Minnesota Community Measurement Pioneers Digital Quality Measurement
Celebrating its 20th anniversary this year, Minnesota Community Measurement (MNCM) is a data-driven organization focusing on clinical quality, cost, and utilization measurement. Liz Cinqueonce, M.B.A., the nonprofit organization’s president and CEO, recently spoke with Healthcare Innovation about its new Common Health Information Reporting Partnership (CHIRP) and other initiatives.
Healthcare Innovation: Could you talk a little about Minnesota Community Measurement’s origins and evolution?
Cinqueonce: We have worked with community partners here in Minnesota since 2005. Originally, the organization was formed through a collaboration between health plans, the Minnesota Medical Association and the Minnesota Hospital Association to try to bring data together from those different partners to really understand a broader view of what was happening with healthcare in the state, and specifically around clinical quality. That original mission has grown and expanded over time. In the early days, we were primarily doing measurement by aggregating results across the health plans to provide that broader statewide view. But now we aggregate data directly from medical groups and their electronic health record systems to get a deeper look at clinical quality, and we also do some cost and utilization measurement using data from our health plan members.
HCI: What was your background before becoming CEO there?
Cinqueonce: I am in my eighth year with Minnesota Community Measurement. I started out as chief operating officer. My first professional positions were in health policy and government affairs. I worked for the Minnesota Pharmacists Association for about 13 years, and my last position there was as their vice president of public affairs. In Minnesota, we had a mandate passed for e-prescribing. I think we were one of the first states in the nation to pass that mandate. At that point, I transitioned into state government. I spent about five years working in the Minnesota Department of Health and the Minnesota Department of Human Services, first around e-prescribing and electronic health record adoption. We have an EHR mandate in Minnesota, too, which I think was pretty unique at the time. And then, when the HITECH Act passed and health information exchange became the order of the day, I was working with the agency to help put policy in place around the HIE framework.
HCI: Does MNCM have committees or projects looking at particular clinical outcomes and how to improve them — for instance around diabetes care?
Cinqueonce: Yes, and you're getting to the core of what the organization is. Really the cornerstone of all of the work that we do is convening our community partners to understand the priority areas where we need measures and where we need to be publicly reporting measures. What are the areas where we can really collaborate to learn more about what works and how we can spread those best practices? So we have a measurement and reporting committee that does that prioritization process for us.
On the national level, we're known for our work in measure development, because in those early days, there were a lot of measures that focused on processes, but not many that focused on outcomes of care. So we were one of the early pioneers in developing outcomes measures and patient-reported outcomes measures. Part of our work certainly is related to data collection and validation. Public transparency has also been a really big, important part of our mix with our public reports.
HCI: I recently interviewed Gabrielle Rude, the CEO of the Wisconsin Collaborative for Healthcare Quality. Would you say that the two organizations are working on similar things?
Cinqueonce: Yes. We collaborate routinely with WCHQ. I think the world of them. But their origins were kind of the opposite of ours. They started on the provider side of things, and we started using payer data. But we've come much closer together over the years. We both now are calculating measures off of clinical data from medical groups and really doing complementary things in some ways.
HCI: So what is the Common Health Information Reporting Partnership or CHIRP? Is it designed to facilitate the flow of data between payers and providers?
Cinqueonce: Yes, that’s exactly it. During a strategic planning session we were having with our board, we were talking about the barriers to having value-based care arrangements implemented on a broader scale. The answer came back that data barriers were interfering with that. So we went on an interview tour with providers and payers to dig into what exactly those challenges were, to explore whether there was something that Minnesota Community Measurement could help to address.
What we heard from payers was that they were investing a lot of money in developing and trying to deliver gap reports to healthcare providers, but they didn't feel like they were getting the uptake on it. They didn't feel like they were seeing a lot of ROI for those investments that they were making, and they really wanted to move the needle on some of their quality measures.
From the provider side, what we heard was that they had a number of different requests coming in from payers for clinical data, but none of them were the same, and they were being asked for different types of queries in different formats and it was just really burdensome for their data analytics departments.
Their second pain point was actually related to the gap reports that they were receiving from the payers. At the provider level, the most important thing is to get things into the clinical workflows. But if you're receiving data in all different formats and from different plans, it's really hard to create a seamless way to integrate that into your data systems and then ultimately get it into your workflows. We also heard that a lot of times they wouldn't trust it because of the claims lag. They found that they would have people doing outreach and following up on something that actually had already happened.
