Friday, January 3, 2014

2013 Minnesota health reform review

Here is a review of some of Minnesota’s health reform activities in 2013.

Medicaid and the Affordable Care Act
February brought significant changes for Minnesota’s public health insurance programs. Gov. Mark Dayton signed legislation Feb. 19 that providing access to quality health care coverage for an additional 35,000 low-income adults. The bill took advantage of a key component of the federal Affordable Care Act, which allows states to expand Medical Assistance (MA) eligibility.

Also in February, Gov. Mark Dayton and Human Services Commissioner Lucinda Jesson announced DHS was partnering with six major health care providers to test a new payment model that prioritizes quality, preventive care and rewards providers for achieving mutually-agreed upon health goals. The Health Care Delivery Systems Demonstration project was expected to affect the care of more than 100,000 Minnesotans and save Minnesota's Medicaid program approximately $90 million over three years.

The federal Department of Health and Human Services also provided guidance to states, including Minnesota, interested in pursuing a provision in the Affordable Care Act known as the Basic Health Plan. Based on this, DHS announced that Minnesota's nation-leading health care program for the working poor, MinnesotaCare, would have a path for being preserved and improved.
In September, Minnesota Commerce Commissioner Mike Rothman released the individual policy premium rates in advance of MNSure’s opening. The rates were the lowest average rates in the country for health insurance plans sold through exchanges. MNSure saw strong demand for coverage with 10,000 user accounts being created in the first 10 days of MNsure’s launch in October. By December, the number of people signed up topped 24,000 and more than 50,000 accounts had been created. In addition, MNsure added seven more health plans for Minnesotans in the Southeastern region of the state and extended deadlines at the end of the year.

SIM Minnesota
In February 2013 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 October 2016. The goal is to help Minnesota’s providers and communities work together to create healthier futures for Minnesotans. This effort is a joint initiative of DHS and MDH. Minnesota will use the grant money to test new ways of delivering and paying for health care using the Minnesota Accountable Health Model. Taskforces were announced in June and started meeting later in the year.

Health Care Homes
The number of Minnesota’s primary care clinics choosing to become health care homes continued to rise in 2013. By the end of the year, Minnesota had more than 322 certified health care homes, or about 43 percent of primary care clinics, serving more than 3 million Minnesotans.

Quality measures
In August, Minnesota released the nation’s largest statewide patient experience survey. The survey included results from the more than 230,000 patient-completed surveys on patient experience of care—known as the Clinician and Group Surveys – Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS)—from 651 clinics. The data was collected as part of Minnesota's Statewide Quality Reporting and Measurement System.

Statewide Health Improvement Program
Minnesota’s Statewide Health Improvement Program received another round of funding from the Minnesota Legislature in 2013. The Minnesota Department of Health (MDH) awarded more than $21.2 million in Statewide Health Improvement Program (SHIP) grants in November to counties and cities across Minnesota. The grants will be used by communities – in partnership with local businesses, schools, and local governments – to implement projects and programs that will promote exercise and physical activity, improve nutrition, and decrease tobacco use.

Senior care
Reform 2020 advanced through the Legislature and received funding in 2013. The effort transforms Minnesota's Medicaid program to better meet the challenges of rising health care costs and a growing aging population while better serving Minnesotans' long-term care needs. One of the priorities of Reform 2020 is keeping more seniors and people with disabilities living in their homes and communities.

The Minnesota Legislature also passed new home care licensing regulations that the Minnesota Department of Health is in the process of implementing.

In December, the Minnesota Department of Health reported that Minnesota saw a significant slowdown in health care spending increases. Health care spending in Minnesota increased 2 percent to $38.2 billion from 2010 to 2011. In addition, Minnesota's per-person health care spending in 2011 of $7,145 was lower than the national per-person cost of $8,175. Plus, health care spending accounted for a smaller share of Minnesota's economy, 13.6 percent, compared to the national number of 16.9 percent.

A one-of-a-kind DHS program that provides nursing homes additional payment for quality improvement projects showed promise for encouraging overall nursing home quality improvement, according to a study published this month in the journal Health Affairs. Researchers analyzed the impact that the Performance-based Incentive Payment Program (PIPP) had on care quality in participating nursing homes.

