data is available fr this measure this year. Medical Grup Perfrmance ver Time (2015 t 2017) The measure specificatin was revised this year t Cmb 10, which includes three additinal vaccines: pneumcccal cnjugate (PCV), rtavirus, and influenza. Due t this change, n trend data is available fr this measure this year MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

39 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Cntrlling High Bld Pressure by Medical Grup Fr the 2017 reprt year, 58 medical grups were reprtable fr the Cntrlling High Bld Pressure measure because they had at least 60 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 58 medical grups accunted fr 8,374 f the 9,871 MHCP patients (85 percent) wh were eligible fr this measure statewide, and the 58 reprtable medical grups accunted fr 41 percent f medical grups prviding care t MHCP patients in Minnesta wh have been identified thrugh health plan claims data fr this measure. The mst successful medical grup fr this measure, Entira Family Clinics, achieved best practice with 89 percent f their MHCP patients; while the least successful, Advanced Medical Clinic, achieved it with 28 percent f their MHCP patients. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Furteen medical grups had rates and cnfidence intervals greater than the statewide medical grup average (72 percent) fr MHCP patients. These medical grups are listed belw in rder frm highest t lwest perfrmance. Entira Family Clinics May Clinic Health System - Mankat CentraCare Health Sanfrd Health - Farg Regin HealthPartners Clinics Allina Health Largest Imprvement frm 2016 t 2017 The largest medical grup imprvement since reprt year 2016 in Cntrlling High Bld Pressure was made by University f Minnesta Physicians, which achieved a 26 percentage pint increase fr their MHCP patients. Medical Grup Perfrmance ver Time (2015 t 2017) A detailed table f medical grup perfrmance ver time can be fund in Appendix MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 39

40 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Clrectal Cancer Screening by Clinic Fr the 2017 reprt year, 531 clinics were reprtable fr the Clrectal Cancer Screening measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 531 clinics accunted fr 114,324 f the 118,418 MHCP patients (97 percent) wh were eligible fr this measure statewide, and the 531 reprtable clinics accunted fr 75 percent f clinics prviding care t MHCP patients in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. The mst successful clinic fr this measure, Obstetrics, Gyneclgy and Infertility - Edina, achieved best practices with 92 percent f their MHCP patients; while the least successful, AXIS Medical Center, achieved it with nly ne percent f their MHCP patients. A detailed table f clinic level perfrmance rates can be fund in Appendix 3. Clinics with Abve Average MHCP Rates in Reprt Year 2017 One hundred frty-three clinics had rates and cnfidence intervals greater than the statewide average (56 percent) fr MHCP patients. These clinics are listed belw in rder frm high t lw perfrmance fr each clumn, and frm highest in the left clumn t lwest in the right clumn. 40 Obstetrics, Gyneclgy and Infertility - Edina Obstetrics, Gyneclgy and Infertility - Maple Grve CentraCare Health Plaza- Internal Medicine CentraCare Health- Lng Prairie Hennepin Cunty Medical Center (HCMC) Clinics - Glden Valley Clinic CentraCare Health Plaza- Obstetrics and Wmen's Clinic Allina Health Specialties - Abbtt Nrthwestern General Medicine Assciates - Edina Allina Health - Chanhassen Sanfrd Bemidji Main Clinic - Internal Medicine HealthPartners - Ctr fr Internatl Hlth May Clinic Health System Faribault Campus Lcatin Allina Health - Sharpe Dilln Ccksn & Assciates Fairview Rgers Clinic Sanfrd Hawley Clinic May Clinic Health System- Franciscan Healthcare in LaCrescent Assciates In Wmen's Health - Edina HealthPartners - West Lakewd Health System - Mtley Clinic University f Minnesta Health - Fairview Maple Grve Medical Center Sanfrd Blackduck Clinic Fairview Prir Lake Clinic Allina Health - Buffal Sanfrd Siux Falls Internal Medicine Clinic CentraCare Health- Sauk Centre Perham Health New Yrk Mills Clinic Tri-Cunty Health Care - Bertha Clinic Diamnd Wmen's Center Suthdale Obstetric and Gyneclgy Cnsultants- Edina Fairview Crsstwn Clinic CentraCare Clinic - St. Jseph Sanfrd Aberdeen Clinic Fairview Farmingtn Clinic EH East Deer River Clinic Fairview Uptwn Clinic Fairview Andver Clinic CentraCare River Campus- Internal Medicine Allina Health - Eagan Fairview Apple Valley Clinic May Clinic - Speciality Practice CentraCare Health Paynesville- Richmnd Allina Health - Centennial Lakes 2018 MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. May Clinic Health System Le Sueur EH Central Crsslake Clinic HealthPartners - Hlth Ctr fr Wmen Ortnville Area Health Services-Nrthside Medical Clinic University f Minnesta Health - Primary Care Center HealthPartners - University Ave Fairview Eagan Clinic Allina Health - Uptwn Sanfrd Canby Clinic Fairview Zimmerman Clinic May Clinic Health System Fairmnt CentraCare Clinic - Nrthway Fairview Burnsville Clinic CentraCare Health- Mnticell Medical Grup University f Minnesta Health - Wmen's Health Specialists Clinic Allina Health - Vadnais Heights Fairview Brklyn Park Clinic Park Nicllet Clinic - St. Luis Park Internal Medicine Allina Health - Plymuth Sanfrd Health Detrit Lakes Clinic Park Nicllet Clinic - Champlin Fairview Elk River Clinic

41 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams May Clinic Health System New Prague Fairview Riverside Integrated Primary Care Allina Health - Frest Lake Park Nicllet Clinic - Glden Valley Allina Health - Edina Centracare Clinic-Albany May Clinic Health System Mankat Nrthridge Fairview New Brightn Clinic Fairview Hug Clinic HealthPartners - White Bear Lake Fairview Fridley Clinic Sanfrd Farg Suthpinte Clinic - Internal Medicine Allina Health - Ckat Fairview Princetn Clinic Allina Health - Richfield HealthPartners - Arden Hills Mankat Clinic - Daniel's Health Center Park Nicllet Clinic - Wayzata Allina Health - Champlin May Clinic Health System Springfield Park Nicllet Clinic - Prairie Center Allina Health - Farmingtn Allina Health - Shreview Oakdale Obstetrics & Gyneclgy, PA - Maple Grve EH East Lakeside Clinic Allina Health - Burnsville Allina Health - Chaska May Clinic Health System- Franciscan Healthcare in Calednia Sanfrd Bemidji Main Clinic - Family Medicine Park Nicllet Clinic - Eagan Allina Health - Brklyn Park Allina Health - Nicllet Mall Fairview Bass Lake Clinic Perham Health Clinic May Clinic - Nrtheast May Clinic Health System Waseca Fairview Rush City Clinic Fairview Milaca Clinic May Clinic Health System Mankat Eastridge EH Central Baxter Clinic Fairview EdenCenter Clinic May Clinic - Baldwin Building, Family Medicine Nrth Memrial Clinic - New Hpe Park Nicllet Clinic - Shakpee EH East Duluth Clinic 1st St Allina Health - Blaine HealthPartners - Lin Lakes Fairview Clumbia Heights Clinic Allina Health - Isles EH East Nrthern Pines Clinic Fairview Blmingtn Lake Xerxes Sanfrd Mrhead Clinic - Family Medicine Fairview Hiawatha Clinic Allina Health - Ramsey Avera - Pipestne Cunty Medical Center Alexandria Clinic, A Service f Duglas Cunty Hspital EH Central Brainerd Clinic EH West Detrit Lakes Clinic HealthPartners - Brklyn Center Nrth Memrial Clinic - Plymuth City Center May Clinic - Baldwin Building, Primary Care Internal Medicine HealthPartners - Inver Grve Heights HealthPartners - Elk River EH East Hermantwn Clinic Allina Health - Cambridge Fairview Oxbr Clinic May Clinic Health System Owatnna Sanfrd Health Alexandria Bradway Clinic Allina Health Specialties - New Ulm Medical Center Allina Health - West St. Paul Allina Health - Bandana Square Allina Health - Nrthfield Fairview Chisag Lakes Clinic Hennepin Cunty Medical Center (HCMC) Clinics - Richfield Clinic HealthPartners - Maplewd Riverwd Aitkin Clinic Stillwater Medical Grup - Curve Crest Clinic HealthPartners - Cn Rapids Allina Health - Cn Rapids Allina Health - Faribault Largest Imprvement frm 2016 t 2017 The largest clinic level imprvement since reprt year 2016 in Clrectal Cancer Screening was made by Hennepin Cunty Medical Center (HCMC) Clinics - Glden Valley Clinic, which achieved a 33 percentage pint increase fr their MHCP patients MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 41

42 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Clrectal Cancer Screening by Medical Grup Fr the 2017 reprt year, 100 medical grups were reprtable fr the Clrectal Cancer Screening measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 101 medical grups accunted fr 116,135 f the 118,418 MHCP patients (98 percent) wh are eligible fr this measure statewide, and the 100 reprtable medical grups accunted fr 81 percent f medical grups prviding care t MHCP patients in Minnesta wh submitted data t MNCM fr this measure. The mst successful medical grup fr this measure, Obstetrics and Gyneclgy Assciates, achieved best practice with 85 percent f their MHCP patients; while the least successful medical grup, Axis Medical Center, achieved best practice with nly ne percent f their MHCP patients. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Eighteen medical grups had rates and cnfidence intervals greater than the statewide average (56 percent) fr MHCP patients. These medical grups are listed belw in rder frm high t lw perfrmance fr each clumn. Obstetrics and Gyneclgy Assciates Suthdale Ob/Gyn Cnsultants Ortnville Area Health Services-Nrthside Medical Clinic Oakdale Ob/Gyn Fairview Health Services May Clinic Alexandria Clinic Allina Health Clinics Lakewd Health System Sanfrd Health - Farg Regin HealthPartners Clinics Allina Health Specialties Mankat Clinic, Ltd. May Clinic Health System CentraCare Health Essentia Health Sanfrd Health - Siux Falls Regin Park Nicllet Health Services Largest Imprvement frm 2016 t 2017 The largest medical grup imprvement since reprt year 2016 in Clrectal Cancer Screening was made by Open Dr Health Center, which achieved a 17 percentage pint increase fr their MHCP patients. Medical Grup Perfrmance ver Time ( ) A detailed table f medical grup perfrmance ver time can be fund in Appendix MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

43 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Chlamydia Screening in Wmen by Medical Grup Fr the 2017 reprt year, 72 medical grups were reprtable fr the Chlamydia Screening in Wmen measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 72 medical grups accunted fr 16,654 f the 19,461 MHCP patients (86 percent) wh were eligible fr this measure statewide, and the 72 reprtable medical grups accunted fr 47 percent f medical grups prviding care t MHCP patients in Minnesta wh have been identified thrugh health plan claims data fr this measure. The mst successful medical grup in this measure, Face t Face Health & Cunseling Service, Inc., achieved best practice with 85 percent f their MHCP patients; while the least successful, Glence Reginal Health Services, achieved it with nly nine percent f their MHCP patients. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Eleven medical grups had rates and cnfidence intervals greater than the statewide medical grup average (57 percent) fr MHCP patients. These medical grups are listed in rder f highest t lwest perfrmance. Face t Face Health & Cunseling Service, Inc. Planned Parenthd Minnesta, Nrth Dakta, Suth Dakta HealthPartners Clinics NrthPint Health & Wellness Center Obstetrics and Gyneclgy Assciates Allina Health Park Nicllet Health Services Hennepin Cunty Medical Center (HCMC) Clinics Entira Family Clinics Fairview Medical Grup CentraCare Health Largest Imprvement frm 2016 t 2017 The largest medical grup imprvement since reprt year 2016 in Chlamydia Screening in Wmen was made by Alexandria Clinic, which achieved a 24 percentage pint increase fr their MHCP patients. Medical Grup Perfrmance ver Time (2015 t 2017) A detailed table f medical grup perfrmance ver time can be fund in Appendix MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 43

44 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Depressin Remissin at Six Mnths by Clinic Fr the 2017 reprt year, 277 clinics were reprtable fr the Depressin Remissin at Six Mnths measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 277 clinics accunted fr 21,691 f the 25,551 MHCP patients (85 percent) wh were eligible fr this measure statewide, and the 277 reprtable clinics accunted fr 45 percent f clinics prviding care t MHCP patients in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. The mst successful clinic fr this measure, Entira Family Clinics - West St. Paul, achieved remissin at six mnths with 32 percent f their MHCP patients. Fifty-five clinics tied fr having n MHCP patients wh achieved depressin remissin at six mnths. A detailed table f clinic perfrmance rates can be fund in Appendix 3. Clinics with Abve Average MHCP Rates in Reprt Year 2017 Thirty-ne clinics had rates and cnfidence intervals greater than the statewide average (five percent) fr MHCP patients. These clinics are listed belw in rder frm high t lw perfrmance fr each clumn, and frm highest in the left clumn t lwest in the right clumn. Entira Family Clinics - West St. Paul Park Nicllet Clinic - Plymuth Park Nicllet Clinic - Blmingtn CentraCare Health- Sauk Centre May Clinic - Nrthwest Park Nicllet Clinic - Shakpee Allina Health - Farmingtn Byntn Health Service Park Nicllet Clinic - St. Luis Park Internal Medicine Park Nicllet Clinic - Minneaplis Sanfrd Mrhead Clinic - Behaviral Health HealthPartners - Blmingtn HealthPartners - White Bear Lake Park Nicllet Clinic - Prir Lake CentraCare Health- Melrse Park Nicllet Clinic - Eagan Fairview Milaca Clinic Sanfrd Health Detrit Lakes Clinic Allina Health - Frest Lake CentraCare Clinic- Big Lake Perham Health Clinic Allina Health - Faribault Fairview Hiawatha Clinic Allina Health - Buffal Allina Health - First Street Park Nicllet Clinic - St. Luis Park Family Medicine Allina Health - Nrthfield Olmsted Medical Center - Rchester Sutheast - Psychiatry Allina Health - West St. Paul Allina Health - Cambridge Park Nicllet Clinic - Psychiatry Largest Imprvement frm 2016 t 2017 The largest clinic imprvement since reprt year 2016 in Depressin Remissin at Six Mnths was made by Park Nicllet Clinic - St. Luis Park Internal Medicine, achieving a 13 percentage pint increase fr their MHCP patients MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

45 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Apprpriate Treatment fr Children with URI by Medical Grup Fr the 2017 reprt year, 84 medical grups were reprtable fr the Apprpriate Treatment fr Children with URI measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 84 medical grups accunted fr 16,117 f the 18,978 MHCP patients (85 percent) wh are eligible fr this measure statewide, and the 84 reprtable medical grups accunted fr 54 percent f medical grups prviding care t MHCP patients in Minnesta wh have been identified thrugh health plan claims data fr this measure. Eight medical grups achieved ptimal care with 100 percent f their MHCP patients: Nrth Clinic, United Family Medicine, Cedar Riverside Peple s Center, Suth Lake Pediatrics, West Side Cmmunity Health Services, MinuteClinic, FirstLight Health System, and May Clinic Health System St. James. The least successful medical grup, RiverView Health, achieved best practice with 55 percent f their MHCP patients. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Fifteen medical grups had rates and cnfidence intervals greater than the statewide medical grup average (93 percent) fr MHCP patients. These medical grups are listed belw in rder frm high t lw perfrmance fr each clumn. United Family Medicine Suth Lake Pediatrics West Side Cmmunity Health Services MinuteClinic FirstLight Health System Stellis Health, PA University f Minnesta Physicians HealthEast Clinics Hennepin Cunty Medical Center (HCMC) Clinics HealthPartners Clinics Park Nicllet Health Services Children's Clinic Netwrk Emergency Physicians, P.A. Allina Health Fairview Medical Grup Largest Imprvement frm 2016 t 2017 The largest medical grup imprvement since reprt year 2016 in Apprpriate Treatment fr Children with URI was made by Tri-Cunty Health Care, which achieved an 11 percentage pint increase fr their MHCP patients. Medical Grup Perfrmance ver Time ( ) A detailed table f medical grup perfrmance ver time can be fund in Appendix MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 45

