Friday, July 31, 2015

State health care contracting reforms save taxpayers $650 million

Gov. Mark Dayton and Department of Human Services (DHS) Commissioner Lucinda Jesson announced July 28 that Minnesota’s first statewide competitive bidding process for managed care contracts, and other contract adjustments, saved taxpayers nearly $650 million. The savings come from both contracting reform (nearly $450 million) and a contract settle-up provision allowing DHS to recoup unspent health insurance dollars ($200 million). These public programs provide more than 800,000 Minnesotans high-quality health coverage. With today’s savings, the Dayton Administration has implemented cost saving reforms that have resulted in more than $1.65 billion in savings for taxpayers since 2011.
More information is in a news release about the managed care contracts on the Governor's Office website.

Mental health center adds primary care to become health care home

Minnesota has 382 medical clinics that are certified as health care homes, but Zumbro Valley Health Center is the state’s first community mental health center to become a health care home.

MDH certified Zumbro Valley Health Center as a health care home in May, after it completed required certification steps such as adding primary care services. The organization is the first mental health center in Minnesota to achieve this designation.

“It’s exciting to see a mental health center deciding to become a health care home,” said Minnesota Health Commissioner Dr. Ed Ehlinger. “A key opportunity for improving health care in Minnesota is to break down some of the divisions between physical and mental health so we can effectively coordinate care and treat the whole person.”

MDH and DHS are jointly responsible for the development and implementation of Minnesota’s Health Care Homes initiative.

Minnesota’s health care home model offers an innovative, team-based approach to primary care in which providers, families, patients, and other team members work in partnership to improve the health and quality of life for individuals, especially those with chronic and complex conditions. Health care homes put patients and families at the center of their care, develop proactive approaches through care plans and offer more continuity of care through increased care coordination between providers and community resources.

“This is a significant step forward in reducing health disparities for people with mental illness,” said Department of Human Services Commissioner Lucinda Jesson. “Care should be accessible and equitable for all Minnesotans and we congratulate Zumbro Valley Health Center for leading the way.”

Findings from a number of national studies indicate people with severe mental illness die as much as 25 years earlier than the public. The leading causes of these premature deaths are physical diseases such as heart disease, lung disease, diabetes and cancer. One contributing factor is that many with mental illness do not routinely see their primary care physicians for physical health screenings.

As a certified health care home, Zumbro Valley Health Center will provide integrated care services to individuals diagnosed with one or more major chronic conditions. This includes care coordination services to enhance each individual's well-being by organizing timely access to resources and necessary services to ensure continuity of care.

"Since launching our primary care clinic, we have worked with nearly 200 people with co-morbid conditions," said Zumbro Valley Health Center Chief Executive Officer Dave Cook. "A number of these individuals have significant medical conditions such as heart disease, diabetes or obesity along with their mental illness or addiction diagnoses." Cook added there is no additional cost for this care and staff have begun speaking with clients who are eligible for health care home services.
Health Care Homes were developed as part of Minnesota's health reform legislation in May 2008. In 2014, the University of Minnesota released research that shows the clinics’ collaborative, patient-centered model of health care delivery reduced costs and outperformed other clinics on quality measures. 

Zumbro Valley Health Center delivers systematic coordination of health care to people with mental health, medical and addiction disorders. Zumbro Valley Health Center is a private, non-profit organization serving Southeast Minnesota.

Novel MDH study yields first statewide estimate of potentially preventable health care events

For the first time, the Minnesota Department of Health (MDH) has analyzed the state’s emergency department visits, hospital admissions and hospital readmissions and found that over the course of a year nearly 1.3 million of those patient visits costing nearly $2 billion were potentially preventable.
MDH used 2012 claims data from the Minnesota All Payer Claims Database (MN APCD) and data analytics developed by Minnesota’s 3M Company to estimate the volume of potentially preventable patient visits to hospitals and emergency departments.  Minnesota is the first state in the nation to successfully conduct such an analysis using APCD data and set a baseline estimate for potentially preventable hospital visits.

