BHCAG: Who We Are

1. Community DialogueDecember 9, 2011Call to Action: Using Incentives to ImproveOptimal Depression Care

2. 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 2

3. 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 3

4. MNBTE Participating Purchasers • Private and public purchasers • Provide health care to over 900,000 covered lives • Finance incentive rewards for their members treated at higher performing clinics • 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 • 3M • Best Buy • Carlson Companies • Honeywell • Medtronic • South West/West Central Service Cooperative 4

5. 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 5

6. 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. 6

7. Overview of 2011 DDS:Depression Remission at Six Months Statewide Rates Percent of Patients in Remission 7

8. 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 8

9. 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 improvement • 1Severity of Depression and Magnitude of • Productive Loss, Annals of Family Medicine, • July/August 2011 9

10. 2012 MNBTE Performance Design: Depression Achievement • Two measures eligible for achievement rewards; clinic qualifies for only one • Continue rewards for Remission Rate @ 6 Months Definition: 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 Months Definition: 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 10

11. 2012 MNBTE Performance Design: Depression Improvement • Add 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 11

12. 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 12

13. Depression Toolkit Project • 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 13