46 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Breast Cancer Screening by Medical Grup Fr the 2017 reprt year, 64 medical grups were reprtable fr the Breast Cancer Screening measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 64 medical grups accunted fr 15,602 f the 21,412 MHCP patients (73 percent) wh were eligible fr this measure statewide, and the 64 reprtable medical grups accunted fr 47 percent f the medical grups prviding care t MHCP patients in Minnesta wh have been identified thrugh health plan claims data fr this measure. The mst successful medical grup fr this measure, Alexandria Clinic, achieved best practice with 85 percent f their MHCP patients; while the least successful, Advanced Medical Clinic, achieved it with 15 percent f their MHCP patients. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Twenty-ne medical grups had rates and cnfidence intervals greater than the statewide medical grup average (63 percent) fr MHCP patients. These medical grups are listed belw in rder frm highest t lwest. Alexandria Clinic May Clinic Health System - Waseca May Clinic Health System - Lake City Multicare Assciates Tri-Cunty Health Care Stellis Health, PA HealthPartners Clinics May Clinic Health System-Owatnna NrthPint Health & Wellness Center May Clinic Health System - Mankat May Clinic Allina Health May Clinic Health System - Red Wing Affiliated Cmmunity Medical Centers Fairview Medical Grup Mankat Clinic, Ltd. Sanfrd Health - Farg Regin HealthEast Clinics Essentia Health CentraCare Health Park Nicllet Health Services Largest Imprvement frm 2016 t 2017 The largest medical grup imprvement since reprt year 2016 in Breast Cancer Screening was made by Lake Regin Healthcare, which achieved a 16 percentage pint increase fr their MHCP patients. Medical Grup Perfrmance ver Time (2015 t 2017) A detailed table f medical grup perfrmance ver time can be fund in Appendix MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

47 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Diabetes Care by Clinic Fr the 2017 reprt year, 369 clinics were reprtable fr the Optimal Diabetes Care measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 369 clinics accunted fr 41,546 f the 45,130 MHCP patients (92 percent) wh were eligible fr this measure statewide, and the 369 reprtable clinics accunted fr 58 percent f clinics prviding care t MHCP patients in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. The mst successful clinic in this measure, Fairview Blmingtn Lake Xerxes achieved ptimal care with 63 percent f their MHCP patients; while the least successful, Prairie Ridge Hspital & Health Services - Elbw Lake, achieved it with three percent f their MHCP patients. A detailed table f clinic perfrmance rates can be fund in Appendix 3. Clinics with Abve Average MHCP Rates in Reprt Year 2017 Fifty-five clinics had rates and cnfidence intervals that were greater than the statewide average (33 percent) fr MHCP patients. These clinics are listed belw in rder frm high t lw perfrmance fr each clumn, and frm highest in the left clumn t lwest in the right clumn. Fairview Blmingtn Lake Xerxes Fairview EdenCenter Clinic Fairview Rsemunt Clinic Fairview Blaine Clinic CentraCare River Campus-Internal Medicine Fairview Eagan Clinic Fairview Highland Park Clinic Fairview Crsstwn Clinic HealthEast Rseville Clinic Sanfrd Health Pierre Clinic Allina Health - Blaine Nrth Memrial Clinic - Plymuth City Center Sanfrd Health Vermillin Clinic HealthPartners - Ctr fr Internatl Hlth Allina Health - Eagan Fairview Nrth Branch Clinic HealthPartners - West Fairview Elk River Clinic Sanfrd Farg Suthpinte Clinic - Family Medicine HealthPartners - Elk River Fairview Oxbr Clinic May Clinic Health System Faribault Hwy 60 HealthPartners - Arden Hills Fairview Burnsville Clinic Fairview Blmingtn Lake Minneaplis May Clinic Health System St. Peter HealthPartners - Cn Rapids Fairview Fridley Clinic Entira Family Clinics - Wdbury Park Nicllet Clinic - Shakpee Fairview Andver Clinic Allina Health - Farmingtn Fairview Apple Valley Clinic HealthPartners - Eagan HealthPartners - Riverside Fairview Hiawatha Clinic Fairview Brklyn Park Clinic Park Nicllet Clinic - Burnsville Allina Health - Edina Entira Family Clinics - East Side HealthPartners - Brklyn Center Apple Valley Medical Clinic - Family Practice Fairview Lakes Medical Center CentraCare Health Plaza-Family Medicine Allina Health - Maplewd Allina Health - Cn Rapids Fairview New Brightn Clinic May Clinic Health System Mankat Eastridge Park Nicllet Clinic - Brkdale May Clinic Health System Red Wing HealthPartners - Wdbury Park Nicllet Clinic - St. Luis Park Internal Medicine Allina Health - Faribault May Clinic Health System Owatnna May Clinic - Baldwin Building, Primary Care Internal Medicine Largest Imprvement frm 2016 t 2017 The largest clinic level imprvement since reprt year 2016 in Optimal Diabetes Care was made by Fairview Blmingtn Lake Xerxes, which achieved a 27 percentage pint increase fr their MHCP patients MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 47

48 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Diabetes Care by Medical Grup Fr the 2017 reprt year, 74 medical grups were reprtable fr the Optimal Diabetes Care measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 74 medical grups accunted fr 44,759 f the 45,130 MHCP patients (99 percent) wh were eligible fr this measure statewide, and the 74 reprtable medical grups accunted fr 76 percent f medical grups prviding care t MHCP patients in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. The mst successful medical grup in this measure, Fairview Health Services, achieved ptimal care with 45 percent f their MHCP patients, while the least successful, Lakewd Health Center Clinic, achieved it with less than seven percent f their MHCP patients. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Eight medical grups had rates and cnfidence intervals greater than the statewide average (33 percent) fr MHCP patients. These medical grups are listed belw in rder f highest t lwest perfrmance. Fairview Health Services Apple Valley Medical Clinic Entira Family Clinics Sanfrd Health - Siux Falls Regin Park Nicllet Health Services Allina Health Clinics HealthPartners Clinics May Clinic Health System Largest Imprvement frm 2016 t 2017 The largest medical grup imprvement since reprt year 2016 in Optimal Diabetes Care was made by Suthside Cmmunity Health Services, which achieved a 14 percentage pint increase fr their MHCP patients. Medical Grup Perfrmance ver Time (2015 t 2017) The measure specificatin was revised in 2016 t include the statin use cmpnent in the measure calculatin. Due t this change, n trend data is available fr this measure this year MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

49 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Adults Ages by Clinic Fr the 2017 reprt year, 323 clinics were reprtable fr the Optimal Asthma Cntrl Adults Ages measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 323 clinics accunted fr 29,102 f the 33,142 MHCP patients (88 percent) wh were eligible fr this measure statewide, and the 323 reprtable clinics accunted fr 48 percent f clinics prviding care t MHCP patients ages in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. There was wide variatin in the success f clinics t achieve ptimal asthma care with their MHCP patients ages The variatin culd be due t a number f factrs, sme f which can be influenced by a clinic. The mst successful clinic fr this measure, Park Nicllet Clinic - Glden Valley, achieved ptimal care with 79 percent f their MHCP patients ages There were furteen clinics that tied fr having n MHCP patients age achieved ptimal asthma cntrl. A detailed table f clinic level perfrmance rates can be fund in Appendix 3. Clinics with Abve Average MHCP Rates in Reprt Year 2017 One hundred and twelve clinics had rates and cnfidence intervals that were greater than the statewide average (40 percent) fr MHCP patients aged These clinics are listed belw in rder frm high t lw perfrmance fr each clumn, and frm highest in the left clumn t lwest in the right clumn. Park Nicllet Clinic - Glden Valley Fairview Chisag Lakes Clinic Allina Health - Savage CentraCare Health Plaza- Pediatrics Park Nicllet Clinic - Shakpee Fairview Rsemunt Clinic Allina Health - Eagan Fairview Riverside Integrated Primary Care Allina Health - Farmingtn HealthPartners - Andver HealthPartners Central Minnesta Clinics Fairview Lin Lakes Clinic Entira Family Clinics - White Bear Lake/Banning Ave Fairview Lakes Medical Center Park Nicllet Clinic - Prir Lake Fairview Prir Lake Clinic Fairview Zimmerman Clinic Fairview Highland Park Clinic Allina Health - Buffal Allina Health - Shakpee HealthPartners - Lin Lakes Fairview Blmingtn Lake Minneaplis Allina Health - Ckat CentraCare Clinic - Nrthway Park Nicllet Clinic - Champlin Allina Health - St. Michael Mankat Clinic - Nrth Mankat Fairview Hiawatha Clinic Allina Health - Plymuth Allina Health - Annandale Allina Health - Uptwn Fairview Blmingtn Lake Xerxes Fairview Apple Valley Clinic Fairview Princetn Clinic HealthPartners - Elk River Allina Health - Nrthfield Fairview New Brightn Clinic 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. Fairview Uptwn Clinic Fairview EdenCenter Clinic HealthPartners - Eagan Allina Health - Chaska Fairview Brklyn Park Clinic HealthPartners - Cn Rapids Allina Health - Blaine Fairview Nrth Branch Clinic Allina Health - Presctt May Clinic Health System St. Peter HealthPartners - Nkmis Fairview Elk River Clinic Nrth Memrial Clinic - Glden Valley Physicians Fairview Bass Lake Clinic Allina Health - First Street Allina Health - Maple Grve Allina Health - Richfield Mankat Clinic - Daniel's Health Center Park Nicllet Clinic - St. Luis Park Internal Medicine 49

50 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Fairview Rgers Clinic Park Nicllet Clinic - Prairie Center Fairview Blaine Clinic Allina Health - Shreview Allina Health - Hpkins Fairview Clumbia Heights Clinic Park Nicllet Clinic - Carlsn HealthPartners - Maplewd Fairview Fridley Clinic Allina Health - Highland Park Hennepin Cunty Medical Center (HCMC) Clinics - Dwntwn Pediatric Clinic Park Nicllet Clinic - St. Luis Park Family Medicine Allina Health - Faribault HealthPartners - Arden Hills Affiliated Cmmunity Medical Centers - Litchfield Clinic (East) Fairview Eagan Clinic Allina Health - Dean Lakes Fairview Burnsville Clinic EH East Hayward Clinic Park Nicllet Clinic - Eagan HealthPartners - White Bear Lake FirstLight Health System - Mra Allina Health - Ramsey Fairview Andver Clinic Allina Health - Maplewd Campus Allina Health - West St. Paul Park Nicllet Clinic - Blmingtn EH East Deer River Clinic Allina Health - Cttage Grve Allina Health - Frest Lake Affiliated Cmmunity Medical Centers - Redwd Falls Clinic Allina Health - Brklyn Park Allina Health - Cn Rapids Allina Health - Elk River Fairview Riverside Family Practice Nrth Memrial Clinic - Brklyn Park Physicians Hennepin Cunty Medical Center (HCMC) Clinics - East Lake Clinic Allina Health - Inver Grve Heights Allina Health Specialties - New Ulm Medical Center Allina Health - Fridley May Clinic Health System Austin EH East Superir Clinic Mankat Clinic - Main Street Park Nicllet Clinic - Maple Grve HealthPartners - Brklyn Center HealthPartners - Riverside Affiliated Cmmunity Medical Centers- Marshall Clinic Allina Health - Cambridge HealthPartners - Apple Valley Allina Health - Blmingtn HealthPartners - St Paul Park Nicllet Clinic - Burnsville Affiliated Cmmunity Medical Centers - Willmar Clinic EH East Duluth Clinic 1st St Allina Health - Bandana Square Largest Imprvement frm 2016 t 2017 The largest clinic level imprvement since reprt year 2016 in Optimal Asthma Cntrl - Adults was made by Park Nicllet Clinic - Prir Lake, which achieved a 29 percentage pint increase fr their MHCP patients MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

51 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Adults Ages by Medical Grup Fr the 2017 reprt year, 71 medical grups were reprtable fr the Optimal Asthma Cntrl Adults Ages measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 71 medical grups accunted fr 32,621 f the 33,142 MHCP patients (98 percent) wh were eligible fr this measure statewide, and the 71 reprtable medical grups accunted fr 62 percent f medical grups prviding care t MHCP patients ages in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. There was wide variatin in the success f medical grups t achieve ptimal asthma care with their MHCP patients ages The variatin culd be due t a number f factrs, sme f which can be influenced by a medical grup. The mst successful medical grup fr this measure, Suth Lake Pediatrics, achieved ptimal asthma cntrl with 81 percent f their MHCP patients ages There were six medical grups that tied fr having n MHCP patients ages wh achieved ptimal asthma care. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Fifteen medical grups had rates and cnfidence intervals greater than the statewide average (40 percent) fr MHCP patients ages These medical grups are listed belw in rder f highest t lwest perfrmance. Suth Lake Pediatrics HealthPartners Central Minnesta Clinics Fairview Health Services Children's Respiratry & Critical Care Specialists Mankat Clinic, Ltd. Allina Health Clinics Park Nicllet Health Services Sanfrd Health - Siux Falls Regin FirstLight Health System HealthPartners Clinics Affiliated Cmmunity Medical Centers Entira Family Clinics CentraCare Health May Clinic Health System Essentia Health Largest Imprvement frm 2016 t 2017 The largest medical grup imprvement since reprt year 2016 in Optimal Asthma Cntrl - Adults was made by Riverwd Healthcare Center, which achieved a 34 percentage pint increase fr their MHCP patients. Medical Grup Perfrmance ver Time (2015 t 2017) A detailed table f medical grup perfrmance ver time can be fund in Appendix MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 51

52 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Vascular Care by Clinic Fr the 2017 reprt year, 180 clinics were reprtable fr the Optimal Vascular Care measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 107 clinics accunted fr 13,521 f the 18,307 MHCP patients (74 percent) wh were eligible fr this measure statewide, and the 107 reprtable clinics accunted fr 17 percent f clinics prviding care t MHCP patients in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. The mst successful clinic fr this measure, Fairview Crsstwn Clinic, achieved ptimal care with 77 percent f their MHCP patients; while the least successful, Cmmunity-University Health Care Center, achieved it with 21 percent f their MHCP patients. A detailed table f clinic perfrmance rates can be fund in Appendix 3. Clinics with Abve Average MHCP Rates in Reprt Year 2017 Twenty clinics had rates and cnfidence intervals greater than the statewide clinic average (45 percent) fr MHCP patients. These clinics are listed belw in rder frm highest t lwest perfrmance. Fairview Crsstwn Clinic Entira Family Clinics - East Side Sanfrd Health Vermillin Clinic Fairview Eagan Clinic Fairview Oxbr Clinic HealthPartners - Ctr fr Internatl Hlth University f Minnesta Heart Care at Fairview Ridges Specialty Care Center CentraCare Health Plaza-Family Medicine Fairview Fridley Clinic HealthPartners - Cm Fairview Brklyn Park Clinic University f Minnesta Heart Care at Fairview Suthdale Hspital Fairview Burnsville Clinic HealthEast Rice Street Clinic University f Minnesta Health Heart Care at University f Minnesta Medical Center Sanfrd Siux Falls Cardivascular Institute Allina Health Specialties - United Heart and Vascular Clinic Allina Health Specialties - Metrplitan Heart & Vascular Inst. - Cn Rapids Allina Health - Cn Rapids Allina Health Specialties - Minneaplis Heart Institute - ANW Largest Imprvement frm 2016 t 2017 The largest clinic level imprvement since reprt year 2016 in Optimal Vascular Care was made by Fairview Eagan Clinic, which achieved a 23 percentage pint increase fr their MHCP patients MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

53 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Vascular Care by Medical Grup Fr the 2017 reprt year, 54 medical grups were reprtable fr the Optimal Vascular Care measure because they had at least 30 patients that met measure specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 42 medical grups accunted fr 17,965 f the 19,307 MHCP patients (93 percent) wh were eligible fr this measure statewide, and the 54 reprtable medical grups accunted fr 58 percent f medical grups prviding care t MHCP patients in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. There was wide variatin in the success f medical grups t achieve ptimal vascular care with their MHCP patients. The mst successful medical grup fr this measure, Fairview Health Services, achieved ptimal care with 59 percent f their MHCP patients; while, the least successful, Open Cities Health Center, achieved it with nly twenty percent f their MHCP patients. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Five medical grups had rates and cnfidence intervals greater than the statewide medical grup average (45 percent) fr MHCP patients. These medical grups are listed belw in rder frm highest t lwest perfrmance. Fairview Health Services Allina Health Specialties May Clinic University f Minnesta Physicians Allina Health Clinics Largest Imprvement frm 2016 t 2017 The largest medical grup imprvement since reprt year 2016 in Optimal Vascular Care was made by Avera Medical Grup, which achieved a 17 percentage pint increase fr their MHCP patients. Medical Grup Perfrmance ver Time (2015 t 2017) The measure specificatin was revised in 2016 t include the statin use cmpnent in the measure calculatin. Due t this change, n trend data is available fr this measure this year MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 53

