Community DialogueDecember 9, 2011

Call to Action: Using Incentives to ImproveOptimal Depression Care

BHCAG: Who We Are

Multi-stakeholder membership coalition● Majority of members private and public purchasers● Buy-side focused agenda● Use collective voice of purchasers to improve

‒ Consumer engagement and access‒ Provider accountability and outcomes‒ Reduce health care costs

Vision: Health care consumers get the care they need at the right time, in the right place, at the right price

Mission: Redirect the health care system to focus on a collective goal of optimal health and total value

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Minnesota Bridges to Excellence (MNBTE)

Implemented in 2006– National initiative– Redesigned by BHCAG to leverage MN infrastructure

ICSI guidelines MNCM measures and public reporting

Goals:– Improve the quality of care for patients– Raise the level of purchaser and consumer awareness about the

variation in quality– Spark provider competition based on quality outcomes

BHCAG manages and administers program– Added administration of State of MN Quality Incentive Program in 2011

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MNBTE Participating Purchasers

3M Best Buy Carlson Companies Honeywell Medtronic South West/West Central

Service Cooperative

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● State of Minnesota Department of Human Services (managed care population)

● State of Minnesota Employee Group Insurance Plan

● Target● University of Minnesota● U.S. Bank●  Wells Fargo

● Private and public purchasers● Provide health care to over 900,000 covered lives● Finance incentive rewards for their members treated at higher

performing clinics

Measures Eligible for MNBTE P4P Rewards

Optimal Diabetes Care (since program inception)

Optimal Vascular Care (2008, when changed from CAD)

Optimal Depression Care (2009)

– Remission @ Six Months

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Overview 2011 DDS: Statewide Rates 2007 - 2011

*2007,2008,2009,2010 Daily aspirin use (ages 41-75) on aspirin therapy

**2011 Daily aspirin use if co-morbidity of IVD

Caution should be made when making comparisons to 2011 because the aspirin component changed, and can’t be recast like A1c and Blood Pressure.

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Overview of 2011 DDS:Depression Remission at Six Months Statewide Rates

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Public Reporting on Depression Care Measures

Prior to 2011, clinics voluntarily reported to MNCM on depression care measures (around 150 clinics)

State of MN mandated reporting on depression measures in 2011 (now around 560)

Lots of room for improvement– Statewide Average similar to where Optimal Diabetes

was when MNBTE implemented

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2012 MNBTE Program

Continue to pay rewards for Optimal Diabetes and Optimal Vascular Care

Depression is key ambulatory focus– MNBTE purchasers had more patients with depression (24,132) in

2011 than diabetes (11,005) or vascular care (2,907) Excludes DHS patient counts since they don’t participate in depression care

– Indirect relationship between severity of depression and productivity;

1-point increase in PHQ-9 score = 1.65% productivity loss1

– Depression is frequently co-morbid with other chronic conditions Growing literature on impact of depression on optimal management

of other chronic conditions Add two more measures eligible for rewards as additional

motivation for improvement1Severity of Depression and Magnitude of Productive Loss, Annals of Family Medicine, July/August 2011

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2012 MNBTE Performance Design: Depression

AchievementTwo measures eligible for achievement rewards; clinic qualifies for only one

– Continue rewards for Remission Rate @ 6 MonthsDefinition: Patients with major depression or dysthymia whose initial PHQ-9 score is >9 and the patients’ subsequent score within 6 months is <5.

– Add rewards for Response Rate @ 6 MonthsDefinition: Patients with major depression or dysthymia whose initital PHQ-9 score is >9 and the patients’ subsequent score reflects a 50% of greater reduction within 6 months

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2012 MNBTE Performance Design: Depression

ImprovementAdd reward for Use of the PHQ-9 and characterize it as an “improvement” reward

– Most likely for 2012 and 2013 only–Patients can’t get to remission or response if never given PHQ-9

Current clinic level use rates range from 0% to 100%; statewide average 61%

–Increase the number of patients with depression who are given PHQ-9 to determine their “severity” of depression

Clinics with a use rate of < 30% eligible (around 200 clinics) Clinics’ 2012 report year “use rate” must increase by 10 percentage points

over 2011 report year “use rate” Clinics that qualify receive reward

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Depression Toolkit Project

Result of observing performance for 560+ clinics reporting in 2011– Range of 0% - 30% for remission @ 6 months

But only 30 clinics above 10%

Jointly managed by BHCAG and MNCM– AF4Q Quality Improvement Project– Funded by RWJF grant

Audience is non-DIAMOND primary care; may also be helpful to behavioral health providers

Workgroup of providers and consumers established to identify tools to assist in the identification and treatment of depression in primary care

– Leverage DIAMOND tools to the extent possible

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Depression Toolkit Project

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Goals:●Engage providers and patients in the identification of the tools/aids that are within the project budget●Improve care providers give (determined by improvement in the depression measure performance results)●Aid adult patients in self management

Deliverables:●Develop toolkit with providers to be used by providers●Develop patient oriented, self management tools with input from consumers and patients●Promote and disseminate toolkit in late 2012