for performance measurement and reporting to foster such quality improvement efforts, especially for those small practices that are already struggling with competing market demands.
HealthPartners, Inc., is a large nonprofit health care organization structured as a mixed-model health plan serving 630,000 members in group practices throughout Minnesota. Organized as a broad network of physicians and hospitals, HealthPartners provides services in practices with 10 to 600 physicians. Among its members, 30 percent receive care from HealthPartners Medical Group and Clinics, a staff-model group, and 70 percent from other contracted medical groups. HealthPartners serves its members across a range of health needs, from preventative to chronic disease services.
In addition to tracking performance on individual measures, HealthPartners calculates a composite score for a set of critical aspects of care received by the patient for a given condition. Data for these composite measures—addressing diabetes, cardiovascular disease, preventive care, and depression—are derived from administrative data and chart abstraction based on either electronic or paper records. Computer-based and paper registries are maintained separately from medical records and are not currently used to report performance. Rigorous validation of measures consists of four functions: drafting technical specifications, testing the measures, applying appropriate sampling methodology, and modifying the measures as needed.
A quality measurement steering committee, including medical group representatives, oversees measurement development and reporting at HealthPartners. The committee develops the composite measures mentioned above to align with provider-developed, evidence-based guidelines of the Institute for Clinical Systems Improvement (ICSI). ICSI is a not-for-profit collaborative in Minnesota consisting of medical groups and hospital systems, and serving as a driving force for improvement in the delivery of health care. The association between ICSI and HealthPartners has facilitated providers’ acceptance of and involvement in performance measurement.
The cost to the plan for record review is $12 per review and approximately $0.014 per member per month (PMPM) for all health plan members (see Table C-2). In comparison, the plan’s review cost for 2004 Health Plan Employer Data and Information System commercial reporting in 2004 was approximately $0.013 PMPM (see Table C-3). Additional resources needed for data collection activities include staff time for identifying patient samples