54 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Children Ages 5-17 by Clinic Fr the 2017 reprt year, 207 clinics were reprtable fr the Optimal Asthma Cntrl Children Ages 5-17 measure because they had at least 30 patients that met the measurement specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 207 clinics accunted fr 20,597 f the 25,272 MHCP patients (82 percent) wh were eligible fr this measure statewide, and the 207 reprtable clinics accunted fr 33 percent f clinics prviding care t MHCP patients ages 5-17 in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. The mst successful clinic, Advancements in Allergy and Asthma Care, Ltd., achieved ptimal care with 92 percent f their MHCP patients ages Fur clinics tied fr having n MHCP patients wh achieved ptimal asthma cntrl. A detailed table f clinic perfrmance rates can be fund in Appendix 3. Clinics with Abve Average MHCP Rates in Reprt Year 2017 Sixty-eight clinics had rates and cnfidence intervals that were greater than the statewide clinic average (51 percent) fr MHCP patients ages These clinics are listed belw in rder frm high t lw perfrmance fr each clumn, and frm highest in the left clumn t lwest in the right clumn. Advancements in Allergy and Asthma Care, Ltd. Fairview Lin Lakes Clinic Suth Lake Pediatrics - Eden Prairie Lakewd Health System - Staples Clinic Fairview Elk River Clinic Allina Health - Blmingtn Suth Lake Pediatrics - Minnetnka Fairview Lakes Medical Center Mankat Clinic - Daniel's Health Center CentraCare Clinic - Nrthway Suth Lake Pediatrics - Maple Grve Park Nicllet Clinic - Blmingtn Wayzata Children's Clinic - Minnetnka Sanfrd Siux Falls Children's Specialty Clinic Affiliated Cmmunity Medical Centers- Marshall Clinic HealthPartners - White Bear Lake Sanfrd Siux Falls Children's Clinic 26th & Sycamre Clinic CentraCare Health Plaza- Pediatrics HealthPartners Central Minnesta Clinics Sanfrd Farg Suthpinte Clinic - Specialty Clinics May Clinic Health System Austin Fairview Milaca Clinic Central Pediatrics Wdbury Allergy, Asthma & Immunlgy - Shreview Fairview Children's Clinic Allina Health - Buffal Sanfrd Mrhead Clinic - Pediatrics Fairview Andver Clinic Affiliated Cmmunity Medical Centers - Redwd Falls Clinic Allina Health - Frest Lake Park Nicllet Clinic - Burnsville Fairview Rsemunt Clinic Sanfrd Siux Falls Children's Clinic 69th & Luise Clinic Hennepin Cunty Medical Center (HCMC) Clinics - East Lake Clinic Fairview Oxbr Clinic Sanfrd Farg Children's Suthwest Clinic Hennepin Cunty Medical Center (HCMC) Clinics - Dwntwn Pediatric Clinic Sanfrd Wrthingtn Clinic May Clinic Health System Faribault Campus Lcatin Allina Health - Cn Rapids Park Nicllet Clinic - Prir Lake Allina Health - Ramsey HealthPartners - Riverside Affiliated Cmmunity Medical Centers - Willmar Clinic Allina Health - Inver Grve Heights Park Nicllet Clinic - Maple Grve HealthPartners - Blmingtn Park Nicllet Clinic - Eagan Park Nicllet Clinic - St. Luis Park Pediatrics Allina Health - Eagan Allina Health - Bandana Square Fairview Fridley Clinic Fairview Clumbia Heights Clinic MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

55 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams May Clinic Health System Red Wing May Clinic - Baldwin Building, Pediatrics Central Pedatrics St. Paul HealthPartners - St Paul Allina Health - First Street Children's Respiratry & Critical Care Specialists - Minnetnka Park Nicllet Clinic - Shakpee EH East Duluth Clinic 1st St May Clinic Health System Albert Lea HealthPartners - Anka Children's Respiratry & Critical Care Specialists - Minneaplis HealthPartners - Brklyn Center Children's Respiratry & Critical Care Specialists - St Paul EH Central Baxter Clinic Mankat Clinic - Children's Health Center Largest Imprvement frm 2016 t 2017 The largest clinic level imprvement since reprt year 2016 in Optimal Asthma Cntrl Children was made by HealthPartners - Apple Valley, which achieved an 18 percentage pint increase fr their MHCP patients MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 55

56 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Children Ages 5-17 by Medical Grup Fr the 2017 reprt year, 67 medical grups were reprtable fr the Optimal Asthma Cntrl Children Ages 5-17 measure because they had at least 30 patients that met measure specificatins enugh patients t ensure a reasnable level f cnfidence in the reprted rate. These 67 medical grups accunted fr 24,818 f the 25,272 MHCP patients (98 percent) wh were eligible fr this measure statewide, and the 67 reprtable medical grups accunted fr 61 percent f medical grups prviding care t MHCP patients ages 5-17 in Minnesta and surrunding areas wh submitted data t MNCM fr this measure. The mst successful medical grup fr this measure, Advancements in Allergy and Asthma Care, achieved ptimal care with 92 percent f their MHCP patients ages There were tw medical grups (Nrth Clinic and Raiter Clinic, LTD - IHN) that tied fr having n MHCP patients ages 5-17 wh achieved ptimal asthma cntrl. A detailed table f medical grup perfrmance rates can be fund in Appendix 3. Medical Grups with Abve Average MHCP Rates in Reprt Year 2017 Twenty medical grups had rates and cnfidence intervals greater than the statewide medical grup average (51 percent) fr MHCP patients ages These medical grups are listed belw in rder f highest t lwest perfrmance. Advancements in Allergy and Asthma Care Wayzata Children's Clinic Suth Lake Pediatrics HealthPartners Central Minnesta Clinics Allergy, Asthma & Immunlgy Clinic CentraCare Health Central Pediatrics Lakewd Health System Fairview Health Services Affiliated Cmmunity Medical Centers Sanfrd Health - Siux Falls Regin May Clinic Children's Respiratry & Critical Care Specialists Mankat Clinic, Ltd. Hennepin Cunty Medical Center (HCMC) Clinics Park Nicllet Health Services Allina Health Clinics May Clinic Health System HealthPartners Clinics Essentia Health Largest Imprvement frm 2016 t 2017 The largest medical grup imprvement since reprt year 2016 in Optimal Asthma Cntrl - Children was made by Lakewd Health System, which achieved a 36 percentage pint increase fr their MHCP patients. Medical Grup Perfrmance ver Time ( ) A detailed table f medical grup perfrmance ver time can be fund in Appendix MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

57 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Please see next page MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 57

58 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams An Examinatin f Statewide MHCP Perfrmance Rates by Race and Hispanic Ethnicity Health care disparities are well-dcumented and persistent in the United States. These disparities are ften based n sciecnmic status, race and ethnicity. Increased reprting f health utcmes by sciecnmic status, race and ethnicity is needed t prmte equity f care and evaluate where the gaps remain. 5 In Minnesta, results frm ur Health Care Disparities Reprts have shwn patients f lwer sciecnmic status have different rates f care even when health care cverage is available, as is the case fr patients enrlled in MHCP. These disparities result frm multiple factrs, ne f which may be that a higher prprtin f MHCP patients are members f underserved races and ethnicities. Researchers agree that cllecting and using data n the races and ethnicities f certain patient ppulatins may build a fundatin fr understanding and reducing disparities. 1, 4 Fr sme measures, available data allws us t examine perfrmance rate differences by race and Hispanic ethnicity at a statewide level within the MHCP patient ppulatin. Methds Statewide cmparisns by race and Hispanic ethnicity were cnducted n the MHCP patient ppulatin using enrllment data supplied by the Minnesta Department f Human Services (DHS). DHS sends mnthly enrllment data t health plans that cntract with the Department t prvide health care services t MHCP recipients. This enrllment data includes race and Hispanic ethnicity infrmatin fr these patients. Race and ethnicity is self-reprted by recipients at the time they enrll in MHCP. Recipients are able t declare mre than ne race n their enrllment frm. Each patient was placed in ne f the fllwing race categries: American Indian r Alaska Native Asian r Pacific Islander r Native Hawaiian Black r African American Multi-Racial Unknwn White Each patient was als placed in the ne f the fllwing Hispanic ethnicity categries: Hispanic Nn-Hispanic Unknwn These categries generally cmply with the Office f Management and Budget directive t prvide an accurate basis fr cmparisn purpses. Hwever, Pacific Islander r Native Hawaiian is cmbined with Asian in this reprt because f the small number f patients wh identified themselves as Pacific Islander r Native Hawaiian. Patients are able t declare mre than ne race when they enrll in MHCP, allwing MNCM t calculate rates fr a Multi-Racial categry. Fr the analyses within this reprt, race and Hispanic ethnicity are reprted separately. Results are presented fr race and Hispanic ethnicity nly if there are at least 30 patients in the categry. The fllwing measures are nt reprted by race and Hispanic ethnicity in this reprt: Optimal Diabetes Care, Optimal Vascular Care, Depressin Remissin at Six Mnths, Optimal Asthma Cntrl - Children Ages 5-17, Optimal Asthma Cntrl - Adults Ages and Clrectal Cancer Screening. As mre clinics submit these data elements and as the data are validated fr best practice, MNCM will be able t reprt a statewide MHCP rate fr these measures by race and Hispanic ethnicity. 5 Institute f Medicine (1999). Unequal Treatment: Cnfrnting Racial and Ethnic Disparities in Health Care MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

59 Race Descriptins ⱡ 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams American Indian r Alaskan Native: A persn having rigins in any f the riginal peples f Nrth and Suth America (including Central America), and wh maintains tribal affiliatin r cmmunity attachment. Asian r Pacific Islander r Native Hawaiian: A persn having rigins in any f the riginal peples f the Far East, Sutheast Asia, r the Indian subcntinent, r a persn having rigins in any f the riginal peples f Hawaii, Guam, Sama, r ther Pacific Islands. Black r African American: A persn having rigins in any f the black racial grups f Africa. Terms such as Haitian r Negr can be used in additin t Black r African American. Multi-Racial: A persn self-identifying with mre than ne f the fllwing races: American Indian r Alaskan Native; Asian r Pacific Islander r Native Hawaiian; Black r African American; and White. Peple in this categry did nt select a catch-all multi-racial r mre than ne race categry; instead, it was created fr reprting purpses. Unknwn: A persn wh has nt self-reprted his r her race during enrllment in MHCP. White: A persn having rigins in any f the riginal peples f Eurpe, the Middle East r Nrth Africa. Hispanic Ethnicity Descriptins Hispanic r Latin: A persn f Cuban, Mexican, Puert Rican, Suth r Central American r ther Spanish culture r rigin. The term Spanish rigin can be used in additin t Hispanic r Latin. Nn-Hispanic: A persn wh is nt f Cuban, Mexican, Puert Rican, Suth r Central American r ther Spanish culture r rigin. Unknwn: A persn wh has nt self-reprted his r her ethnicity during enrllment in MHCP. ⱡ Race and Hispanic Ethnicity definitins are frm the Office f Management and Budget MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 59

60 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Childhd Immunizatin Status (Cmb 10) Figure 11.1 shws Childhd Immunizatin Status (Cmb 10) by race. The Asian r Pacific Islander r Native Hawaiian grup had the highest rate f childhd immunizatins (47 percent), and this rate was significantly abve the MHCP statewide rate (38 percent). The nly ther racial grup that had a rate significantly abve the MHCP statewide rate was the Unknwn racial grup at 41 percent. The Black r African American and American Indian r Alaskan Native racial grups had rates significantly belw the statewide MHCP rate, with the American Indian r Alaskan Native racial grup having the lwest rate. Figure 11.1: Childhd Immunizatin Status (Cmb 10) Statewide Rates by Race Figure 11.2 shws Childhd Immunizatin Status (Cmb 10) rates by Hispanic ethnicity. The Unknwn ethnicity had the highest rate f childhd immunizatin status and this rate was significantly abve the MHCP statewide rate, as well as the rates fr Nn-Hispanic ethnic grups. The rate fr Hispanics was als significantly higher than the statewide MHCP rate. The Nn-Hispanic ethnic grup had the lwest rate. Figure 11.2: Childhd Immunizatin Status (Cmb 10) Statewide Rates by Hispanic Ethnicity MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

61 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Cntrlling High Bld Pressure Figure 12.1 shws the Cntrlling High Bld Pressure rates by race. The Multi-Racial racial grup had the highest rate (78 percent). The Black r African American racial grup had the lwest perfrmance rate and this was significantly belw the MHCP statewide rate. Figure 12.1: Cntrlling High Bld Pressure Statewide Rates by Race Figure 12.2 shws the rates f Cntrlling High Bld Pressure by Hispanic ethnicity. The Unknwn ethnicity categry had the highest rate f cntrlling high bld pressure; hwever, n ethnicity had rates significantly abve the statewide average. Figure 12.2: Cntrlling High Bld Pressure Statewide Rates by Hispanic Ethnicity 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 61

62 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Chlamydia Screening in Wmen Figure 13.1 shws Chlamydia Screening in Wmen rates by race. The Black r African American racial grup cntinued t have the highest chlamydia screening rate, and it was significantly higher than the statewide MHCP rate (56 percent) and the rates fr all ther racial grups. The Asian r Pacific r Native Hawaiian and Multi-Racial grups were the nly ther grups with rates significantly abve the MHCP statewide rate. The White racial grup had the lwest chlamydia screening rate at 51 percent and the nly rate that was significantly belw the MHCP statewide rate. Figure 13.1: Chlamydia Screening in Wmen Statewide Rates by Race Figure 13.2 shws Chlamydia Screening in Wmen rates by Hispanic ethnicity. The Hispanic grup had a highest rate f chlamydia screening and this was significantly abve the MHCP statewide rate. The Unknwn ethnicity categry had the lwest perfrmance rate. Figure 13.2: Chlamydia Screening in Wmen Statewide Rates by Hispanic Ethnicity MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

63 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Apprpriate Treatment fr Children with URI Figure 14.1 shws Apprpriate Treatment fr Children with URI rates by race. The Black r African American racial grup had the highest rate f apprpriate treatment fr children with URI (95 percent), and this rate was significantly abve the MHCP statewide rate (93 percent). The Asian r Pacific Islander r Native Hawaiian and Unknwn racial grups als had rates significantly abve the MHCP statewide rate. The White racial grup had the lwest rate at 91% and cntinued t have a perfrmance rate significantly belw the statewide MHCP rate. Figure 14.1: Apprpriate Treatment fr Children with URI Statewide Rates by Race Figure 14.2 shws Apprpriate Treatment fr Children with URI rates by Hispanic ethnicity. The Unknwn ethnicity categry has the highest rate f apprpriate treatment, and this rate was significantly abve the MHCP statewide rate. Nn-Hispanics had the lwest perfrmance rate at 93 percent. Figure 14.2: Apprpriate Treatment fr Children with URI Statewide Rates by Hispanic Ethnicity 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 63

64 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Breast Cancer Screening Figure 15.1 shws the rates f Breast Cancer Screening by race. The White racial grup had the highest rate f breast cancer screening, and this rate was significantly abve the MHCP statewide rate (61 percent). The White racial grup was the nly grup with a rate significantly abve the MHCP statewide rate at 62 percent. The American Indian r Alaskan Native racial grup had the lwest rate f breast cancer screening, and this rate was significantly belw the MHCP statewide rate. The Black r African American racial grup als had a rate significantly belw the MHCP statewide rate at 56 percent. Figure 15.1: Breast Cancer Screening Statewide Rates by Race Figure 15.2 shws the rates f Breast Cancer Screening by ethnicity. Hispanics had the highest rate f breast cancer screening (69 percent), and this rate was significantly abve the statewide MHCP rate, the Nn-Hispanic rate, and the Unknwn ethnicity rate. The rate fr the Unknwn ethnicity categry was the lwest and this was significantly belw the rate fr Hispanics and Nn-Hispanics, as well as the statewide MHCP rate. Figure 15.2: Breast Cancer Screening Statewide Rates by Hispanic Ethnicity MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