A new report from the Commonwealth Fund found Minnesota was among the best states in the nation when it came to health care for low-income individuals.

Friday, December 20, 2013

MNsure announces new enrollment and payment deadlines

Minnesotans who want individual or family health care coverage beginning January 1, 2014, now have until December 31, 2013, to select a plan on, according to an agreement announced today by MNsure and Minnesota’s health plans.

Payments for this coverage must be received at MNsure or the health plan on or before January 10, 2014.

These new deadlines do not apply to small business customers.

“We are aware of the concerns many consumers have as we approach January 1, and we are taking critical steps to ensure that Minnesotans have comprehensive, affordable health coverage when they need it,” said MNsure interim Chief Executive Officer Scott Leitz. “We thank the health plans for working with us, and we remind consumers to make their plan selections and payments as soon as possible to guarantee their coverage is in place.”

Minnesotans who wait until the last days of December to purchase coverage will not have their identification cards and enrollment materials at the start of January, but medical care will be covered if they meet the new deadlines. In addition, it is important that consumers understand that if the January premium payment does not arrive by the close of business on January 10, 2014, medical tests and other care received between January 1 and January 10 will not be covered.

To help consumers during this busy time, the application and enrollment functions at are available between 6 AM and midnight every day. The Contact Center is open Monday through Friday from 7:30 AM to 8 PM and Saturday and Sunday from 9 AM to 4:30 PM. We also encourage consumers who need support to seek out the help of one of their local community assisters. The assister directory is available at

Minnesotans determined eligible for Medical Assistance or MinnesotaCare through December 31 will have coverage January 1, 2014. Minnesotans already determined eligible for Medical Assistance through MNsure do not need to take any further steps for health insurance coverage to begin January 1, 2014. Minnesotans already determined eligible for MinnesotaCare will get coverage January 1 even if they have not received a premium bill. MinnesotaCare enrollees should pay their premium bill as soon as they receive it.

Consumers with questions about their Medical Assistance or MinnesotaCare coverage can call their caseworkers or the Minnesota Department of Human Services Member Help Desk at 651-431-2670 or 1-800-657-3739.

Open enrollment runs through March 31, 2014. Minnesotans who miss the December 31, 2013, deadline may enroll in coverage that begins February 1, March 1 or April 1. In addition to enrolling on the MNsure website, consumers may also enroll through an insurance broker or by directly contacting the insurance company of their choice.

"Regardless of how you choose to enroll, the MNsure website is there to use as a reference to get information about plans and compare prices and benefits,” said Leitz. “Our goal is to make purchasing health insurance as easy as possible for consumers.”

Minnesota sees significant slowdown in health care spending increases

Health care spending in Minnesota increased 2 percent to $38.2 billion from 2010 to 2011, according to a report released today by the Minnesota Department of Health (MDH).

The report looks at all health care spending, including private health insurance, out-of-pocket spending, state public programs, and Medicare. These latest health care spending data reflect a trend of slowing growth in health care spending since 2007. It also indicates that in national comparisons, Minnesota continues to look competitive with regard to health care spending inflation. Minnesota's growth rate was half the nation's rate of almost 4 percent in 2011, the most recent year for which data are available. This report is available online at

Total spending in 2010 was $37.5 billion or a growth rate of 1.7 percent from 2009. Together with the 2 percent growth seen in 2011, these rates mark the lowest year-over-year change in health care spending since MDH began tracking this trend for Minnesota in the mid-1990s.

In addition, Minnesota's per-person health care spending in 2011 of $7,145 was lower than the national per-person cost of $8,175. Plus, health care spending accounted for a smaller share of Minnesota's economy, 13.6 percent, compared to the national number of 16.9 percent.

"This analysis confirms Minnesota's reputation for leadership and innovation in the health care sector. While Minnesota experienced slower spending growth and lower per capita spending than the national average, we need to continue our focus on transforming the way we deliver care and improving access to care as we strive to reach our goals of lower costs and better outcomes," said Minnesota Commissioner of Health Dr. Ed Ehlinger.