The CHIRP program was designed to address these issues. Where they first started was recognizing we need to have two different data standards. We need to have one that focuses on a common data set for medical groups to send to health plans, and then on the payer side, we needed to have a standard set of information that's coming through to identify gaps in care. We have a governance committee that was convened to determine those two data standards, and also, significantly, to define the use cases for the data that was moving. Those are primarily around improving population health and quality, so that determines the rules of the road for how these data can move.
At first it was just about creating the standards and there wasn’t a huge role for us in the middle of that, but along the way we learned that the vast majority of the data elements that the payers needed were already coming into Minnesota Community Measurement for our core work around quality measurement. So from a provider standpoint, in order to authorize the feeds, they just needed to sign a legal addendum and tell us which plans that they wanted us to push their data to.
HCI: I saw on your website a reference to something called PIPE, which stands for Process Intelligence Performance Engine. What is that?
Cinqueonce: PIPE is the application that we developed to aggregate and validate data, initially for clinical quality measurement, but we are able to leverage that same system for the feeds of data between providers and payers.
HCI: I saw a blog post on your website by Rowan Mahon Pharm.D., M.P.H., discussing the future of digital quality measures, which noted that your organizations’ success in developing PIPE and in supporting statewide reporting requirements highlights the value of standardized, automated data collection. I know that CMS has had a hard time in the short term getting ACOs to convert to digital quality measures. Do you think that the success you have had with this might provide a path for other people to follow?
Cinqueonce: Well, I definitely think that it can be done, right? I mean, we're calculating most of our measures off of clinical data that's coming in from medical groups. So, yes, I think it is a great example that it can be done.
HCI: How long has CHIRP been up and running?
Cinqueonce: All of this work to try to develop this program started before the pandemic, and then it got put on pause, but the true implementation of it has been over the course of the last two years. We are actually in the process right now. So it's not fully implemented. The provider-to-payer data feeds are up and flowing. Later this year, we are going live with the second half of that handshake with the payer-to-provider data feeds. That infrastructure is being built out now, because the data that we are aggregating from payers for this process is new. We expect that the feeds will be live in late summer or early fall, for the payer-to-provider data.
HCI: So is it too early to have received any feedback on whether the benefits and efficiencies that people were hoping to see from this are already happening?
Cinqueonce: We have heard positive feedback from the payers. On the payer side, the efficiencies you see are related to reductions in the number of charts that they have to go out and chase for their HEDIS measures.
Another thing that is important about the CHIRP program is that all of the medical groups that agree to participate in CHIRP commit to going through the NCQA Data Aggregator Validation program with us. Minnesota Community Measurement as an organization went through that process and we did achieve that validated status. But we also have to bring every medical group through their own primary source verification process.
HCI: If the data feeds from payers seem clearer and more timely, it will be interesting to see if it leads to a reduction in provider frustration with participating in value-based care arrangements.
Cinqueonce: Yes, and we actually have heard that from some providers, where they are waiting for the payer-to-provider feeds to stand up before they sign on for their data sharing as well. One of the things I should mention around that timeliness issue is that the feeds that we've set up are set on a cadence where the provider data goes first, so that the health plans have the opportunity to integrate the more recent clinical data before they submit their bidirectional feed, so the gap reports are more accurate. Everything's on a monthly cadence right now, but I think that there is potential for that to become more frequent over time.
HCI: I saw on your website that you just announced the launch of a Performance Hub with interactive performance reports. Could you talk about that?
Cinqueonce: This is getting into the sphere of public reporting that we've always done. The Performance Hub gives a snapshot of what's happening at the statewide level in Minnesota. Within that, we have reports on statewide rates and trends on the measures. It's going to have a year-over-year view of what's happened within a given measure.
We also have information on medical group variation. One of the things that we can look at is the size of the gap between the medical groups with the lowest outcomes and those with the highest. It helps us to be able to find groups that are having really great results and understand what's happening with them and what lessons can be shared. We also have statewide rates by demographics, which gets into how the outcomes vary based on race, ethnicity, language and country of origin. Because we have such granularity of data, we're able to report in a way that is unique among states. I don't think that there are a lot of other organizations like ours that have the depth of data on disparities that we do.