65 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Summary f Findings by Race Fr each measure belw, Table 12 cmpares each racial grup s statewide average t the verall statewide MHCP average as being either significantly abve, significantly belw r similar t the statewide MHCP average. Statistical significance was determined using 95% cnfidence intervals. Table 12: Summary f Findings by Racial Grup 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 65

66 Health Care Disparities Reprt fr Minnesta Health Care Prgrams American Indian r Alaskan Native The American Indian r Alaskan Native racial grup had the lwest rate fr tw measures: Breast Cancer Screening and Childhd Immunizatin Status (Cmb 10). There were n measures where the American Indian r Alaskan Native racial grup had the highest rate. There were three measures (Breast Cancer Screening, Childhd Immunizatin Status - Cmb 10 and Cntrlling High Bld Pressure) where the American Indian r Alaskan Native racial grup s rate was significantly lwer than the MHCP statewide rate. There were n measures where this grup s rate was significantly higher than the MHCP statewide rate. Asian r Pacific Islander r Native Hawaiian The Asian r Pacific Islander r Native Hawaiian racial grup had the highest rate fr the Childhd Immunizatin Status Cmb 10 measure. There were n measures where this grup had the lwest rate. There were three measures (Apprpriate Treatment fr Children with URI, Childhd Immunizatin Status Cmb 10 and Chlamydia Screening in Wmen) where this grup s rate was significantly higher than the MHCP statewide rate. Fr ne measure (Cntrlling High Bld Pressure), their rate was significantly lwer than the MHCP statewide rate. Black r African American There were tw measures where the Black r African American racial grup had the highest rates: Apprpriate Testing fr Children with URI and Chlamydia Screening in Wmen. They had the lwest rate fr the Cntrlling High Bld Pressure measure. Fr tw measures (Apprpriate Treatment fr Children with URI and Chlamydia Screening in Wmen), the Black r African American racial grup had a perfrmance rate significantly abve the MHCP statewide rate; and fr three measures (Breast Cancer Screening, Childhd Immunizatin Status - Cmb 10 and Cntrlling High Bld Pressure) this racial grup had a perfrmance rate significantly belw the MHCP statewide rate. Multi-Racial The Multi-Racial grup had the highest rate fr the Cntrlling High Bld Pressure measure. They did nt have the lwest rate fr any measure. There was ne measure (Chlamydia Screening in Wmen) where the Multi-Racial grup had a perfrmance rate significantly abve the MHCP statewide rate. There were n measures where they had a significantly lwer rate than the MHCP statewide rate. White The White racial grup had the highest rate fr the Breast Cancer Screening measure. The White racial grup had the lwest rate fr Apprpriate Treatment fr Children with URI and Chlamydia Screening in Wmen. Fr ne measure (Breast Cancer Screening), the White racial grup had a perfrmance rate that was significantly abve the MHCP statewide rate. Fr three measures (Apprpriate Treatment fr Children with URI, Chlamydia Screening in Wmen and Cntrlling High Bld Pressure) the White racial grup had a perfrmance rate significantly belw the MHCP statewide rate. Unknwn The Unknwn racial grup did nt have the highest r lwest rate fr any measures. There were n measures where the rate fr the Unknwn racial grup was significantly belw the MHCP statewide rate. Fr tw measures (Apprpriate Testing fr Children with URI and Childhd Immunizatin Status Cmb 10), this racial grup had a perfrmance rate significantly abve the MHCP statewide rate MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

67 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Summary f Findings by Hispanic Ethnicity Fr each measure belw, Table 13 cmpares each Hispanic ethnicity grup s statewide average t the verall statewide MHCP average as being either significantly abve, significantly belw r similar t the statewide MHCP average. Statistical significance was determined using 95% cnfidence intervals. Table 13: Summary f Findings by Hispanic Ethnicity Grup Hispanic Fr tw measures (Chlamydia Screening in Wmen and Breast Cancer Screening), Hispanics had the highest perfrmance rate. There were n measures where they had the lwest rate. Fr three measures (Childhd Immunizatin Status - Cmb 10), Chlamydia Screening in Wmen and Breast Cancer Screening), the perfrmance rates fr Hispanics were significantly abve the MHCP statewide rate. There were n measures where Hispanics had a perfrmance rate significantly belw the MHCP statewide rate. Nn-Hispanic There were n measures where Nn-Hispanics had the highest perfrmance rate. There were three measures (Apprpriate Treatment fr Children with URI, Cntrlling High Bld Pressure, and Childhd Immunizatin Status - Cmb 10) where Nn-Hispanics had the lwest rates. There were tw measures (Childhd Immunizatin Status - Cmb 10 and Cntrlling High Bld Pressure) where the Nn-Hispanics had a perfrmance rate significantly belw the MHCP statewide rate. Unknwn Fr three measures (Apprpriate Treatment fr Children with URI, Childhd Immunizatin Status Cmb 10 and Cntrlling High Bld Pressure), the Unknwn ethnic grup had the highest rates. There were tw measures (Chlamydia Screening in Wmen and Breast Cancer Screening) where the Unknwn ethnic grup had the lwest rates. Fr tw measures (Apprpriate Treatment fr Children with URI and Childhd Immunizatin Status Cmb 10), they had perfrmance rates significantly higher than the MHCP statewide rate. There was ne measure (Breast Cancer Screening) where the Unknwn ethnic grup had rates significantly belw the MHCP statewide rate MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 67

68 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Limitatins related t Race/Ethnicity Data This reprt includes statewide cmparisns by racial and Hispanic ethnicity grups. A minimum f 30 MHCP patients is required t reprt rates by racial and Hispanic ethnicity grup at statewide and medical grup levels. Very few medical grups met this minimum reprting threshld, which is necessary fr cmparisns by race and Hispanic ethnicity acrss medical grups. As a result, this reprt des nt include medical grup rates by race and Hispanic ethnicity. T be included in a HEDIS measure, a patient must meet specified cntinuus enrllment criteria. Cntinuus enrllment in a health plan defines a sufficient timeframe during which a health care service culd be perfrmed. A shrter enrllment perid makes it less likely that a health care service wuld be rendered. MHCP patients ften have multiple interruptins in enrllment due t events such as the lss f MHCP eligibility. Since MHCP patients wh are represented in HEDIS measures are nly thse with cntinuus enrllment, the measure may nt reflect the experience f all MHCP patients. When HEDIS perfrmance rates are further calculated by race and Hispanic ethnicity, as reprted abve fr the MHCP ppulatin, the cntinuus enrllment criteria may als impact sme racial grups mre than thers. It is imprtant fr medical grups and clinics t be aware f the impact that cntinuus enrllment has n HEDIS measure results in general and fr each racial and Hispanic ethnicity grup MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

69 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Please see next page MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 69

70 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams An Examinatin f Statewide MHCP Perfrmance Rates by DHS Regin Statewide results shwed variatin in perfrmance amng the different gegraphic regins in Minnesta. Methds Statewide cmparisns by regin were cnducted n the MHCP patient ppulatin using enrllment data supplied by the Minnesta Department f Human Services (DHS). DHS sends mnthly enrllment data t the health plans it cntracts with t prvide health care services t MHCP patients. Each patient was placed int ne f fur gegraphic regins f the state based n the cunty lcatin f the clinic where they received care at during the measurement perid. Regin Descriptins Nrthwest regin: The cunties in this regin include: Becker, Beltrami, Clay, Clearwater, Duglas, Grant, Hubbard, Kittsn, Lake f the Wds, Mahnmen, Marshall, Nrman, Otter Tail, Penningtn, Plk, Ppe, Red Lake, Rseau, Stevens, Traverse and Wilkin. Nrtheast regin: The cunties in this regin include: Aitkin, Bentn, Carltn, Cass, Chisag, Ck, Crw Wing, Isanti, Itasca, Kanabec, Kchiching, Lake, Mille Lacs, Mrrisn, Pine, Sherburne, St. Luis, Stearns, Tdd, Wadena and Wright. Metr regin: The cunties in this regin include: Anka, Carver, Dakta, Hennepin, Ramsey, Sctt and Washingtn. Suthern regin: The cunties in this regin include: Big Stne, Blue Earth, Brwn, Chippewa, Cttnwd, Ddge, Faribault, Fillmre, Freebrn, Gdhue, Hustn, Jacksn, Kandiyhi, Lac qui Parle, Le Sueur, Lincln, Lyn, Martin, McLed, Meeker, Mwer, Murray, Nicllet, Nbles, Olmstead, Pipestne, Redwd, Renville, Rice, Rck, Sibley, Steele, Swift, Wabasha, Waseca, Watnwan, Winna and Yellw Medicine MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

71 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Clrectal Cancer Screening Figure 16 shws the rates f Clrectal Cancer Screening by DHS regin. MHCP patients had the highest screening rate fr clrectal cancer in the Nrtheast and Suthern regins (57 percent), and these rates were significantly abve the MHCP statewide rate (56 percent). Only the Metr regin (55 percent) had a screening rate significantly belw the MHCP statewide rate. Figure 16: Clrectal Cancer Screening Rates by DHS Regin 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 71

72 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Depressin Remissin at Six Mnths Figure 17 shws the rates f Depressin Remissin at Six Mnths by DHS regin. The percentage f MHCP patients wh experienced depressin remissin at six mnths was highest in the Nrtheast regin (six percent) and this rate was statistically abve the MHCP statewide rate (five percent). The Suthern regin had the lwest rate at fur percent and it was the nly rate significantly belw the MHCP statewide rate. Figure 17: Depressin Remissin at Six Mnths Rates by DHS Regin MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

73 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Diabetes Care Figure 18 shws the rates f Optimal Diabetes Care by DHS regin. The Suthern regin had the highest rate f ptimal care (34 percent) and this was significantly abve the MHCP statewide rate (33 percent). The Metr regin (33 percent) als had a rate that was significantly abve the MHCP statewide rate. The lwest rate was fund in the Nrthwest regin at 29 percent and this rate was significantly belw the MHCP statewide rate, alng with the Nrtheast regin at 30 percent. Figure 18: Optimal Diabetes Care Rates by DHS Regin 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 73

74 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Adults Ages Figure 19 shws the rates f Optimal Asthma Cntrl Adults Ages by DHS regin. The Metr regin had the highest rate (41 percent), and this rate was significantly abve the MHCP statewide rate (40 percent). The lwest rate was fund in the Nrthwest regin at 35 percent and this rate was significantly belw the MHCP statewide rate, alng with the Nrtheast regin at 39 percent. Figure 19: Optimal Asthma Cntrl Adults Ages Rates by DHS Regin MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

75 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Vascular Care Figure 20 shws the rates f Optimal Vascular Care by DHS regin. The Metr regin had the highest rate (47 percent) and this rate was significantly abve the MHCP statewide rate (45 percent). The lwest rate was fund in the Nrthwest regin at 42 percent. The rates fr the Nrthwest, Nrtheast, and Suthern regins were all significantly belw the MHCP statewide rate. Figure 20: Optimal Vascular Care Rates by DHS Regin 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 75

76 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Children Ages 5-17 Figure 21 shws the rates f Optimal Asthma Cntrl Children Ages 5-17 by DHS regin. The Metr regin had the highest rate (53 percent), and this rate was significantly abve the MHCP statewide rate (51 percent). The lwest rate was fund in the Nrthwest regin at 42 percent; the rates fr the Nrthwest, Nrtheast, and Suthern regins were all significantly belw the MHCP statewide rate. Figure 21: Optimal Asthma Cntrl Children Ages 5-17 Rates by DHS Regin MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

77 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Summary f Findings by DHS Regin Fr each measure belw, Table 14 cmpares each reginal grup s statewide average t the verall statewide MHCP average as being either significantly abve, significantly belw r similar t the statewide MHCP average. Statistical significance was determined using 95% cnfidence intervals. Table 14: Summary f Findings by Regin 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 77

78 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams The Nrthwest Regin The Nrthwest regin had the lwest rate fr fur f the six measures: Optimal Diabetes Care, Optimal Vascular Care, Optimal Asthma Cntrl Children Ages 5-17, and Optimal Asthma Cntrl Adults Ages All f these rates were significantly belw the MHCP statewide rate. There were n measures where this regin s rate was significantly abve the MHCP statewide rate. The Nrtheast Regin The Nrtheast regin had the highest rate fr tw measures: Depressin Remissin at Six Mnths and Clrectal Cancer Screening. The Nrtheast regin did nt have the lwest rate fr any measure. Fr tw measures (Depressin Remissin at Six Mnths and Clrectal Cancer Screening), this regin had a perfrmance rate significantly abve the MHCP statewide rate. Cnversely, the Nrtheast regin had a perfrmance rate significantly belw the MHCP statewide rate fr fur measures: Optimal Diabetes Care and Optimal Vascular Care, Optimal Asthma Cntrl Children Ages 5-17 and Optimal Asthma Cntrl Adults Ages The Metr Regin There were three measures where the Metr regin had the highest rate: Optimal Vascular Care, Optimal Asthma Cntrl Children Ages 5-17, and Optimal Asthma Cntrl Adults Ages There was ne measure (Clrectal Cancer Screening) where this regin had the lwest rate. Fr fur measures (Optimal Diabetes Care, Optimal Vascular Care, Optimal Asthma Cntrl Adults Ages 18-50, and Optimal Asthma Cntrl Children Ages 5-17), the Metr regin had a perfrmance rate significantly abve the MHCP statewide rate. Fr ne measure (Clrectal Cancer Screening), this regin als had a significantly lwer perfrmance rate than the MHCP statewide rate. The Suthern Regin The Suthern regin had the highest perfrmance rate fr ne measure: Optimal Diabetes Care. This regin had the lwest rate fr the Depressin Remissin at Six Mnths measure. There were tw measures (Optimal Diabetes Care and Clrectal Cancer Screening) where the Suthern regin had a perfrmance rate significantly abve the MHCP statewide rate. There were three measures (Depressin Remissin at Six Mnths, Optimal Vascular Care, and Optimal Asthma Cntrl Children Ages 5-17) where this regin had a rate significantly belw the MHCP statewide rate MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

79 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Cnclusin The 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams sptlights that MHCP perfrmance rates are imprving fr sme measures, but declining fr ther measures. Prgress in addressing disparities can be seen mst ntably by imprved health utcmes fr tw measures and narrwing f the gap between purchasers fr six measures. But setbacks can als be seen fr eight measures where perfrmance rates decreased fr MHCP patients, and fr fur measures where the gap between MHCP and Other Purchasers patients widened. The results f this reprt highlight that there is still significant rm fr imprvement t reduce health care disparities and clse the gaps. Inequities within ur health care system cntinue t exist and are unacceptable. This reprt shws it is pssible fr medical grups and clinics t achieve ptimal health utcmes fr all patients regardless f their sciecnmic status. We are finding that mre and mre medical grups are using infrmatin frm this reprt t benchmark prgress and make imprvements. Overall, we cntinue t see statewide gaps between care received by MHCP patients and Other Purchasers patients. Gaps widened this year fr fur measures (Apprpriate Treatment fr Children with URI, Depressin Remissin at Six Mnths, Optimal Vascular Care, and Breast Cancer Screening) and these differences were statistically significant. Cnversely, gaps between purchasers narrwed significantly fr fur measures (Chlamydia Screening in Wmen, Cntrlling High Bld Pressure, Optimal Asthma Cntrl Adults Ages 18-50, and Clrectal Cancer Screening). Differences between race and Hispanic ethnicity were fund fr every measure within the MHCP patient ppulatin. Perfrmance rates fr the Black r African American racial grup cntinued t be lw cmpared t ther racial grups fr several measures; hwever, rates fr Black r African Americans were significantly abve the statewide MHCP rate fr tw measures. Hispanic patients had rates that were significantly abve the statewide MHCP rate fr three measures. This reprt features MHCP reginal rates fr the six DDS measures. This analysis was included t prvide mre infrmatin abut the health utcmes f MHCP patients in varius regins in Minnesta. There were ntewrthy perfrmance differences in MHCP rates fr each measure by regin. The Metr regin had abve average rates fr fur measures. Cnversely, the Nrthwest regin had the lwest rate fr fur measures, and all rates were significantly belw the MHCP statewide rate. Imprving health utcmes fr all patients requires a thrugh examinatin f perfrmance data at a medical grup r clinic level, in additin t statewide and natinal levels. The public reprting f health care perfrmance rates can drive quality imprvement, particularly when rates are reprted at a level where mre accuntability lies and actins t address disparities are mre likely t have an effect. While data alne will nt reduce disparities, it is an imprtant tl fr identifying imprvement pprtunities and assessing prgress. The infrmatin in this reprt can be useful t plicy makers, public health prfessinals, cmmunities f clr, and health care systems t supprt fcused imprvement effrts. Much wrk remains t ensure MHCP patients achieve the same health care utcmes as Other Purchaser patients MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 79

