Does your clinic measure up? Check Minnesota’s quality ratings.

Clinics are struggling to manage chronic diseases such as diabetes and asthma for thousands of Minnesotans, but a new report shows they are making progress in the post-pandemic era — some more than others.

The rate of diabetes patients at optimal health fell below 41% in 2020, when the emergence of COVID-19 disrupted routine medical care, but it rose back up to 46.3% in 2023, according to Minnesota Community Measurement (MNCM). The nonprofit tracks health care quality and costs statewide and issued its annual update and clinic scores late last month.

The percentage of patients with optimized management of their diabetes is the highest since the measure was revised in 2017. Fourteen of 20 measures of clinical quality improved by significant margins in 2023, including the rates of screening patients when recommended for colon cancer and depression.

Even a percentage point increase on these measures means hundreds or thousands more patients are receiving better care, said Jess Donovan, MNCM’s chief executive. “Every step forward counts.”

Despite the progress, Minnesota clinics fell below the state’s goal of keeping diabetes under control for at least 50% of their adult patients. Had clinics collectively met that target, another 14,000 Minnesotans would have had their diabetes in check, reducing risks for heart and kidney failure, eye damage and other complications.

Performance varied dramatically. Entira Family Clinics locations in the Twin Cities and Gundersen Health System clinics in southeast Minnesota kept 57% of adult patients with diabetes at optimal health. Patients meet this criteria if they have low blood sugar and blood pressure levels, refrain from smoking, and take aspirin and cholesterol-lowering drugs.

NorthPoint Health and Wellness Center only achieved a 20% success rate by comparison. Results for the north Minneapolis provider were expected to be lower, around 37%, because it treats many low-income and uninsured patients who struggle to afford prescriptions and healthy foods that help control their diabetes. But the actual results fell below expectations.

Many people had disrupted Medicaid health benefits in 2023, when the federal pandemic emergency declaration was lifted, so they were less likely to visit doctors and fill prescriptions they needed, said Dr. Kevin Gilliam, medical director for NorthPoint, which is operated in partnership with Hennepin County.

NorthPoint’s scores improved in 2024, but diabetes management remains a challenge for low-income patients, Gilliam said.

The clinic has responded with solutions such as access to healthy foods at a food shelf, he said, “so people aren’t needing to make a choice between a meal or medication.”

The measurement data isn’t intended as a way to compare clinics, because they each have unique patient populations and challenges, Donovan said. The goal is to give clinics data so they can identify weaknesses and find solutions in their practices and partnerships with community organizations.

France Avenue Family Physicians in Edina had one of the best diabetes management rates in the state in 2023, but only helped 4% of its patients with depression achieve remission within a year. The state average was 11%.

Turnarounds are possible. Meeker Memorial Hospital & Clinics in Litchfield was below average in asthma management in 2022 but above average the next year. Mayo Clinic boosted its colon cancer screening rate at its clinics in Rochester in that timeframe as well.

Clinics struggled in 2022 after the U.S. Preventive Services Task Force lowered the age to 45 at which to start colon cancer screening for people at average risk. Many clinics improved in 2023 on that measure but continued to slide in another area: pediatric immunizations.

The share of children receiving all 10 recommended vaccinations by age 2 declined in Minnesota clinics from nearly 57% in 2020 to less than 45% in 2023.

Hesitancy over the COVID-19 vaccine during the pandemic has spread to other vaccines. In some cases, parents are seeking out most of the vaccines, but not getting their toddlers vaccinated against influenza, said Dr. Steven Inman, medical director of the Children’s Health Network.

Some clinics in his group achieved 70% vaccination rates, offering extended hours for vaccinations and the option for parents to get their shots at the same time.

Patients can look up clinics or medical groups individually on the MNHealthScores website to see if their care is above or below expectations. They also can see if their clinics are more expensive.

Total spending on health care continued to increase in 2023, reaching $798 per commercially insured patient per month, according to the measurement report. That was an increase from $736 in 2022, driven largely by more spending on prescription drugs and more lab tests, emergency room visits and outpatient surgeries.

Per-patient spending varied by clinics and medical groups, even after statistically adjusting for clinics with sicker patient populations. Spending reached an above-average $843 per month for Gundersen patients, for example, including insurance payments and patient copays and deductibles.

The data is more than a report card on clinics and should serve as a road map for community organizations and the health care issues they should target, said Clarence Jones, executive director of Hue-MAN Partnership. The Minneapolis organization forms partnerships to address health care disparities.

The report for the first time revealed outcome data by the ZIP codes of the patients, and not just by the clinics providing their care. Suburban patients generally fared better. Patients with diabetes living in Stillwater or Minnetonka, for example, were more likely to have their conditions well-managed than those living in Minneapolis, Windom or Two Harbors.

Racial disparities existed as well. Among American Indian patients, only 52% sought colon cancer screening when recommended (the statewide rate was 70%) and only 28% with diabetes were at optimal health.

Community groups can help clinics by coming up with solutions that will motivate people in their neighborhoods or racial groups to improve their personal health, Jones said.

“We can’t just keep throwing stones,” he said. “There are ways for us to address these issues. The question becomes, how do you get people to enter the conversation.”