“Minnesota has one of the most efficient and cost-effective health care systems in the nation but this study shows we still have room for improvement,” said Minnesota Commissioner of Health Dr. Ed Ehlinger. “Equipped with these findings, we will work with providers and community leaders to ensure patients more consistently receive the right care, in the right place at the right time.”

In this context, potentially preventable health care events are defined as hospital and emergency department visits that patients possibly could have avoided under the right circumstances such as timely access to primary care, improved medication management, greater health and health system literacy, and better coordination of care among clinicians, social service providers, patients and families.  Examples include a visit to an emergency department for a urinary tract infection that could have been treated in primary care or a readmission to a hospital because of poor follow up care after a discharge.
Volume and cost associated with potentially preventable health care events in Minnesota, 2012These 2012 patient visits consumed about $1.9 billion in health care spending by employers, health plans and individuals. This accounted for about 4.8 percent of total health care spending in the state that year. This volume of spending does not, however, represent real potential savings because not all identified events were actually clinically preventable and preventing them may require new investments elsewhere in the system.

“Even for those events that may be actually preventable, the best opportunity for prevention may exist farther upstream than the points of care included in this study,” said MDH’s State Health Economist Stefan Gildemeister. “Though we do see a substantial opportunity for cost savings in the health care system, the best prevention for many of these events may lie outside of the health care delivery system altogether.”

A large share of 2012 emergency department visits – 1.2 million, or about two out of three visits – was potentially preventable. These visits cost $1.3 billion. Many patients were seen more than once for a condition that was potentially preventable.  For example, as many as 50,000 Minnesotans had four or more potentially preventable ED visits in a calendar year. Of those potentially preventable ED visits, infections of the upper respiratory tract (9 percent), abdominal pain (7 percent), and musculoskeletal system and connective tissue diagnoses such as back pain (7 percent) were the most prevalent diagnoses. Medicaid members made up a disproportionately high percentage of overall emergency department visits.  In 2012, Medicaid patients made up 14 percent of the population, but accounted for 40 percent of ED visits in the state.

Nearly 50,000 events were potentially preventable hospital admissions totaling $373 million. The top three conditions for potentially preventable admissions included: pneumonia, excluding pneumonia related to bronchiolitis and respiratory syncytial virus (13 percent), heart failure (12.1 percent), and COPD (8.1 percent).

About 22,000 hospital readmissions costing $237 million were found to be potentially preventable. For readmissions, the three most frequent conditions account for approximately 15.2 percent of all readmissions and include heart failure (6.6 percent), blood infection (septicemia) and disseminated infection (5.1 percent), and major depressive disorder and other unspecified psychoses (3.5 percent).

“Minnesota’s providers, including Hennepin Health, are very focused on improving outcomes and reducing high-cost care that is not good for patients,” said Ross Owen, director of Hennepin Health. “This work requires approaches that look not just at coordinating medical care but at addressing social factors and preventing these events from happening in the first place. This MDH report is an important statewide step toward understanding that opportunity.”

The report includes a number of strategies for reducing potentially preventable events that Minnesota providers, State agencies, and other stakeholders are already pursing to reduce potentially preventable events.
  • Ensuring all patients have access to timely, high-quality preventive care in outpatient settings, and a usual source of care or medical home
  • Ensuring consistent and strong engagement by patients and families, with a focus on the availability of information or guidance about preventive care and treatment that is accessible to patients with varying levels of health literacy and in multiple languages
  • Improving coordination of care across settings of care, in particular between long-term care settings and hospitals
  • Making use of emerging providers, such as community paramedics or community health workers, to provide care coordination and connect vulnerable patients to social supports that can help them avoid hospitalizations or ED visits
  • Ensuring that secure electronic exchange of clinical information occurs effectively and in real time across settings and provider systems
  • As recommended by the RARE campaign, improving comprehensive discharge planning, medication management and transition care support/transition communications
The study was conducted using data from the Minnesota All Payer Claims Database (MN APCD), which includes data from both public and private insurance payers. Minnesota is one of a small number of states to collect health insurance data on such a comprehensive scale, and the first to use its APCD to conduct a comprehensive analysis of these events. The study also employed patient classification methodologies and analytic services from 3M Health Information Systems, a business of 3M Company.