80 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Acknwledgements Data management, perfrmance assessment and reprt prductin are prvided by MN Cmmunity Measurement, an independent, nn-prfit rganizatin dedicated t accelerating the imprvement f health in Minnesta and surrunding cmmunities thrugh the measurement and public reprting f health care infrmatin. The 10 health plans and cunty-based purchasing rganizatins that cntributed data fr this reprt are: Blue Crss and Blue Shield f Minnesta HealthPartners Hennepin Health Itasca Medical Care Medica PreferredOne PrimeWest Health System Sanfrd Health Plan Suth Cuntry Health Alliance UCare MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

81 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Medical Grups (Primary Care) Reprted in 2017 (120) AALFA Family Clinic Advanced Medical Clinic Affiliated Cmmunity Medical Centers Alexandria Clinic Allina Health Clinics Allina Health Specialties Altru Health System Apple Valley Medical Clinic Avera Medical Grup Avera Medical Grup - Pipestne Avera Medical Grup- Marshall Avera Medical Grup- McGreevy Clinic, United Medical Center, Wrthingtn Specialty Clinic Axis Medical Center Bluestne Physician Services Byntn Health Service Burnsville Family Physicians Cedar Riverside Peple's Center CentraCare Health Chippewa Cunty Mntevide Hspital & Medical Clinic Cmmunity University Health Care Center Crmwell Medical Clinic PLLC - IHN Cuyuna Reginal Medical Center Dawsn Clinic Duluth Family Medicine Clinic Edina Sprts Health & Wellness Entira Family Clinics Essentia Health Face t Face Health & Cunseling Service, Inc. Fairview Health Services Fairview Medical Grup Fairview Mesaba Clinics Family Practice Medical Center f Willmar FirstLight Health System France Avenue Family Physicians - Minnesta Healthcare Netwrk Gateway Family Health Clinic Glence Reginal Health Services Glenwd Medical Center Grand Itasca Clinic Gundersen Health System HealthEast Clinics HealthPartners Central Minnesta Clinics HealthPartners Clinics Hendricks Cmmunity Hspital Assciatin Hennepin Cunty Medical Center (HCMC) Clinics Hudsn Physicians Hutchinsn Health Indian Health Bard f Minneaplis Kittsn Memrial Clinic Lac Qui Parle Clinic Lake Regin Healthcare Lake Superir Cmmunity Health Center Lake View Clinic - Tw Harbrs Lakeview Clinic Lakewd Health Center Clinic Lakewd Health System Life Medical Madelia Cmmunity Hspital & Clinic Mankat Clinic, Ltd. May Clinic May Clinic Health System May Clinic Health System - Albert Lea and Austin May Clinic Health System - Fairmnt May Clinic Health System - Franciscan Healthcare in La Crsse May Clinic Health System - Lake City May Clinic Health System - Mankat May Clinic Health System - New Prague May Clinic Health System - Red Wing May Clinic Health System - St. James May Clinic Health System - Waseca May Clinic Health System-Owatnna Mille Lacs Health System Multicare Assciates Native American Cmmunity Clinic Neighbrhd Healthsurce Nrth Clinic Nrth Memrial Nrthfield Hspital + Clinics NrthPint Health & Wellness Center Nrthwest Family Physicians Olmsted Medical Center Open Cities Health Center Open Dr Health Center Ortnville Area Health Services-Nrthside Medical Clinic Park Nicllet Health Services Parkview Medical Clinic - Minnesta Healthcare Netwrk Planned Parenthd Minnesta, Nrth Dakta, Suth Dakta Prairie Ridge Hspital & Health Services Raiter Clinic, LTD - IHN Renville Cunty Hspital and Clinics Richfield Medical Grup Ridgeview Clinics RiverView Health Riverwd Healthcare Center 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 81

82 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Additinal Medical Grup Prvider Types Reprted in 2017 (41) Sanfrd Health - Farg Regin Sanfrd Health - Siux Falls Regin Sawtth Muntain Clinic Scandia Clinic Scenic Rivers Health Services Sibley Medical Center DBA Ridgeview Sibley Medical Center Sleepy Eye Medical Center Smart Clinic-Custm Clinic Suthside Cmmunity Health Services St. Crix Reginal Medical Center St. Luke's Clinics St. Paul Family Medical Center Stellis Health, PA Stevens Cmmunity Medical Center OB/GYN Metrplitan Obstetrics & Gyneclgy Oakdale Ob/Gyn OBGYN West Obstetrics and Gyneclgy Assciates Partners Ob/Gyn Urgent Care/Cnvenience Care Clinics Emergency Physicians, P.A. Express Healthcare MinuteClinic Pririty Pediatrics Urgent Care Pediatric All Abut Children Pediatrics - Children's Health Netwrk Central Pediatrics Children's Clinic Netwrk Children's Health Care Children's Respiratry & Critical Care Specialists Fridley Children's & Teenagers' Medical Center - Allergy/Immunlgy Advancements in Allergy and Asthma Care Allergy & Asthma Specialists, PA Stillwater Medical Grup Synergy Family Physicians, P.A Tri-Cunty Health Care United Family Medicine United Hspital District Clinic Unity Family Healthcare - Avn Unity Family Healthcare, Family Medical Center University f Minnesta Physicians Valley Family Practice- MHN Vibrant Health Family Clinics and Minnesta Health Netwrk West Side Cmmunity Health Services Williams Integracare Clinic Winna Health Services Premier OB/GYN f Minnesta Suthdale Ob/Gyn Cnsultants Western ObGyn Seven Day Clinic Suburban Emergency Assciates Target Clinic Children's Physician Netwrk Pediatric & Yung Adult Medicine Pediatric Services - Children's Physician Netwrk Suth Lake Pediatrics Suthdale Pediatric Assciates, Ltd Wayzata Children's Clinic Allergy, Asthma & Immunlgy Clinic Behaviral Health Assciated Clinic f Psychlgy Assciates in Psychiatry & Psychlgy Family Life Center Lakeland Mental Health Center Minnesta Mental Health Clinics Nrthern Psychiatric Assciates 82 Oak Ridge Center Peple Incrprated Stark Mental Health Clinic Ramsey Cunty Mental Health Western Mental Health Center, Inc. Wdland Centers Zumbr Valley Health Center 2018 MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

83 2016 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Appendix 1: Data Surces and Data Cllectin Administrative and Hybrid Measures Data used fr the administrative and hybrid measures riginated frm health plan administrative claims databases. Hybrid measures were supplemented by medical recrd review. Data elements were specified by HEDIS 2017 Technical Specificatins (2016 dates f service). HEDIS is prduced and maintained by the Natinal Cmmittee fr Quality Assurance (NCQA). The technical specificatins prvided detailed steps and instructins t ensure that the submitted data met rigrus standards. The data elements were cllected by the health plans using the HEDIS technical specificatins that fllwed the annual HEDIS calendar. In additin, each health plan s data were subjected t extensive validatin prcesses t ensure quality measures fllwed the standards described in Vlume 5, HEDIS Cmpliance Audit : Standards, Plicies and Prcedures. All health plan data were audited by a NCQA-certified HEDIS auditr. MNCM develped a data structure dcument with detailed steps and instructins t ensure data were submitted in a cnsistent way. In 2017, 10 data surces Blue Crss and Blue Shield f Minnesta, HealthPartners, Hennepin Health, Itasca Medical Care, Medica, PreferredOne, PrimeWest Health System (cunty-based purchaser), Sanfrd Health Plan, Suth Cuntry Health Alliance (cunty-based purchaser) and UCare submitted data t MNCM. The submitted data reflects patients/members enrlled in the fllwing prducts: cmmercial HMO/POS/ PPO, Medicare Cst, Medicare Risk, and Minnesta Health Care Prgrams (pre-paid Medical Assistance including dual eligibles and MinnestaCare). Administrative and hybrid measures did nt include patients wh were uninsured, wh self-paid, r patients wh were served by Medicaid/Medicare Fee-fr-Service. All health plan data files were submitted t MNCM fr aggregatin, validatin and public reprting. An independent vendr under cntract with MNCM cnducted the aggregatin and validatin prcesses. Each health plan file was carefully reviewed t ensure cnfrmance with the data structure and identify unusual r unanticipated patterns. The files were als checked fr prper frmatting, missing and invalid values, and t cnfirm accurate recrd cunts. Preliminary health plan rates were calculated and returned t each health plan fr additinal validatin. Once the file validatin checks were finalized, the data files frm all 10 health plans were aggregated t create a cmprehensive data file f results by medical grup. The aggregated data file was then checked fr accurate recrd cunts and preliminary measure rates were calculated. The preliminary rates were carefully reviewed by MNCM staff and the data aggregatin vendr. Particular attentin was paid t ntable changes frm previus years at the statewide and medical grup levels. After these checks were finalized, preliminary rates were cmpiled int the 2017 Health Care Disparities Reprt and sent t DHS and medical grups fr review and cmment. Any data cncerns identified were reviewed t determine if the issues were related t the submitted data. Direct Data Submissin Measures The data surce f clinic level results was the clinics themselves. All data elements were specified by MNCM in the 2017 Direct Data Submissin (DDS) Guides (2016 dates f service). These guides prvided detailed steps and instructins t ensure that data were submitted in a cnsistent way. Data fr DDS measures were reprted at tw levels: by clinic site and medical grup. Clinics were defined as single sites where patients received care. Medical grups generally cnsisted f multiple clinic sites. Often, medical grups prvide centralized administrative functins fr several clinic sites. Medical grups/clinics that submitted data fr individual clinics first registered thrugh the MNCM Data Prtal. Once registered, they had the ptin t submit data n a clinic s ttal patient ppulatin r fr a representative sample f the clinic s ttal patient ppulatin. Detailed instructins fr sampling were prvided in the DDS guides. Medical 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 83

84 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams grups/clinics that submitted data thrugh this prcess were required t submit data fr all clinics within the medical grup. Clinic abstractrs cllected data frm medical recrds either by extracting the data frm electrnic medical recrds thrugh a data query r abstracting the data frm paper-based medical recrds. Medical grups cmpleted numerus quality checks befre data were submitted t MNCM. All apprpriate HIPAA requirements were fllwed. Medical grups/clinics submitted the required data elements directly thrugh the MNCM Data Prtal. Once data were submitted, an extensive validatin prcess was fllwed which included quality checks f all files and n-site audits fr selected clinics. Fr n-site audits, MNCM used NCQA s 8 and 30 File Sampling Prcedure, develped in 1996 in cnsultatin with Jhns Hpkins University. Fr a detailed descriptin f this prcedure, g t ncqa.rg. Audits were cnducted by MNCM staff and/r cntracted auditrs wh were independent f medical grups and/r clinics. Validatin is critical t ensure the data are reliable, cmplete and cnsistent MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

85 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Appendix 2: Methds Measures reprted Three types f measures were reprted at the medical grup level: measures that used an administrative data nly methd submitted by the health plans, measures that used a hybrid methd (administrative claims data plus medical recrd review) submitted by the health plans and measures that used data submitted directly t MNCM by medical grups and clinics frm electrnic health recrds r paper-based medical charts. The fllwing HEDIS measures used the hybrid methd (referenced in Appendix 1): Childhd Immunizatin Status (Cmb 10) Cntrlling High Bld Pressure The fllwing HEDIS measures used data submitted by the health plans using the administrative methd (referenced in Appendix 1): Apprpriate Treatment fr Children with Upper Respiratry Infectin (URI) Breast Cancer Screening Chlamydia Screening in Wmen The fllwing measures used data submitted directly t MNCM by medical grups and clinics (referenced in Appendix 1): Optimal Diabetes Care Optimal Vascular Care Depressin Remissin at Six Mnths Optimal Asthma Cntrl - Children Ages 5-17 Optimal Asthma Cntrl - Adults Ages Clrectal Cancer Screening Each year, these measure specificatins are reviewed against current evidence-based guidelines. Specificatins fr measures that use the hybrid and administrative methd were calculated using NCQA s 2017 HEDIS Technical Specificatins. Specificatins fr DDS measures were calculated in the MNCM Data Prtal using MNCM s 2017 DDS Guide and Technical Specificatins. Eligible Ppulatin Specificatins The eligible ppulatins fr the administrative and hybrid HEDIS measures were identified by each participating health plan utilizing its respective administrative databases. NCQA s 2017 HEDIS Technical Specificatins prvided the standard definitins fr the eligible ppulatin fr each measure, which included data elements such as age, cntinuus enrllment and anchr date requirements. The eligible ppulatins fr the measures reprted directly t MNCM by medical grups and clinics were identified by a medical grup n behalf f their individual clinics. MNCM s 2017 DDS Guide and Technical Specificatins prvided the standard definitins fr the eligible ppulatin fr each measure, which included elements such as age, apprpriate diagnsis cdes, number f visits needed in the measurement timeframe, and established patient criteria. Fr administrative measures, the entire eligible ppulatin was the denminatr. Fr hybrid measures, the eligible ppulatin served as the sampling frame frm which t draw the number f patients fr chart audit and the reference fr weighting MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 85

86 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Patient Attributin t Medical Grups/Clinics Health plans assigned patients t a medical grup using frequency-based attributin lgic and a standard medical grup definitin based n Tax Identificatin Numbers. Administrative billing cdes determined the frequency f patient visits t medical grups. Fr mst measures, patients were assigned t the medical grup they visited mst frequently during the measurement year. Patients wh visited tw r mre medical grups with the same frequency were attributed t the medical grup visited mst recently in the measurement year. Fr ne measure Apprpriate Treatment fr Children with URI patients were assigned t the clinic they visited fr the specific service. T submit data at the clinic level fr the DDS measures, medical grups attributed each patient t a single clinic within their medical grup. Each medical grup s patient attributin methd was defined by the medical grup and was reviewed by MNCM as part f the denminatr certificatin prcess. Mst patients were attributed t an assigned primary care prvider. Sme patients were attributed t the prvider wh saw the patient mst ften r mst recently in the measurement year. Sampling Methd fr Hybrid HEDIS Measures As previusly nted, the hybrid methd required each participating health plan t first identify the eligible ppulatin meeting measurement specificatins using its administrative databases. This ppulatin f eligibles served as the sampling frame frm which t draw the denminatr (the patients fr whm medical recrd review wuld be cmpleted). The resurce-intensive nature f medical recrd review necessitated pulling a randm sample f the eligible ppulatin fr medical recrd review. This review was cnducted fr all enrllees drawn fr the sample. MNCM used a tw-stage, randm sampling prcess. This strategy was designed with statisticians t ensure reprting fr the maximum number f medical grups while minimizing the impact f weighting n the results fr any ne medical grup. The sampling prcedure began with each health plan prviding a data file cntaining a recrd fr each eligible patient fr each hybrid measure. This file als identified eligible patients that had been selected fr the annual HEDIS sample. Additinal patients were then selected frm the remaining eligible ppulatin t meet MNCM minimum reprting requirements. Sampling Methd fr Measures Cllected by Direct Data Submissin Medical grups culd submit data n their full ppulatin r a sample f at least 60 patients per clinic, but were strngly encuraged t submit their ttal ppulatin f patients. Fr medical grups that chse t submit a sample, the 2017 DDS Guide described accepted methds t select a systematic sample. This step was reviewed by MNCM as part f the denminatr certificatin prcess. In 2017, abut 99 percent f clinics fr Optimal Diabetes Care; 100 percent f clinics fr Optimal Vascular Care; 100 percent f clinics fr Optimal Asthma Cntrl Children Ages 5-17; 100 percent f clinics fr Optimal Asthma Cntrl Adults Ages 18-50; and abut 93 percent f clinics fr Clrectal Cancer Screening submitted their ttal ppulatin f patients. Fr Depressin Remissin at Six Mnths, clinics were required t submit their ttal ppulatin. Numeratr Specificatins Fr administrative measures, the numeratr was the number f patients frm the eligible ppulatin wh met numeratr targets. Fr hybrid measures, the numeratr was the number f patients frm the sample wh met numeratr targets. Fr DDS measures, the numeratr was the number f patients identified frm either the eligible ppulatin r the sample wh meet the numeratr targets. The targets were specified by MNCM in the DDS Guide and cmpliance with these specificatins was audited. Weighting fr Hybrid Measures Because data fr the hybrid measures were taken frm a sample, results were weighted t btain accurate rates. This allwed fr aggregatin and unbiased reprting by medical grup. Weighting enabled MNCM t draw a sample n which t estimate medical grup and statewide rates. Weighting was applied t efficiently utilize health plan resurces fr data cllectin n a randmly sampled ppulatin. Weights were calculated fr each sampling stratum (i.e., health 2018 MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

