MHQP: Massachusetts primary care physicians achieve measurable improvements in health care quality

Massachusetts primary care physicians continue to achieve measurable improvements in important aspects of health care quality as reported by Massachusetts Health Quality Partners (MHQP). Today, the organization released its sixth annual Quality Insights: Clinical Quality in Primary Care report, comparing the performance of more than 150 medical groups across the state. MHQP found steady progress in results for clinical quality measures reported on over the six years, including well child visits and depression management.

“Physicians can use MHQP data to compare their results with those of other groups across the state and within geographic regions, focus on gaps in their performance, examine best practices, and target opportunities for improving the way they provide care”

As Massachusetts and the nation seek ways to improve the quality of health care and slow the growth of spending, comparative provider performance information will play a key role in delivery-system reform, according to MHQP's executive director, Barbra Rabson.

“The fundamentals of system reform – more emphasis on primary care and prevention; better coordination and integration of care with the patient's wants and needs at the center of the care process; and payment systems that reward and encourage quality and efficiency – all require the measurement and reporting of performance,” said Rabson. “Massachusetts has a significant head start on what is expected to be a rapid proliferation of quality measurement and reporting nationwide, especially as the use of electronic medical records grows.”

This year's report finds that, overall, Massachusetts physicians performed better than the national average on 28 of 29 adult and pediatric quality-of-care measures reported by MHQP, and above the national 90th percentile on 15 of these measures. The participating medical groups performed below the national average on just one measure – the use of appropriate medications for adults with asthma. The results are available at mhqp.org, where consumers can compare medical groups' performance in providing high-quality adult and pediatric primary care, including how well they help their patients manage chronic illness or avoid the overuse of certain medications and tests.

Focusing on improvement

Dr. Barbara Spivak, president of the Mount Auburn Cambridge IPA and a member of MHQP's Physicians Council, points out that MHQP's quality reports give health care providers objective, actionable information about where and how they can improve. “Physicians can use MHQP data to compare their results with those of other groups across the state and within geographic regions, focus on gaps in their performance, examine best practices, and target opportunities for improving the way they provide care,” she said.

For example, two of the large primary care medical groups that participate in MHQP’s public reporting efforts have used their performance data to address a major opportunity for improving the treatment of patients with severe depression. Major depression is a serious and potentially life-threatening disease in its own right, and people with medical problems who are also depressed are much less likely to respond to medical treatment.

Two years ago, when a review of MHQP's data made it clear that a large number of patients with depression were not getting the full benefit of their prescribed treatments, Cambridge Health Alliance (CHA) launched a quality improvement initiative for depression management that includes expanded outreach to patients, enhanced training and toolkits for care teams, and new internal reports to track the group's performance.

Similarly, Harvard Vanguard Medical Associates, a multispecialty medical group that is part of Atrius Health, has made depression management a top priority for improvement using MHQP data as a key measurement tool. By taking advantage of its electronic medical record, pharmacy systems, educational tools, and teamwork between primary care and behavioral health clinicians, Harvard Vanguard has brought about significant improvements across its physician network.

“By focusing on our patients' compliance with antidepressant treatment, we have managed to improve the prognosis for people suffering from this serious condition that contributes to medical illness, disability, and risk of suicide,” said Dr. Steven Adelman, Harvard Vanguard's Chief of Behavioral Health.

Antidepressant medications can alleviate serious depression provided that they are taken as prescribed while the patient is being carefully monitored by a clinician. MHQP's quality reports include two measures related to compliance – whether patients receive a 12-week supply, which is the minimum amount of time needed for antidepressants to start working, and whether they receive at least a six-month supply, which is the minimum amount of time needed to fully recover from depression.

Statewide, Massachusetts medical groups perform above the national average on both of MHQP's antidepressant medication measures but below the national 90^th percentile benchmark. Further, there is wide variation in performance among groups. For instance, while, statewide, 51% of patients who were prescribed antidepressants filled their prescription and received at least a six-month supply, there is a 50 percentage point difference (76% vs. 26%) between the highest and lowest performing groups.

Another area where MHQP found wide variation was in the appropriate treatment of low back pain. While, statewide, Massachusetts physicians scored above the national average in avoiding the inappropriate use of imaging studies (x-rays, CT scans and MRIs) for adults with low back pain, the highest performing group had a 97% score, while the lowest score was 52%. High performance in this measure not only results in safer, better-quality care, but helps reduce unnecessary medical spending.

The MHQP Quality Insights report uses performance data contributed by Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, and Tufts Health Plan. The report is based on widely accepted standards developed by the National Committee for Quality Assurance (NCQA) to assess the quality of care delivered to members of health insurance plans nationally.