For more information, see Health Economics Program.

Thursday, December 11, 2014

Minnesota selects 12 communities for over $4 million in accountable health awards

Twelve Minnesota Accountable Communities for Health (ACH) are poised to demonstrate how health care and community organizations can work together to create profound change in population health. Minnesota's Commissioner of Health and Commissioner of Human Services selected these Accountable Communities for Health in December to each receive a $370,000 grant, out of a total grant amount of $4.4 million.

Minnesota is testing the ACH model as part of its $45 million State Innovation Model grant from the federal government. Researchers estimate that health care accounts for only about 20 percent of a population's health, while modifiable community, social, and economic factors contribute 80 percent.

Keeping a person healthy, especially a person with complex chronic conditions, often requires a dedicated team of clinical and community providers. The awards will support these ACHs' efforts to promote health and improve health care by strengthening clinical and community partnerships.

"By integrating different kinds of care, the Accountable Communities for Health model holds significant promise," said Lucinda Jesson, commissioner of the Minnesota Department of Human Services. "A broad range of community partners – primary care, behavioral health, social services, long-term care and public health – work together to improve the quality and effectiveness of care for those who need it. This can transform how we are delivering care in Minnesota."

To test the model, the commissioners selected communities with different experiences providing accountable care. Key components of accountable care include value-based payment arrangements, community and provider collaboration, care coordination, population health measurement, management and evaluation and integration across provider settings.

"It is exciting to see public health, communities, health and human service providers and so many others step forward to form these partnerships in an effort to improve the health of Minnesotans," said Minnesota Commissioner of Health Dr. Ed Ehlinger.
The participating ACH sites represent population and geographic diversity:
  • UCare/Federally Qualified Health Center Urban Health Network (FUHN), Minneapolis.
  • Vail Place/North Memorial, Hopkins.
  • Hennepin County/Hennepin Health, Minneapolis.
  • Generations Health Care Initiatives, Duluth.
  • New Ulm Medical Center, New Ulm.
  • Otter Tail County Public Health, Fergus Falls.
  • Allina Health Systems/Northwest Metro Alliance, Minneapolis.
  • CentraCare Health Foundation, St. Cloud.
  • Southern Prairie Community Care, Marshall.
  • Lutheran Social Service of Minnesota/Bluestone Physician Services, St. Paul.
  • Unity Family Health Care, Little Falls.
  • North Country Community Health Services, Bagley.
Shelly Zuzek, Clinical Services Director at Vail Place, a leader in mental health services, says their model for this partnership is rooted in team-based care and involves the collaboration of a diverse set of professionals who will work to engage patients in multiple ways. "Part of our funding will cover costs associated with a community paramedic who will work directly with our care team to support patients in their homes and in community-based settings," Zuzek said. "This is an example of the potential we have to impact people as they transition across the health care system and into the community. We look forward to seeing how this collaboration improves the overall health of the populations we are targeting."

Otter Tail County Public Health has been working with partners in their community to develop a "Rural Health Model that Works." This model of care embeds public health practices of prevention, promotion and protection working in partnership with consumers, health care providers, and community organizations. County Public Health Director and CHS Administrator Diane Thorson, said they have used community conversations to learn what is important to their communities. "Our community values choice rather than mandates. Choices allow for engagement and empowerment of individuals to select treatment plans based upon evidence-based practices, community resources, and personal lifestyle," Thorson said. "We will hold our community and provider systems accountable for improving health outcomes."

The Center for Medicare and Medicaid Innovation (CMMI) awarded Minnesota a State Innovation Model (SIM) testing grant of over $45 million to use across a three-year period ending in December 2016. As a joint effort between the Minnesota Department of Health and the Minnesota Department of Human Services with support from Governor Mark Dayton's office, Minnesota is using the grant money to test new ways of delivering and paying for health care using the Minnesota Accountable Health Model framework. The goal of this model is to improve health in communities, provide better care and lower health care costs.