87 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams plan/health plan prduct/medical grup). A weight was equal t the ttal eligible ppulatin fr that stratum divided by the ttal sample size fr that stratum. In calculating rates fr a ppulatin (medical grup r statewide) the denminatr was the sum f the weights fr all patients in that ppulatin, and the numeratr was the sum f the weights fr patients in the ppulatin wh met the numeratr targets. Weighting fr Measures Cllected by Direct Data Submissin Data fr the DDS measures were taken frm a sample but nly fr clinics that elected t sample their ttal ppulatin. In thse cases, results were weighted t accunt fr the ttal ppulatin, thus allwing a perfrmance rate t be calculated based n the cmplete census f all patients in the clinic. Fr Depressin Remissin at Six Mnths, clinics were required t submit their ttal ppulatin and thus the results are nt weighted. Calculating Rates fr Administrative and Hybrid HEDIS Measures Medical grup level rates were expressed as percentages. They were calculated as 100 times the number wh met the numeratr targets divided by the number wh were eligible fr the measure. Rates calculated fr measures using the administrative methd were straightfrward. Hwever, rates calculated fr measures using the hybrid methd required weighting because f the sampling prcedures. Rates and 95 percent asymmetrical cnfidence intervals were calculated fr each measure fr each medical grup. Asymmetrical cnfidence intervals were used t avid cnfidence interval lwer-bund values less than zer and upper-bund values greater than 100. Medical grup rates were first calculated fr each grup and then a medical grup average was calculated. The medical grup average was displayed when cmparing medical grup perfrmance t prvide cntext. Calculating Rates fr Measures Cllected by Direct Data Submissin Clinic level rates were expressed as percentages. They were calculated as 100 times the number wh met the numeratr specificatins divided by the number in the denminatr fr the measure. Rates calculated fr measures using the ttal eligible ppulatin were straightfrward calculatins whereby the ttal eligible ppulatin served as the denminatr. Hwever, fr clinics that elected t sample frm their ttal ppulatin, the rates calculated fr the measures required weighting t accunt fr the ttal eligible ppulatin f the clinics. Due t the dynamic nature f clinic patient ppulatins, rates and 95 percent cnfidence intervals were calculated fr each measure fr each clinic regardless f whether clinics submitted a full ppulatin r a sample. Clinic level rates were first calculated fr each clinic and then a clinic average rate was calculated. The clinic average rate was displayed when cmparing a single clinic t the perfrmance f all clinics t prvide cntext. Assigning Payer Prduct Types fr Measures Cllected by Direct Data Submissin As part f MNCM s DDS prcess, medical grups submitted data directly t MNCM t calculate clinic-level perfrmance rates. This infrmatin did nt include payer prduct type. T calculate MHCP and Other Purchaser rates fr DDS measures, infrmatin submitted via DDS was supplemented with infrmatin frm health plans t btain a patient s payer prduct type (e.g., cmmercial, Medicaid, Medicare). Wrking with representatives f medical grups and health plans, MNCM develped a prcess t link DDS perfrmance data t health plan enrllment data and apprpriately assign prduct type per patient. Limitatins The medical grups and clinics identified in this reprt d nt represent all medical grups and clinics in Minnesta. MNCM established minimum threshlds fr public reprting t ensure statistically reliable rates. Only medical grups and clinics that met thse threshlds were reprted. Because hybrid measures are based n a sample, a higher threshld was used 60 patients per medical grup were required fr public reprting t ensure a reasnable level f cnfidence in the reprted rate. Administrative measures are based n a cmplete census f managed care patients, s a minimum threshld f 30 patients per medical grup was required. DDS measures are based n cmplete census f all patients, regardless f payer, s a minimum threshld f 30 patients per clinic was required. It shuld als be nted that medical grups and clinics that were reprted fr ne measure may nt have been reprted fr all measures MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 87

88 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams It is imprtant t reiterate that data used t calculate rates fr administrative and hybrid measures reflected patients insured thrugh ne f 10 health plans. Medical grups with patients wh were insured thrugh ther health plans, wh were uninsured, wh self-paid, r wh were served by a Medicaid/Medicare Fee-fr-Service prgram were nt reflected in these results. Therefre, the data fr these measures may nt have represented a medical grup s entire patient ppulatin. Cautin is recmmended when making cmparisns frm year t year. Annual rate differences can ccur due t natural variatin, changes in measurement specificatins, changes in data surces and ther unspecified factrs. Limitatins and implicatins f using cntinuus enrllment criteria with MHCP patients Cntinuus enrllment specifies the minimum amunt f time that a patient must be enrlled in a health plan befre he r she is eligible t be cunted fr a measure. Cntinuus enrllment criteria are used by health plans t ensure ample time fr a patient t btain health care services while enrlled. The purpse is t standardize the methd f patient inclusin in a measure acrss all health plans and medical grups. When used as part f a measurement tl, cntinuus enrllment defines a sufficient timeframe during which a health care service culd be perfrmed. A shrter enrllment perid makes it less likely fr a health care service t be rendered and als makes it difficult fr a health plan t respnd t the needs f a patient. Patients can have interruptins in enrllment with a health plan. These interruptins are referred t as gaps in enrllment. During a gap, a patient des nt have health insurance cverage, making it less likely fr him/her t btain health care services. Unfrtunately, MHCP patients may have multiple gaps during a 12 mnth perid due t events such as the lss f MHCP eligibility. Fr mst HEDIS measures, a 45 day gap still allws a patient t be included in a measure; hwever, a study f the Medicaid ppulatin in Oregn demnstrated that these patients ften have gaps that exceed 45 days. 10 Since Medicaid patients (including thse enrlled in MHCP) wh are represented in HEDIS measures are nly thse with cntinuus enrllment, the measure results may nt be reflective f the experience f all Medicaid/MHCP patients. When perfrmance rates are further calculated by race fr the MHCP ppulatin, the cntinuus enrllment criteria magnifies the cncern abut representatin. A review by DHS shwed cntinuus enrllment criteria reduced the representatin f sme racial grups within a HEDIS measure, and sme measures were impacted mre than thers. When designing quality imprvement interventins targeting specific patient ppulatins particularly prjects based n race it will be imprtant fr medical grups and clinics t be aware f the impact that cntinuus enrllment has n HEDIS measures in general and fr each racial grup specifically. T wrk with a mre representative ppulatin, an adjustment f the cntinuus enrllment criteria may be necessary depending n the measures selected. Data Analyses Identifying High-Perfrming Medical Grups/Clinics Fr each measure, we calculated bth individual medical grup rates and a medical grup average rate fr MHCP patients. We identified medical grups that achieved high perfrmance by cmparing the individual medical grup/ clinic rate with the medical grup/clinic average. Medical grups with high rates and 95 percent cnfidence intervals that were fully abve the medical grup average were nted as high perfrmers. These high perfrmers were highlighted in the Results by Measure sectin fr each measure. The perfrmance rates fr all medical grups were presented by perfrmance rate in descending rder in Appendix 3. The same methds were perfrmed at the clinic level fr the DDS measures. Identifying Medical Grups with Biggest Imprvements Fr each measure, we cmpared each individual medical grup s rate during reprt year 2017 with their rate during reprt year 2016, and calculated a percentage pint difference. Medical grups with the largest percentage pint increases were highlighted MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

89 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Medical Grup Perfrmance ver Time (Three Years) Fr each measure, this analysis was dne t determine patterns f medical grup perfrmance ver time. Patterns were reviewed fr the three reprting years (2015, 2016 and 2017). See Medical Grup Perfrmance ver Time (2015 t 2017) in the Results by Measure sectin and Appendix 4 fr detailed tables f medical grups. Patterns in rate changes ver the three reprting years (2015, 2016, and 2017) were reviewed. Only medical grups with rates fr all three reprting perids per measure were included in the analysis. The analysis was defined as three reprting years t allw as many grups as pssible t have three years f reprted data and the pprtunity t be included in the analysis. The percent and number f medical grups were reprted fr each f the fllwing patterns f rate changes ver the past three years fr each measure: High perfrmance and abve average rates: Medical grups with a rate and cnfidence interval greater than the statewide average fr each f the three years. Cnsistently imprved: Medical grups with mre than a tw percentage pint increase between each cnsecutive year. Relatively stable: Medical grups that had n mre than a tw percentage pint increase r decrease between each cnsecutive year (negative tw percent t psitive tw percent). Cnsistently declined: Medical grups with mre than a tw percentage pint decrease between each cnsecutive year. Variable perfrmance (with an imprvement r with a decline): Medical grups with an up/dwn pattern that was nt cnsistent and did nt fall int ne f the ther categries MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 89

90 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Appendix 3: Medical Grup and Clinic Perfrmance Rate Tables This sectin includes detailed tables per measure. The fllwing elements are included in each table: The medical grup/clinic name in rder f high rate t lw rate. The ttal number f patients in the denminatr fr each measure (N). The medical grup/clinic s verall rate fr each measure in their MHCP ppulatin. The lwer and upper bunds f the 95 percent cnfidence interval. A rating that categrizes each medical grup/clinic s perfrmance. An Abve Average rating is fr medical grups/clinics that have an average and cnfidence interval that is fully abve the verall medical grup/clinic average fr MHCP patients. An Average rating is fr medical grups/clinics that have a cnfidence interval that includes the verall medical grup/clinic average fr MHCP patients. A Belw Average rating is fr medical grups/clinics that have an average and cnfidence interval that is fully belw the verall medical grup/clinic average fr MHCP patients. Cntents f Detailed Tables per Measure Measures with Specificatin Changes frm 2016 t 2017 Table 15: Childhd Immunizatin Status (Cmb 10) by Medical Grup Measures with an Increase in MHCP Rate Table 16: Cntrlling High Bld Pressure by Medical Grup Table 17.1: Clrectal Cancer Screening by Clinic Table 17.2: Clrectal Cancer Screening by Medical Grup Measures with a Decrease in MHCP Rate G Table 18: Chlamydia Screening in Wmen by Medical Grup Table 19: Depressin Remissin at Six Mnths by Clinic Table 20: Apprpriate Treatment fr Children with URI by Medical Grup Table 21: Breast Cancer Screening by Medical Grup Table 22.1: Optimal Diabetes Care by Clinic Table 22.2: Optimal Diabetes Care by Medical Grup Table 23.1: Optimal Asthma Cntrl Adults Ages by Clinic Table 23.2: Optimal Asthma Cntrl Adults Ages by Medical Grup Table 24.1: Optimal Vascular Care by Clinic Table 24.2: Optimal Vascular Care by Medical Grup Table 25.1: Optimal Asthma Cntrl Children Ages 5-17 by Clinic Table 25.2: Optimal Asthma Cntrl Children Ages 5-17 by Medical Grup G MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

91 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 15: Childhd Immunizatin Status (Cmb 10) by Medical Grup (Medical Grups with 60+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 91

92 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 16: Cntrlling High Bld Pressure by Medical Grup (Medical Grups with 60+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

93 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 16: Cntrlling High Bld Pressure by Medical Grup (Medical Grups with 60+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 93

94 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

95 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 95

96 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

97 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 97

98 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

99 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 99

100 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

101 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 101

102 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

103 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.1: Clrectal Cancer Screening by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 103

104 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.2: Clrectal Cancer Screening by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

105 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 17.2: Clrectal Cancer Screening by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 105

106 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 18: Chlamydia Screening in Wmen by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

107 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 18: Chlamydia Screening in Wmen by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 107

108 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 19: Depressin Remissin at Six Mnths by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

109 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 19: Depressin Remissin at Six Mnths by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 109

110 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 19: Depressin Remissin at Six Mnths by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

111 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 19: Depressin Remissin at Six Mnths by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 111

112 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 19: Depressin Remissin at Six Mnths by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

113 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 20: Apprpriate Treatment fr Children with URI by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 113

114 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 20: Apprpriate Treatment fr Children with URI by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

115 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 21: Breast Cancer Screening by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 115

116 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 21: Breast Cancer Screening by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

117 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 22.1: Optimal Diabetes Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 117

118 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 22.1: Optimal Diabetes Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

119 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 22.1: Optimal Diabetes Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 119

120 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 22.1: Optimal Diabetes Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

121 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 22.1: Optimal Diabetes Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 121

122 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 22.1: Optimal Diabetes Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

123 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 22.1: Optimal Diabetes Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 123

124 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 22.2: Optimal Diabetes Care by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

125 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 22.2: Optimal Diabetes Care by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 125

126 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 23.1: Optimal Asthma Cntrl Adults Ages by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

127 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 23.1: Optimal Asthma Cntrl Adults Ages by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 127

128 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 23.1: Optimal Asthma Cntrl Adults Ages by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

129 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 23.1: Optimal Asthma Cntrl Adults Ages by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 129

130 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 23.1: Optimal Asthma Cntrl Adults Ages by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

131 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 23.1: Optimal Asthma Cntrl Adults Ages by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 131

132 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 23.2: Optimal Asthma Cntrl Adults Ages by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

133 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 23.2: Optimal Asthma Cntrl Adults Ages by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 133

134 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 24.1: Optimal Vascular Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

135 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 24.1: Optimal Vascular Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 135

136 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 24.1: Optimal Vascular Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

137 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 24.1: Optimal Vascular Care by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 137

138 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 24.2: Optimal Vascular Care by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

139 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 25.1: Optimal Asthma Cntrl Children Ages 5-17 by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 139

140 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 25.1: Optimal Asthma Cntrl Children Ages 5-17 by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

141 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 25.1: Optimal Asthma Cntrl Children Ages 5-17 by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 141

142 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 25.1: Optimal Asthma Cntrl Children Ages 5-17 by Clinic (Clinics with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

143 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 25.2: Optimal Asthma Cntrl Children Ages 5-17 by Medical Grup (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 143

144 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 25.2: Optimal Asthma Cntrl Children Ages 5-17 by Medical Grups (Medical Grups with 30+ Minnesta Health Care Prgrams patients in denminatr) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

145 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Please see next page MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 145

146 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Appendix 4: Medical Grup Perfrmance ver Time (Three Years) Medical Grup Perfrmance ver Time (Three Years) As previusly nted, the analysis f medical grup perfrmance ver the past three years was dne t determine patterns f medical grup perfrmance per measure ver time. The reprting years f 2015, 2016 and 2017 were reviewed. Our analysis lked fr patterns in rate changes ver these reprting years. Only medical grups with rates fr all three years per measure were included. The time perid f three reprting years was chsen t allw as many medical grups as pssible t have the pprtunity t be included in the analysis. The percent and number f medical grups were reprted fr each f the fllwing patterns f rate changes ver the past three years fr each measure: High perfrmance and abve average rates: Medical grups with a rate and cnfidence interval greater than the statewide MHCP average fr each f the three years. Cnsistently imprved: Medical grups with mre than a tw percentage pint increase between each cnsecutive year. Relatively stable: Medical grups that had n mre than a tw percentage pint increase r decrease between each cnsecutive year (-2 percent t +2 percent). Cnsistently declined: Medical grups with mre than a tw percentage pint decrease between each cnsecutive year. Variable perfrmance (with an imprvement r with a decline): Medical grups with an up/dwn pattern that was nt cnsistent and did nt fall int ne f the ther categries MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

147 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 26: Cntrlling High Bld Pressure Rate Changes fr Reprting Years 2015 t MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 147

148 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 27: Clrectal Cancer Screening Rate Changes fr Reprting Years 2015 t MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

149 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 27: Clrectal Cancer Screening Rate Changes fr Reprting Years 2015 t MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 149

150 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 28: Chlamydia Screening in Wmen Rate Changes fr Reprting Years 2015 t MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

151 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 29: Apprpriate Treatment fr Children with URI Rate Changes fr Reprting Years 2015 t MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 151

152 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 29: Apprpriate Treatment fr Children with URI Rate Changes fr Reprting Years 2015 t MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