Part of the slow growth in health care spending is related to lingering effects of the recession still experienced by many Minnesotans in 2011. Minnesota's uninsured rate remained above 9 percent in 2011. Due to factors including unemployment and lost wealth, some Minnesotans appear to have delayed or used less health care. Higher cost sharing requirements likely exacerbated these choices.

 "There is a vigorous debate at the state and national level over the cause of the slowdown in spending and whether it will be a one-time correction or represent a structural change," said Stefan Gildemeister, MDH's state health economist. "A period of solid recovery which would help remove the considerable effects of the economic slowdown will help to assess more definitively whether factors in Minnesota driving health care have changed fundamentally."

Other possible factors slowing the growth in costs include continued increased cost sharing in the private insurance market, slower development and implementation of medical technologies, and changes in pharmaceutical drug benefit trends. In addition, a number of reforms and private sector initiatives aimed at improving care coordination, promoting value through payment reform and investing in health information technology likely have contributed as well.

The annual report is part of the Minnesota's health reform law enacted in 2008, with the goal of significantly slowing the growth of health care spending. With bipartisan support, the law has resulted in several key efforts including, provider peer grouping and statewide quality reporting, health care homes, and the Statewide Health Improvement Program, an investment in prevention efforts designed to lower health care costs by reducing obesity and tobacco use in Minnesota.

Future spending projections
As part of the 2008 health reform law, the Minnesota Legislature requires MDH to compare projected spending and estimated actual spending to determine the level of savings over time as Minnesota implements its 2008 health reforms. This was the fourth year MDH has compared actual health care spending to projected spending to determine whether underlying trends in health care spending have changed. The comparison shows that projected spending for 2011 exceeded actual spending for 2011 by $1.9 billion. The law defines this difference as savings related to reform. MDH estimates between $99 million and $414 million of the difference between projected and actual spending is attributable to state-administered programs. This exceeds a $50 million threshold established in statute, which triggers a transfer of $50 million from the General Fund to the Health Care Access Fund.

The report shows there has been some disruption in the drivers of health spending growth, but at this time and with existing data MDH cannot determine definitively the weight of the factors that drove this change. Without a structural change in the underlying factors that historically drove spending growth, spending on health care in Minnesota is projected to increase at an average annual rate of 8.2 percent from 2011 to 2021, MDH estimates. These projections depend on an unchanged relationship between economic factors and health care spending. "Minnesota has made progress, but without a continued focus on public health and prevention and reforming Minnesota's health care system, health care spending growth could return to higher levels and consume a larger share of the economy," Ehlinger said. The report projects that without a change in cost drivers, health care spending could more than double in 10 years, growing to $89.1 billion and accounting for almost one-fifth of the state's economy. 

Friday, August 16, 2013

Minnesota conducts nation's largest statewide patient experience survey

Being diagnosed with cancer in his tonsils and lymph nodes in 2012 was a terrible shock for Dave Olson of Lino Lakes. Suddenly his life was in the hands of physicians who advocated for him, talked him through what he needed to understand and helped to guide him toward recovery.

"I could not have been happier with my doctors," Olson said. "It's the way they communicated with me and my wife, making sure everything was explained to me in terms I could understand." The voices of Minnesota patients like Olson can be heard more clearly today as the result of a new statewide survey about patients' experience of care from the Minnesota Department of Health and MN Community Measurement.
Results from the more than 230,000 patient-completed surveys on patient experience of care—known as the Clinician and Group Surveys – Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS)—from 651 clinics are now available for consumers to use along with other information on the cost and quality of health care providers. The data is collected as part of Minnesota's Statewide Quality Reporting and Measurement System and is the most comprehensive look at patient experience on a statewide basis in the country. Minnesota's 2008 health reform law set up this system which requires clinics to report their performance on a standard set of quality measures. MDH partners with MN Community Measurement to collect the data, and MN Community Measurement reports results on Clinics can also use survey results to see where they are performing well, and identify areas for improvement.
"Patient experience, cost, and quality are important features to consider in the overall delivery of care," said Minnesota Commissioner of Health Dr. Ed Ehlinger. "With the addition of the patient experience survey, Minnesota strengthens its position as a national leader in health care reform and reaffirms its commitment to helping Minnesotans make quality decisions about their health care."
Overall, many Minnesotans are happy with their care in terms of getting care when needed; being listened to and receiving information and instructions they understand; experiencing courteous and helpful office staff, and being satisfied with their provider.