Friday, July 18, 2014

Minnesota community collaboratives selected for $3.8 million in e-health awards

Minnesota’s State Innovation Model initiative awarded $3.8 million in grants to help 12 community collaboratives use e-health to promote health and improve care coordination. These grants will enable providers across different health care settings to have access to the information they need to coordinate care and keep people healthy and out of the hospital.

These awards were made possible through Minnesota’s $45 million State Innovation Model (SIM) testing grant. The Minnesota Department of Health and the Department of Human Services (DHS) jointly received this federal grant in 2013 and are using the funds to help implement the Minnesota Accountable Health Model.

“It is exciting that so many Minnesota communities are ready to take advantage of this opportunity to find new ways of using e-health to promote health and prevent disease,” said Minnesota Commissioner of Health Dr. Ed Ehlinger. The initiative received requests for more than $12 million in funding.

The selected collaboratives received 12-month development or 12- to 18-month implementation grants ranging from about $66,000 to $897,000. The grants are designed to help care team members from clinical, community, and social service settings use health information exchange and technology to do a better job of meeting the health needs of patients and community members.

“These e-health projects are a key piece of Minnesota’s strategy to improve care and reduce costs,” said Human Services Commissioner Lucinda Jesson. “Combined with efforts such as our nation-leading Integrated Health Partnerships initiative in our Medicaid program, we are encouraging better care coordination and enabling communities to develop their own approaches.”

More than 90 percent of Minnesota’s hospitals and clinics are already using electronic health records and health information exchange and technologies to improve care. These grants are focused on furthering the benefits of e-health by connecting team members from different settings. Collaboratives needed to include at least one partner from local public health departments, long-term and post-acute care, behavioral health and social services. The collaboratives also needed at least two or more organizations participating in or planning to participate in an accountable care organization (ACO), such as Minnesota’s Integrated Health Partnerships, or similar care delivery model involving payment alternatives to fee-for-service, such as shared risk, shared savings, or total cost of care. A key goal of SIM Minnesota is to test whether ACO payment arrangements improve care and reduce costs.

The collaboratives will primarily use the funds to incorporate health information exchange into their communities, establish a connection with one of Minnesota’s six State-Certified HIE Service Providers, and hire staff dedicated to figuring out how partners can exchange medical and health information. The collaboratives can also use funds for activities including improving hand offs and transitions between settings, creating patient consent processes, and using public health data to improve outcomes.

The Minnesota Accountable Health Model will have two rounds of grant funding to support the secure exchange of medical or health-related information. The following organizations were awarded funding for round one. Federal funds account for 100 percent of the grant amounts listed below, however, the recipients of the grants are required to provide matching funds of 20 percent.

Six collaboratives were selected to receive development grants:
Integrity Health Network (Duluth) $65,885
Medica Health Plans (Minnetonka) $75,000
Fairview Foundation (Ebenezer) $75,000
White Earth Nation (White Earth) $75,000
Lutheran Social Services (St. Paul) $75,000
Wilderness Health (Two Harbors) $75,000
Six collaboratives were selected to receive implementation grants:
Touchstone Mental Health on behalf of Mission Hennepin Community Collaborative (Minneapolis) $567,597
Southern Prairie Community Care (Marshall) $897,780
Winona Health (Winona) $265,950
FQHC Urban Health Network-FUHN (St. Paul) $440,970
Northwestern Mental Health Center (Crookston) $749,323
Otter Tail County Public Health (Fergus Falls) $483,565

Visit the SIM Minnesota website for more information about the initiative.

Tuesday, July 15, 2014

Minnesota’s nation-leading Medicaid reform initiative delivers $10.5 million in savings during first year

Minnesota’s new, nation-leading approach to delivering quality health care more efficiently for low-income individuals and families is paying off. In the first year of a program announced by the Department of Human Services and Governor Mark Dayton in 2013, six health care providers serving 100,000 Minnesotans spent $10.5 million less than projected – cost savings that will benefit Minnesota taxpayers.