153 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 30: Breast Cancer Screening Rate Changes fr Reprting Years 2015 t MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 153

154 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 31: Optimal Asthma Cntrl Adults Ages Rate Changes fr Reprting Years 2015 t MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

155 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 32: Optimal Asthma Cntrl Children Ages 5-17 Rate Changes fr Reprting Years 2015 t MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 155

156 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Appendix 5: Purchaser Perfrmance Rate Differences Statistical Methds f Analysis f Purchaser Perfrmance Rate Differences An analysis was cnducted t assess whether a gap between purchasers within a medical grup was present and, if s, whether that gap was statistically significant. Medical grups were included in the analysis if bth purchaser categries (MHCP and Other Purchasers) met the minimum reprting requirements fr a measure. In ther wrds, fr administrative measures, a medical grup was included in the analysis if each purchaser categry had at least 30 patients; and fr hybrid measures, a medical grup was included if each purchaser categry had at least 60 patients. Assessment was made at the clinic level fr the DDS measures (Optimal Diabetes Care, Optimal Vascular Care, Depressin Remissin at Six Mnths, Optimal Asthma Cntrl Children Ages 5-17, Optimal Asthma Cntrl Adults Ages and Clrectal Cancer Screening). Fr these measures, a clinic was included in the analysis if each purchaser categry had at least 30 patients. The t-test was used t determine if gaps fund between purchasers at the clinic level were statistically significant. The p-value f less than 0.05 included in this reprt is unadjusted fr multiple test differences. A secnd analysis was cnducted examining the 95 percent cnfidence interval arund the rate fr medical grups/clinics and cmparing it t the 95 percent cnfidence interval arund the statewide rate. It was determined whether medical grups/clinics had a rate and cnfidence interval that fell utside the statewide cnfidence interval and had a purchaser gap that was significantly different frm the statewide purchaser gap. Significance was designated at a p-value less than MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

157 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Childhd Immunizatin Status (Cmb 10) Ten medical grups met the minimum reprting requirement f at least 60 patients per purchaser fr this analysis. The purchaser perfrmance rate gap at the statewide level was 23 percentage pints and is statistically significant. This means that the Childhd Immunizatin medical grup rate fr MHCP patients (39 percent) was significantly lwer than that f Other Purchasers (61 percent). All medical grups had a MHCP rate that was lwer than Other Purchasers; eight f thse grups had a statistically significant gap between purchasers. We als assessed whether the gap between purchasers at a medical grup level was significantly different than the gap fund at the statewide level. Fr the Childhd Immunizatin measure, three medical grups had a gap between purchasers that was significantly different than the gap fr the statewide rate and the gap was larger fr tw medical grups. Hwever, fr ne medical grup, the gap was significantly smaller. (See Table 33, Clumn 6) There were n medical grups that had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and had a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 33 summarizes these findings MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 157

158 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 33: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Childhd Immunizatin Status (Cmb 10) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

159 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Cntrlling High Bld Pressure Fifteen medical grups met the minimum reprting requirement f at least 60 patients per purchaser fr this analysis. The purchaser perfrmance rate gap at the statewide level was six percentage pints and is statistically significant. This means that the Cntrlling High Bld Pressure medical grup rate fr MHCP patients (72 percent) was significantly lwer than that f Other Purchasers (78 percent). Of the 15 medical grups, ten f them had rates fr MHCP patients that were lwer than Other Purchasers; fur f these medical grups rate differences were statistically significant. (See Table 34, Clumn 5) Five medical grups had higher rates fr MHCP patients than Other Purchasers and this was statistically significant fr tw medical grups (See Clumn 4). We als assessed whether the gap between purchasers at a medical grup level was significantly different than the gap fund at the statewide level. Fr the Cntrlling High Bld Pressure measure, three medical grups had a purchaser gap that was significantly different than the statewide gap. Three medical grups had a gap that was larger than the statewide gap (See Clumn 6). There were n medical grups that had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and had a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 34 summarizes these findings MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 159

160 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 34: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Cntrlling High Bld Pressure MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

161 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Clrectal Cancer Screening Five hundred and thirty-ne clinics met the minimum reprting requirement f at least 30 patients per purchaser fr this analysis. The purchaser perfrmance rate gap at the statewide level is 19 percentage pints and is statistically significant. This means the Clrectal Cancer Screening statewide rate fr MHCP patients (56 percent) was significantly lwer than that f Other Purchasers (75 percent). Of thse 531 clinics, five hundred and thirteen clinics had rates fr MHCP patients that were lwer than Other Purchasers, f these 408 clinics had statistically significant differences. Eighteen clinics had rates fr MHCP patients that were higher than Other Purchasers (designated with negative signs in Table 35, Clumn 4); hwever, nne f these clinics had MHCP patients with significantly higher perfrmance rates. We als assessed whether the gap between purchasers at a clinic level was significantly different than the gap fund at the statewide level. Fr clrectal cancer screening, 141 clinics had purchaser gaps that were significantly different than the statewide gap. Twelve clinics had a gap significantly larger than the statewide gap, and 129 clinics had a rate significantly smaller than the statewide gap. Seventeen f thse 129 clinics had a MHCP perfrmance rate higher than the Other Purchaser rate. (See clumn 6) The eleven clinics listed belw in alphabetical rder had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and had a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 35 summarizes these findings. Crmwell Medical Clinic, PLLC EH Central Crsslake Clinic HCMC Clinics - Glden Valley Clinic May Clinic Health System New Richland Mille Lacs Health System - Hillman Obstetrics, Gyneclgy and Infertility - Edina Sanfrd Canby Clinic Sanfrd Hawley Clinic Sanfrd Health Ipswich Clinic Scenic Rivers Health Services - Fldwd Tri-Cunty Health Care - Bertha Clinic 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 161

162 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

163 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 163

164 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

165 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 165

166 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

167 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 167

168 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

169 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 169

170 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

171 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 35: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Clrectal Cancer Screening 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 171

172 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Chlamydia Screening in Wmen Seventy medical grups met the minimum reprting requirement f at least 30 patients per purchaser fr this analysis. The purchaser perfrmance rate gap at the statewide level was negative seven percentage pints and is statistically significant. The sign is negative; hwever, which means the Chlamydia Screening medical grup rate fr MHCP patients (57 percent) was significantly higher than that f Other Purchasers (51 percent). Sixteen medical grups had rates fr MHCP patients that were lwer than Other Purchasers; 54 medical grups had rates fr MHCP patients that were higher than Other Purchasers (designated with negative signs in Table 36, Clumn 4). Of thse 54 grups, 20 had a statistically significant gap between purchasers. (See Clumn 5) We als assessed whether the gap between purchasers at a medical grup level was significantly different than the gap fund at the statewide level. Fr the Chlamydia Screening measure, eleven medical grups had purchaser gaps that were significantly different than the statewide gap. Of these eleven medical grups, fur had a gap significantly smaller than the statewide gap; seven had a higher MHCP perfrmance rate than Other Purchasers. (See Clumn 6) One medical grup, listed belw, had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and had a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 36 summarizes these findings. Allina Health MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

173 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 36: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Chlamydia Screening in Wmen 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 173

174 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 36: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Chlamydia Screening in Wmen MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

175 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Depressin Remissin at Six Mnths Tw hundred sixty-six clinics met the minimum reprting requirement f at least 30 patients per purchaser grup fr this analysis. The purchaser perfrmance rate gap at the statewide level was fur percentage pints and is statistically significant. This means that the Depressin Remissin at Six Mnths statewide rate fr MHCP patients (five percent) was significantly lwer than that f Other Purchasers (nine percent). Of the 266 clinics, 211 f them had rates fr MHCP patients that were lwer than Other Purchaser patients; 23 f thse clinics had a significant gap between purchasers. (See Table 37, Clumn 5) This means that these clinics had a significantly lwer MHCP perfrmance rate cmpared t Other Purchasers. Fifty-fur clinics had rates fr MHCP patients that were higher than Other Purchasers (designated with negative signs in Clumn 4), with ne clinic that had a significantly higher MHCP perfrmance rate cmpared t Other Purchasers. We als assessed whether the gap between purchasers at a clinic level was significantly different than the gap at the statewide level. Ten clinics had a larger purchaser gap than the gap at the statewide level; eighteen clinics had a smaller purchaser gap than the gap at the statewide level. (See Clumn 6) The eight clinics listed belw in alphabetical rder had a higher rate fr MHCP patients cmpared t Other Purchaser patients, a MHCP rate higher than the statewide MHCP average and a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 37 summarizes these findings. Affiliated Cmmunity Medical Centers - Willmar Clinic Allina Health Specialties - Allina Mental Health - Unity Fairview Blaine Clinic HealthPartners - Riverside Nrth Memrial Clinic - St. Anthny Olmsted Medical Center - Rchester Sutheast - Psychiatry Range Reginal Health Services dba Fairview Mesaba Clinic - Muntain Irn Sanfrd Mrhead Clinic - Family Medicine 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 175

176 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 37: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Depressin Remissin at Six Mnths MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

177 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 37: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Depressin Remissin at Six Mnths 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 177

178 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 37: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Depressin Remissin at Six Mnths MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

179 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 37: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Depressin Remissin at Six Mnths 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 179

180 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 37: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Depressin Remissin at Six Mnths MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

181 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Apprpriate Treatment fr Children with URI Sixty medical grups met the minimum reprting requirement f at least 30 patients per purchaser fr this analysis. The purchaser perfrmance rate gap at the statewide level is negative three percentage pints and is statistically significant. The sign is negative; hwever, which means the Apprpriate Treatment fr Children with URI medical grup rate fr MHCP patients (93 percent) was significantly higher than that f Other Purchasers (90 percent). Fifteen medical grups had rate gaps f less than ne percent suggesting little r n difference between MHCP and Other Purchaser patients. Seventeen medical grups had rates fr MHCP patients that were lwer than Other Purchasers, and ne f thse medical grups had a significantly lwer MHCP rate cmpared t Other Purchaser rate. (See Table 38, Clumn 5) Frty-tw medical grups had rates fr MHCP patients that were higher than Other Purchasers (designated with negative signs in Clumn 4). We als assessed whether the gap between purchasers at a medical grup level was significantly different than the gap fund at the statewide level. Fr the Apprpriate Treatment fr Children with URI measure, 11 medical grups had purchaser gaps that were significantly different than the statewide gap. Eight f thse medical grups had a gap that was significantly larger than the statewide gap, while three had a gap significantly smaller than the statewide gap. Fr six medical grups, their MHCP perfrmance rate was lwer than Other Purchasers rate. (See Clumn 6) The tw medical grups listed belw in alphabetical rder had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 38 summarizes these findings. Park Nicllet Health Services Suth Lake Pediatrics 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 181

182 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 38: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Apprpriate Treatment fr Children with URI MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

183 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Breast Cancer Screening Sixty medical grups met the minimum reprting requirement f at least 30 patients per purchaser fr this analysis. The purchaser perfrmance rate gap at the statewide level was abut 20 percentage pints and is statistically significant. This means that the Breast Cancer Screening medical grup rate fr MHCP patients (63 percent) was significantly lwer than that f Other Purchasers (83 percent). Fifty-eight f the medical grups had rates fr MHCP patients that were lwer than Other Purchasers; 41 f these medical grups had statistically significant gaps between purchasers within the medical grup. (See Table 39, Clumn 5). Tw medical grups had a rate that was higher fr MHCP patients than Other Purchasers (designated with a negative sign in Clumn 4). We als assessed whether the gap between purchasers at a medical grup level was significantly different than the gap at the statewide level. Fr Breast Cancer Screening, twenty-fur medical grups had a gap significantly smaller than the statewide gap. (See clumn 6) The tw medical grups listed belw in alphabetical rder had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and had a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 39 summarizes these findings. Multicare Assciates f the Twin Cities Raiter Clinic, LTD - IHN 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 183

184 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 39: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Breast Cancer Screening MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

185 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Diabetes Care Three hundred and sixty-eight clinics met the minimum reprting requirement f at least 30 patients per purchaser grup fr this analysis. The purchaser perfrmance rate gap at the statewide level was 15 percentage pints and is statistically significant. This means the Optimal Diabetes Care statewide rate fr MHCP patients (33 percent) was significantly lwer than that f Other Purchasers (48 percent). Of thse 368 clinics, 344 had rates fr MHCP patients that were lwer than Other Purchasers; and f thse clinics, 194 had significant gaps between purchasers. (See Table 40, Clumn 5) This means that 194 clinics had significantly lwer perfrmance rates cmpared t Other Purchasers. Of the 368 clinics, 24 had rates fr MHCP patients that were higher than Other Purchasers (designated with negative signs in Clumn 4) and tw f thse clinics had a difference that was statistically significant. We als assessed whether the value f the gap between purchasers at a clinic level was significantly different than the gap at the statewide level. Ten clinics had a significantly larger purchaser gap than the statewide gap; 57 clinics had a significantly smaller purchaser gap than the statewide gap. And f thse 57 clinics, 22 had a MHCP rate that was higher than its Other Purchasers rate. (See Clumn 6) The 12 clinics listed belw in alphabetical rder had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and had a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 40 summarizes these findings. Cmmunity-University Health Care Center Fairview Blmingtn Lake Xerxes Fairview EdenCenter Clinic HealthEast Rseville Clinic HealthPartners - Ctr fr Internatl Hlth Hennepin Cunty Medical Center (HCMC) Clinics - Brklyn Park Clinic Hennepin Cunty Medical Center (HCMC) Clinics - Glden Valley Clinic Hennepin Cunty Medical Center (HCMC) Clinics - Richfield Clinic May Clinic Health System Cannn Falls Nrth Memrial Clinic - Plymuth City Center Park Nicllet Clinic - Creekside Sanfrd Health Pierre Clinic Cmmunity-University Health Care Center 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 185

186 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 40: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Diabetes Care MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

187 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 40: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Diabetes Care 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 187

188 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 40: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Diabetes Care MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

189 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 40: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Diabetes Care 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 189

190 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 40: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Diabetes Care MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

191 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 40: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Diabetes Care 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 191

192 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 40: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Diabetes Care MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

193 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Adults Ages Three hundred and thirteen clinics met the minimum reprting requirement f at least 30 patients per purchaser fr this analysis. The purchaser perfrmance rate gap at the statewide level is 13 percentage pints and is statistically significant. This means the Optimal Asthma Cntrl statewide rate fr MHCP adult patients ages (40 percent) was significantly lwer than that f Other Purchasers (53 percent). Tw hundred and sixty-six clinics had rates fr MHCP patients that were lwer than Other Purchasers; 103 f thse clinics had MHCP patients with significantly lwer perfrmance rates cmpared t Other Purchasers. Frty-fur clinics had rates fr MHCP adult patients ages that were higher than Other Purchasers (designated with negative signs in Table 41, Clumn 4); hwever, nly ne f these clinics had MHCP patients with significantly higher perfrmance rates. We als assessed whether the gap between purchasers at a clinic level was significantly different than the gap fund at the statewide level. Fr the Optimal Asthma Cntrl Adults Ages measure, 68 clinics had purchaser gaps that were significantly different than the statewide gap. Nine clinics had a gap significantly bigger than the statewide gap, and 59 clinics had a rate significantly smaller than the statewide gap. 31 f thse 68 clinics had a MHCP perfrmance rate higher than the Other Purchaser rate. (See clumn 6) The eleven clinics listed belw in alphabetical rder had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and had a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 41 summarizes these findings. Allina Health - Annandale Allina Health - Faribault Allina Health - Nrthfield Allina Health - Savage HealthPartners - Andver HealthPartners - Cn Rapids HealthPartners - Inver Grve Heights HealthPartners - Maplewd Nrth Memrial Clinic - Brklyn Park Physicians Park Nicllet Clinic - Creekside Park Nicllet Clinic - Prir Lake 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 193

194 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 41: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Asthma Cntrl Adults Ages MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

195 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 41: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Asthma Cntrl Adults Ages MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 195

196 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 41: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Asthma Cntrl Adults Ages MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

197 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 41: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Asthma Cntrl Adults Ages MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 197

198 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 41: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Asthma Cntrl Adults Ages MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

199 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 41: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps Optimal Asthma Cntrl Adults Ages MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 199