"For the first time, people in Minnesota can get information about the experience that other patients, like them, have had at physician practices across the state," said Jim Chase, MN Community Measurement president. "The survey includes important information for patients about access to care, communication, and interactions with staff. Sharing this information can help patients know what they should expect and help physician practices learn what they can do to improve the results."
Nevertheless, the results also show variation in how clinics perform on these four categories. For example, 60 percent of all survey respondents said they experience the top-level of access to care at their clinics. In one clinic, however, only 33 percent of respondents reported top-level access to care; at another clinic, 83 percent of respondents reported top-level access. This variability indicates an opportunity for learning from high performers about how to re-engineer aspects of care delivery. In terms of the other three areas of patient experience of care:
  • Ninety percent of respondents described communication from their providers as top-level. For individual clinics, the range was from a low of 66 percent to a high of 98 percent.
  • Ninety-two percent of respondents gave the office staff at their clinics top marks for being respectful and helpful. One hundred thirty-five clinics performed above average in this category; 86 were below average.
  • 78 percent of respondents gave their provider a top rating of 9 or 10 on a 10 point scale. Individual clinics ranged from a low of 47 percent to a high of 93 percent of providers receiving a top rating.

Two clinics in Minnesota ranked in the top 10 performers across three of four survey categories: Lakewood Health System – Pillager Clinic, and Essentia Health St. Mary's Innovis Health Clinic – Frazee. The Pillager clinic was ranked first across all Minnesota clinics in office staff and provider ratings. "It's wonderful the patients have acknowledged us," said Craig Wolhowe, Vice President of Clinic and Hospital Services with Lakewood Health System, whose main clinic is located in Staples, Minnesota. "We really encourage our providers to take time with their patients."

The CG-CAHPS survey is the national standard for objective reporting of patient experience, making appropriate apples-to-apples comparisons across clinics. While some clinics have long conducted internal surveys to understand their own relationships to their patients, a statewide survey allows for accurate comparisons to be made across care systems. The same questions are asked nationwide and used by providers to improve how they care for patients. Individual responses are pooled for a broad, objective analysis of how patients perceive their care. The data are adjusted to account for differences among patients and allow for more accurate comparison of the results.

Minnesota providers and patients made major contributions to this initiative as well. Several provider systems built the groundwork for today's news through two rounds of voluntary pilot testing in 2008 and 2010 in which more than 100 clinics submitted data for analysis. That data was used to test the statewide survey collection process, and has been used to set goals for improving patient experience at clinics. Patients contributed by providing feedback through the surveys.

"These initial results are just the beginning of what we can learn from the data," said Stefan Gildemeister, who directs the initiative at the Minnesota Department of Health. "We are eager to better understand how well patient experience relates to improved clinical outcomes and performance as high-value, efficient providers."

Friday, May 10, 2013

Did you know MNsure will have a call center to answer questions?

On September 1, 2013, a MNsure call center with a toll-free 1-800 number will open with highly trained staff available to answer questions in a timely manner. Visit MNsure to provide feedback or get involved. 

Meet the MNsure board

Last week, Governor Dayton announced the appointment of the MNsure board, which will oversee Minnesota's health insurance marketplace. The board, which was established by law earlier this legislative session, was chosen through the state's open appointments process from a pool of 112 candidates. Read the board members' bios here.

Health department releases "pay for performance" update

In May the Minnesota Department of Health released its third update to the Minnesota Quality Incentive Payment System for health care providers, since the program started in 2010.

The update includes the system's latest quality measures and performance thresholds for clinics and hospitals.
The incentive payment system, sometimes called pay for performance, is part of Minnesota's 2008 health care reform law. It was implemented in 2010. It is currently being used for participants in the state employee health plan and enrollees in state public insurance programs.

Use of this system by private health care purchasers—which are not required by law to adopt it—is also encouraged. The final framework can be found at Quality Incentive Payment System.