Governor Dayton today applauded these results, thanking health care providers for partnering with the state on the Integrated Health Partnerships (IHP) initiative – a project focused on providing better health care at a lower cost. The initiative has implemented a new payment model that priorities quality, preventive care and rewards providers for achieving mutually agreed-upon health goals.

“Some people talk about reform. We do it,” said Governor Dayton. “Minnesota is the first state in the nation to implement these cost-saving reforms – and we have proven that this new approach delivers results. I thank the health providers who have partnered with us on this initiative, making it possible to deliver better care to over 100,000 Minnesotans.”

The traditional payment system pays providers for the volume of care they deliver, rather than the quality of care they provide. This system results in misguided incentives for providers – rewarding them for the number of procedures they deliver rather than the preventive care Minnesotans need to live healthy lives. With new payment reforms made under the IHP program, participating providers instead receive financial incentives for reducing the total cost of care for Medicaid enrollees while maintaining or improving the quality of care patients receive.

Preliminary results for the first year show that the results-based approach is fulfilling the promise of delivering better care at a lower cost. The IHP demonstration gives participating providers financial incentives to manage the total cost of care and better coordinate medical care for patients enrolled in Medical Assistance, Minnesota’s Medicaid program. Providers who meet a threshold for savings are eligible for a share of the savings; beginning in the second year, they also share the downside risk if costs are higher than projected.

“Delivering health care at a lower cost is critical, and our efforts are paying off,” said Human Services Commissioner Lucinda Jesson. “Because of the common-sense approaches these providers are taking, the people we serve in the Medical Assistance program are getting better, more coordinated care.”

The positive results for the first year are particularly encouraging because the demonstration runs for three years.

Three of the providers – Children’s Hospitals and Clinics of Minnesota, North Memorial Health Care and Northwest Metro Alliance (a partnership between Allina Health and HealthPartners) – are eligible for interim payments, based on initial calculations showing that they met the threshold for savings in the first year. Final results from the IHP’s first year will be calculated in early 2015.

These examples show how participating providers are coordinating care in innovative ways:

  • High-risk patients served by North Memorial are getting home visits from community paramedics, who help them avoid the emergency room by providing care in coordination with their doctor’s offices and clinics. North Memorial uses data from the Department of Human Services to identify those who are most at risk and includes them in its groundbreaking community paramedic program.
  • At Children’s Hospitals and Clinics, every family in the IHP whose child has complex, high-risk needs is matched with a care coordinator to provide a hands-on approach to their medical care. The coordinator is selected based on the child’s medical needs. Children’s has also made it easier for families to get primary care and avoid the emergency room by extending evening hours for its St. Paul general pediatric clinic.
  • The Northwest Metro Alliance, a partnership between Allina Health and HealthPartners, is pursuing multiple strategies. These include opening urgent care sites with evening and weekend hours, having pharmacists follow up with patients who haven’t picked up their medications for chronic conditions, addressing obesity among children, and establishing case management services for hundreds of patients with complex conditions.

Minnesota was the first state to implement a Medicaid payment and delivery demonstration that shares savings and risk directly with provider organizations. After Minnesota’s program began in 2013, similar programs have started or are in the process of beginning in Vermont, New Jersey and Maine.

Minnesota’s IHP has expanded since its first year, with three providers joining in 2014, bringing the total number of MA enrollees in the demonstration to 145,000. More providers are expected to join in 2015. The IHP, originally known as the Health Care Delivery Systems (HCDS) demonstration, is one of the key components of a $45 million federal State Innovation Model (SIM) grant Minnesota received for health care reforms.

The SIM grant provides funding for a joint effort by the Department of Human Services and the Department of Health to develop new ways of delivering and paying for health care and creating healthy communities using the Minnesota Accountable Health Model. Building on the IHP demonstration, this initiative aims to improve health in communities, provide better care and lower health care costs.