200 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Vascular Care One hundred and seventy-nine clinics met the minimum reprting requirement f at least 30 patients per purchaser grup fr this analysis. The purchaser perfrmance rate gap at the statewide level was 19 percentage pints and is statistically significant. This means that the Optimal Vascular Care statewide rate fr MHCP patients (45 percent) was significantly lwer than that f Other Purchasers (64 percent). One hundred and sixty-five f thse clinics had rates fr MHCP patients that were lwer than Other Purchasers; f thse clinics, 97 had significant gaps between purchasers. (See Table 42, Clumn 5) This means 97 clinics had significantly lwer perfrmance rates cmpared t Other Purchasers. Of the 179 clinics, furteen had rates fr MHCP patients that were higher than Other Purchasers (designated with negative signs in Clumn 4). Nne f the furteen clinics had a significantly higher perfrmance rate cmpared t Other Purchasers. We als assessed whether the value f the gap between purchasers at a clinic level was significantly different than the gap at the statewide level. Fur f the clinics had a significantly larger purchaser gap than the statewide gap; 23 clinics had a significantly smaller purchaser gap than the statewide gap. Of thse 23 clinics, furteen had a MHCP rate that was higher than their Other Purchasers rate. (See Clumn 6) The eight clinics listed belw in alphabetical rder had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 42 summarizes these findings. Entira Family Clinics - East Side HealthEast Rice Street Clinic HealthPartners - Ctr fr Internatl Hlth Hennepin Cunty Medical Center (HCMC) Clinics - Richfield Clinic Lakewd Health System - Pillager Clinic Mille Lacs Health System - Onamia Sanfrd Health Vermillin Clinic University f Minnesta Physicians - Phalen Village Family Medicine Clinic MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

201 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 42: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps - Optimal Vascular Care 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 201

202 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 42: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps - Optimal Vascular Care MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

203 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 42: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps - Optimal Vascular Care 2018 MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 203

204 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Children Ages 5-17 One hundred and seventy-five clinics met the minimum reprting requirement f at least 30 patients per purchaser grup fr this analysis. The purchaser perfrmance rate gap at the statewide level was 10 percentage pints and is statistically significant. This means that the Optimal Asthma Cntrl statewide rate fr MHCP children ages 5-17 (51 percent) was significantly lwer than that f Other Purchasers (61 percent). One hundred and thirty-tw f thse clinics had rates fr MHCP patients that were lwer than Other Purchasers; f thse clinics, 35 had significant gaps between purchasers. (See Table 43, Clumn 5) That means 35 clinics had significantly lwer perfrmance rates cmpared t Other Purchasers. Of thse 175 clinics, 43 had rates fr MHCP patients that were higher than Other Purchasers (designated with negative signs in Clumn 4), with three clinics that had significant gaps between purchasers. Als f thse 175 clinics, ne clinic had a rate f zer percent fr bth their MHCP patients and Other Purchaser patients. We als assessed whether the value f the gap between purchasers at a clinic level was significantly different than the gap at the statewide level. Tw clinics had a significantly larger purchaser gap than the statewide gap, while twenty-five clinics had a significantly smaller purchaser gap than the statewide gap. Of thse twenty-five clinics, twenty had a MHCP rate that was higher than its Other Purchasers rate. (See Clumn 6) The eight clinics listed belw had a higher rate fr MHCP patients cmpared t Other Purchasers, a MHCP rate higher than the statewide MHCP average and had a purchaser rate gap that was significantly lwer than that fund fr the statewide purchaser rate gap. Table 43 summarizes these findings. Affiliated Cmmunity Medical Centers - Willmar Clinic Affiliated Cmmunity Medical Centers- Marshall Clinic Allina Health - Buffal Allina Health - Frest Lake Allina Health - Inver Grve Heights Fairview Elk River Clinic May Clinic - Speciality Practice May Clinic Health System Mankat Specialty Clinic MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

205 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 43: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps - Optimal Asthma Cntrl Children Ages MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 205

206 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 43: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps - Optimal Asthma Cntrl Children Ages MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

207 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Table 43: Statistical Analysis Summary f Purchaser Perfrmance Rate Gaps - Optimal Asthma Cntrl Children Ages MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 207

208 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Appendix 6: Glssary Attributed patient fr measures cllected by health plans (administrative and hybrid) A patient assigned, r attributed, t a medical grup fr measurement purpses when the patient had ne r mre visits t that medical grup during the measurement year. If a patient visited mre than ne medical grup during the measurement year, the patient was attributed t the clinic at which he/she was seen the greatest number f times. If the number f visits t tw different medical grups was the same, the patient was attributed t the medical grup he/she visited mst recently. An example f an unattributed patient culd be smene a health plan identified using pharmacy data. Since this patient did nt visit a medical grup during the measurement year, he/she culd nt be assigned t a medical grup during the attributin prcess. The federal Tax Identificatin Number is used as the cmmn identifier fr aggregating files acrss all health plans. Attributed patient fr measures cllected by Direct Data Submissin (DDS) Medical grups must attribute each patient t a single clinic within their medical grup. Each medical grup s patient attributin methd is defined by the medical grup and is then reviewed by MNCM as part f the denminatr certificatin prcess. Benchmarks The benchmarks (standards used fr cmparisns) include the 2017 natinal cmmercial HEDIS rate and the 2017 natinal Medicaid HEDIS rate. The benchmark HEDIS rate is a natinal average f mre than 90 percent f managed health care plans and sme PPO health plans that submit data t NCQA t measure perfrmance against a detailed set f measure criteria. Benchmarks were included in this reprt fr measures with a cmparable natinal Medicaid HEDIS rate (Apprpriate Treatment fr Children with URI, Childhd Immunizatin Status (Cmb 10), and Chlamydia Screening in Wmen). Clinic Any lcatin where primary r specialty care ambulatry services are prvided fr a fee by ne r mre physicians. Direct Data Submissin (DDS) measures Measures cllected using the DDS prcess, which include Optimal Diabetes Care, Optimal Vascular Care, Depressin Remissin at Six Mnths, Optimal Asthma Cntrl Children Ages 5-17, Optimal Asthma Cntrl Adults Ages and Clrectal Cancer Screening. The results f these measures are calculated using data submitted by medical grups/clinics. These data cme frm electrnic health recrds r paperbased medical charts. Dual eligibles Patients wh were enrlled in bth Medicare and Minnesta State Public prgrams. Healthcare Effectiveness Data and Infrmatin Set (HEDIS) measures HEDIS measures, prduced by NCQA, are a set f standardized, quantifiable measures designed t allw reliable cmparisns f the perfrmance f insurers and care prviders acrss a brad range f imprtant health issues. HEDIS measures include: Apprpriate Treatment fr Children with URI, Childhd Immunizatin Status (Cmb 10), Cntrlling High Bld Pressure, Breast Cancer Screening and Chlamydia Screening in Wmen. The data fr these measures cme frm health plan claims and/r medical recrd review. Health plan files are aggregated and then results are reprted at the medical grup level. Institute fr Clinical Systems Imprvement (ICSI) ICSI is an independent cllabrative that helps its members prvide evidence-based health care services t patients. Cmprised f apprximately 50 medical grups and spnsred by three Minnesta nnprfit health plans, ICSI unites diverse stakehlders t deliver patient-centered and value-driven care in Minnesta and surrunding areas. Measure categries MNCM cmbines measures int the fllwing categries t summarize medical grup/clinic perfrmance: MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

209 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Measure Specificatin Changes since 2016 Measures in this categry had specificatin changes in the previus year. Due t this, n trend data is available. Large Increase and Large Decrease These categries include measures that displayed a MHCP rate change whse abslute value was greater than r equal t five percentage pints frm 2016 t Mderate Increase and Mderate Decrease These categries include measures that displayed a MHCP rate change whse abslute value was greater than r equal t ne percentage pint and less than r equal t five percentage pints frm 2016 t Small Increase and Small Decrease These categries include measures that displayed a MHCP rate change whse abslute value was less than r equal t ne percentage pint frm 2016 t Medical grup One r mre clinic sites perated by a single rganizatin. Minnesta Health Care Prgrams (MHCP) These health care prgrams (i.e., Medical Assistance including dual eligibles and MinnestaCare) prvide service under bth fee-fr-service and managed care delivery systems purchased by DHS. This reprt nly includes perfrmance rates fr the managed care prgrams (i.e., Medical Assistance including dual eligibles and MinnestaCare). MHCP medical grup average This represents the average perfrmance f all medical grups fr patients cvered by MHCP. The MHCP medical grup average includes nly thse MHCP patients wh were attributed t medical grups. Sme medical grups meet the minimum threshld necessary fr MNCM t reprt their perfrmance and thers d nt; hwever all f their data are included in calculating this average. This rate is the mst apprpriate average t use n the graphs that cmpare a single medical grup with the perfrmance f all medical grups. The medical grup average tends t be slightly higher than the MHCP statewide average because it includes patients wh accessed care within the measurement year. MHCP medical grup averages are nly used n charts that cmpare medical grups. MHCP statewide average This represents the average perfrmance rate at the statewide level fr all MHCP patients. MHCP statewide averages include patients wh were attributed t a medical grup and patients wh were nt attributed t a medical grup. MN Cmmunity Measurement (MNCM) MNCM is an independent, cmmunity- based, nn-prfit rganizatin dedicated t accelerating the imprvement f health in Minnesta and surrunding cmmunities thrugh measurement and public reprting f health care perfrmance. Fr mre infrmatin, please visit mncm.rg. Natinal Cmmittee fr Quality Assurance (NCQA) A natinal nn-prfit rganizatin dedicated t imprving health care quality. NCQA accredits and certifies a wide range f health care rganizatins, as well as prduces HEDIS measures. Other Purchasers This includes cmmercial (emplyer-based insurance cverage) and Medicare managed care data (excluding dual eligibles insured thrugh MHCP). It als includes health plan data frm cmmercial HMO/POS and sme PPO prducts, plus Medicare Cst and Medicare Advantage. Statistical significance - The significance level is the principle used fr rejecting the null hypthesis (e.g. the difference between a medical grup rate and the statewide rate ccurred by chance). T test this hypthesis, the difference between the findings f the study and the null hypthesis is calculated. With the assumptin that the null hypthesis is true, the prbability f the difference is determined and cmpared t the significance level (in this reprt, the significance level is defined as p<0.05). If the prbability is less than the significance level, then the null hypthesis is rejected and the utcme is said t be statistically significant MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 209

210 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Self-Paid Patients wh pay fr their wn health care services. Statewide rates This includes patients meeting measurement criteria enrlled in managed care health plans including cmmercial, Medicaid managed care and Medicare managed care MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

211 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Appendix 7: Measure Definitins Measures with Specificatin Changes in 2017 Childhd Immunizatin Status (Cmb 10) Measures the percentage f children tw years f age wh had fur diphtheria, tetanus and acellular pertussis (DTaP); three pli (IPV); ne measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (HepB), ne chicken px (VZV); fur pneumcccal cnjugate (PCV); ne hepatitis A (HepA); tw r three rtavirus (RV); and tw influenza (flu) vaccines by their secnd birthday. Increase in MHCP Rate Measures Mderate Increase Cntrlling High Bld Pressure Measures the percentage f patients ages with a diagnsis f hypertensin whse bld pressure was adequately cntrlled at: (1) Patients ages whse bld pressure was <140/90 mm Hg, (2) Patients ages with a diagnsis f diabetes whse bld pressure was <140/90 mm Hg r (3) Patients ages withut a diagnsis f diabetes whse bld pressure was <150/90 mm Hg. The representative bld pressure is the mst recent bld pressure reading during the measurement year (as lng as the reading ccurred after the diagnsis f hypertensin was made). Small Increase Clrectal Cancer Screening Measures the percentage f adults ages wh had apprpriate screening fr clrectal cancer screenings. Decrease in MHCP Rate Measures Small Decrease Chlamydia Screening in Wmen Measures the percentage f sexually active wmen ages wh had at least ne test fr Chlamydia infectin during the measurement year. Depressin Remissin at Six Mnths Measures the percentage f patients whse PHQ-9 scre is less than five at six mnths after their initial scre was dcumented, which is the definitin f remissin. It s based n the denminatr f patients with a diagnsis f majr depressin r dysthymia whse initial PHQ-9 scre is greater than nine. Apprpriate Treatment fr Children with Upper Respiratry Infectin (URI) Measures the percentage f children ages three mnths t 18 years with a diagnsis f URI wh were nt given an antibitic prescriptin within three days f the episde perid (July 1 f prir year t June 30 f measurement year). A higher rate represents better perfrmance. Breast Cancer Screening Measures the percentage f wmen ages wh had a mammgram during the measurement year r prir year. The Breast Cancer Screening measure had revisins t its age criterin in The age criterin fr previus years included ages Mderate Decrease Optimal Diabetes Care Measures the percentage f patients with diabetes (Types 1 and 2) ages wh reached all five treatment gals t reduce the risk f cardivascular disease. The treatment gals include hemglbin A1c (A1c) less than 8, bld pressure less than 140/90 mmhg, n a statin medicatin unless allwed cntraindicatins r exceptins are present, daily aspirin use if they have a c-mrbidity f Ischemic Vascular Disease (IVD), and dcumented tbacc-free status. In 2015, the measure was a fur-cmpnent cmpsite measure withut the statin use cmpnent MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 211

212 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Optimal Asthma Cntrl Children Ages 5-17 Measures the percentage f patients ages 5-17 with persistent asthma wh have reached all f the fllwing tw targets t cntrl their asthma: (1) evidence f well cntrlled asthma and (2) nt at risk fr elevated exacerbatin as evidenced by n patient-reprted emergency department visits and hspitalizatins. Large Decrease Optimal Vascular Care Measures the percentage f patients with vascular disease ages wh reached all three treatment gals t reduce mdifiable risk factrs. The treatment gals include bld pressure less than 140/90, n a statin medicatin unless allwed cntraindicatins r exceptins are present, daily aspirin use, and dcumented tbacc-free status. In 2015, the measure specificatin included an LDL cmpnent f LDL-C less than 100 mg/dl. Optimal Asthma Cntrl Adults Ages Measures the percentage f patients ages with persistent asthma wh have reached all f the fllwing tw targets t cntrl their asthma: (1) evidence f well cntrlled asthma and (2) nt at risk fr elevated exacerbatin as evidenced by n patient-reprted emergency department visits and hspitalizatins MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.

213 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams Appendix 8: References 1. American Health Insurance Plans (2006). Addressing Disparities in Health. Available at HealthAndMedicine/DiversityAndCulturalCmpetency. 2. Rbert Wd Jhnsn Fundatin (2010). Quality & Equality in U.S. Health Care: A Message Handbk. 3. Snwden AM, Kunerth V, Carlsn, AM, McRae JA, Vetta E. Addressing Health Care Disparities Using Public Reprting. American Jurnal f Medical Quality, July/August 2012: Lavizz-Murey, R. (2008). Racial disparities in health care quality shuld mean equality. Healthcare Financial Management, January 2008: Chin MH, Alexander-Yung M, Burnet DL Health care quality imprvement appraches t reducing child health disparities. Pediatrics 124: S224-S Hrner RD, Salazar W, Geiger J, Bullck K, Crbie-Smith G, Crng M, Flres G Changing healthcare prfessinals behavirs t eliminate disparities in healthcare: What d we knw? Hw might we prceed? Am J Managed Care 10 (Special Issue): SP12-SP Gallagher MP, Cass A, Craig JC Applying evidence int rutine clinical care at a unit level: The exemplar f renal anemia management. Nephrlgy 15: Institute f Medicine (1999). Unequal Treatment: Cnfrnting Racial and Ethnic Disparities in Health Care. 9. Emmens KM, Lbb R, Pule E, Bennett G, Stffel E & Syngal, S. (2009). Clrectal cancer screening: Prevalence amng lw-incme grups with health insurance. Health Affairs, 2009, 28 (1), Available at rg/strage/emmns_healthaffairs.pdf. 10. Hward RN, Marshall LM, Petersn JM, Khn MA (2002). Tracking Oregn Medicaid patients enrllment and health utilizatin patterns. The Jurnal f Public Health Management Practice, 2002, 8(4), MN Cmmunity Measurement All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement. 213

214 2017 Health Care Disparities Reprt fr Minnesta Health Care Prgrams MN Cmmunity Measurement Bradway Place East, # Bradway Street NE Minneaplis, MN Telephne: (612) MN Cmmunity Measurement. All rights reserved. May be used by participating medical grups as defined in the Medical Grup Data Sharing Agreement.