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Minnesota: Comprehensive Quality Improvement and Payment Reform

In 2003, Minnesota became the first state to require public reporting of never events based on the National Quality Forum list of severe reportable events (see Table 2 in the Feature). The Minnesota Department of Health, the Minnesota Hospital Association, and the Minnesota Medical Association—founding members of the Minnesota Alliance for Patient Safety—worked with the legislature to establish a statewide reporting system for never events. The Minnesota Department of Health annually publishes provider-specific data about such events, including the type and outcome. When a serious, reportable error occurs, the hospital or surgical center must investigate the incident and set up processes to prevent similar errors. The work of the Minnesota Alliance for Patient Safety and its members related to error detection, reporting, and prevention has led to significant changes in hospital culture, including a willingness to talk more openly about errors and work together to develop policies to prevent them.

In January 2005, Minnesota again led the nation when HealthPartners, a not-for-profit health maintenance organization based there, became the first purchaser of health services in the U.S. to deny payment for preventable adverse events and conditions. HealthPartners does not pay for services associated with any of the "serious reportable events" identified by the National Quality Forum. Since 2005, Minnesota's government health insurance programs (Medicaid Medical Assistance, General Assistance Medical Care, and MinnesotaCare), other states, and the federal government have followed HealthPartners' lead by implementing nonpayment policies related to preventable adverse events.

Nonpayment for preventable adverse events is just one component of a broader quality reporting and payment reform strategy in Minnesota. In 1993, the Institute for Clinical Systems Improvement (ICSI) was established by HealthPartners, Mayo Clinic, and Park Nicollet Health Services to improve patient care in Minnesota through innovations in evidence-based medicine. In addition, MN Community Measurement (MNCM) was created by Minnesota's health plans in 2004 to report statewide health care quality measures across medical groups. ICSI and MNCM put Minnesota ahead of most states in its capacity to understand what contributes to health care value and health system performance. These organizations also create a forum to discuss, test, and act on new ideas, including nonpayment for preventable adverse events.

For more information

See the Minnesota Profile from Aiming Higher for Health System Performance: A Profile of Seven States that Perform Well on the Commonwealth Fund's 2009 State Scorecard (New York: The Commonwealth, October 2009).

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