“This latest information provides even more evidence that coordinating care and using community resources can result in improved health at lower cost,” Health Commissioner Ed Ehlinger said. “We are excited about the benefits this approach can offer the state, and we appreciate the many health care providers who have partnered with us in this effort.”

Monday, July 14, 2014

Minnesota to test how emerging professionals impact health care teams

The Minnesota Department of Health (MDH) awarded $30,000 grants to five organizations to test the potential of emerging professionals to strengthen health care teams and improve access to care.

These awards were made possible through Minnesota’s $45 million State Innovation Model (SIM) testing grant. MDH and the Department of Human Services (DHS) jointly received this federal grant in 2013 and are using the funds to help implement the Minnesota Accountable Health Model. The model helps providers and communities work together to reduce costs and create healthier futures for Minnesotans. It supports community and provider partnerships, team care, care coordination, Accountable Care Organizations, payment reform, and health information technology investments.

The model also seeks to improve care by supporting a team approach. In this context, SIM Minnesota wants to test the effectiveness of community health workers, community paramedics, and dental therapist/advanced dental therapists in helping organizations achieve Minnesota’s goals related to health system transformation. The initiative chose to focus on these providers in part because they have the potential to increase access for low income and underserved populations and to help fill current gaps in primary health care and dental care.

As part of the SIM grant, MDH and DHS will evaluate how integrating emerging professions into a team environment changes the team’s overall capacity and the patient’s outcomes. For example, does bringing on a dental therapist to the dental team free up time for the dentist to work on more complicated dental issues (e.g. root canals) or does a community paramedic help to prevent hospital readmissions with the hospital discharge follow-up services they provide.  

The Minnesota Accountable Health Model will have three rounds of grant funding to support the integration of emerging professions into the health care workforce. The following organizations were awarded 12 months of start-up funding for round one. Each organization is also contributing funds toward the emerging professional they plan to hire (indicated below).  

• Children’s Dental Services, Minneapolis -- Advanced Dental Therapist

• HealthEast Care System, St. Paul -- Community Paramedic

• Minnesota Visiting Nurse Association, Minneapolis -- Community Health Worker

• Well Being Development, Ely -- Community Health Worker

• West Side Community, St. Paul -- Advanced Dental Therapist
Federal funds of $150,000 account for about 35 percent of this $425,000 project. Non-governmental sources, essentially salary match funds, account for 65 percent of the project.  

More about emerging professionals
Community Health Workers are frontline public health workers who are trusted members of the community or often have a close understanding of their community. This relationship enables them to serve as a liaison or intermediary between health care, social services and the community to increase cultural competence, improve access to health care for racial and ethnic minorities, improve the quality of care for chronically ill people, promote healthy communities, and educate clients and others about access to and use of health care resources.

Community Paramedics are advanced paramedics that work to increase access to primary and preventive care and decrease use of emergency departments, which in turn decreases health care costs.  Among other things, Community Paramedics may play a key role in providing follow-up services after a hospital discharge to prevent hospital readmission. Community Paramedics can provide health assessments, chronic disease monitoring and education, medication management, immunizations and vaccinations, laboratory specimen collection, hospital discharge follow-up care and minor medical procedures. Community Paramedics work under the direction of an Ambulance Medical Director.

Dental Therapists are mid-level practitioners licensed by the Board of Dentistry, who are members of an oral health care team and provide evaluative, preventive, restorative, and minor surgical dental care within their scope of practice. Dental Therapists (DT) work under the direction of a Dentist. Advanced Dental Therapists (ADT) are certified by the Board of Dentistry and, with their advanced training and clinical practice, are able to provide all the services that a Dental Therapist provides plus additional dental services such as oral evaluation and assessment, treatment plan formulation, non-surgical extraction of certain diseased teeth, and more. ADT’s also practice under the supervision of a dentist, but the dentist does not need to see the patient prior to receiving care or be on site during a procedure.  Minnesota is the first state to authorize the licensing of Dental Therapists and certification of Advanced Dental Therapists. Dental Therapists and Advanced Dental Therapists play a key role in increasing access to dental care and preventing emergency room visits for dental related problems.