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.

Minnesota sees e-health transformation during the past decade

Minnesota has seen an e-health transformation during the last 10 years. Consumers have gained unprecedented access to their health information, and most Minnesota hospitals and clinics have moved from paper to electronic health records.

This was a key take away of the tenth annual Minnesota e-Health Summit is celebrating 10 years of the Minnesota e-Health Initiative. The Minnesota Department of Health released its most recent e-health data as part of the annual Minnesota e-Health Summit June 11-12.
 
In Minnesota, 93 percent of clinics and 99 percent of hospitals have adopted electronic health records systems that make health information readily available to both providers and patients. Before 2004, fewer than 9 percent of Minnesota hospitals and 17 percent of clinics had electronic health records.

According to Minnesota Health Commissioner Dr. Ed Ehlinger, these e-health advances are the result of a decade of work by thousands of Minnesotans in government, businesses, nonprofits, and health care settings such as hospitals, clinics, nursing homes, and public health. “Minnesota has made great strides in health information technology to improve patient experience, health care quality, patient safety, and public health,” said Commissioner Ehlinger. “We must continue to support Minnesota’s e-Health Initiative to achieve the next step of e-health which is the creation of policies and processes that not only impact individual health but also improve the health of all Minnesotans and their communities.”
 
To mark this achievement, Governor Dayton proclaimed June 11, 2014 as Minnesota e-Health Day. This June also marks the 10th Anniversary of the Minnesota e-Health Initiative, a public-private collaborative that has helped drive progress on e-health in Minnesota.
 
Minnesota’s e-health achievements include the following:

  • Consumer access to health information and online guidance has risen significantly since 2004.
  • 72 percent of Minnesota’s clinics now offer an online patient portal with access to personal health information, making monitoring of health easier.
  • 76 percent of clinics use automated tools to identify needed preventive care services; 70 percent use automated reminders for missing labs and tests; and 95 percent of clinics use medication guides and alerts.
  • 92 percent of Minnesota clinics report that electronic health records alert them to potential medication errors, and 96 percent report that the electronic health records enhance patient care in the clinic.
Though Minnesota is a national leader in e-health, there is still much work to be done in this dynamic and rapidly evolving field. Minnesota needs to ensure more providers, in addition to clinics and hospitals, adopt and use electronic health records. It also needs to ensure these providers can effectively and securely use and share electronic health information to better serve their patients and their communities. The future of e-health in Minnesota also includes a system that helps generate and share evidence about what practices are working and can promote healthy choices among Minnesotans and their communities. It would also support collaboration among care teams across settings such as hospitals, clinics, long-term care, behavioral health and public health.
 

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.
 
MNsure
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.

Research
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 MNsure.org, 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 www.MNsure.org 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 http://www.mnsure.org/tools/locater/index.jsp.

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 http://www.health.state.mn.us/healtheconomics.

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.