MN publishes statewide quality measures

The Minnesota Department of Health published the 2012 amendments to the Statewide Quality Reporting and Measurement System rules in the State Register. The adopted rule and appendices are available at the Statewide Quality Measurement and Reporting Website. 

Minnesota law requires the Minnesota Department of Health to establish a standardized set of quality measures for health care providers across the state and to produce an annual report on health care quality. A subset of the standardized set of quality measures will be used for public reporting purposes.

The Commissioner of Health is required to annually evaluate the measures included in the standardized set of quality measures. These rules were adopted in December 2009 and amended in November 2010 and 2011. The 2012 amendments to Minnesota Rules, Chapter 4654, Permanent Rules Relating to Health Care Quality Measures, were approved by the Office of Administrative Hearings on October 16, 2012, and were published in the November 13, 2012, edition of the State Register.

Commissioner fills new health care reform post

Minnesota Commissioner of Health Ed Ehlinger has appointed Manny Munson-Regala to serve as his assistant for health reform. Manny will report directly to the commissioner and will help coordinate and manage MDH's health reform activities. In his role, he will also help manage the department’s relationships with partners, including those at other state agencies and in the health care community.

“We’re excited to have Manny join our health reform team,” said Commissioner Ehlinger. “The goal is to have him be a resource for MDH staff and health-reform stakeholders who can help move our efforts forward and strengthen our relationships with our health reform partners.”

One of Commissioner Ehlinger’s top priorities is to have the state take a public health approach to health reform that involves integrating clinical care, public health, and social services; rebalancing funding between prevention and treatment; expanding community oriented primary care; and encouraging an efficient health care market that assures the highest value medical care.

Munson-Regala holds a law degree and has experience in the public and private sector in executive roles related to insurance regulation, health reform, and health insurance exchanges. He has served in a number of executive roles at the Minnesota Department of Commerce, including acting commissioner of the department during the transition from Gov. Pawlenty to Gov. Dayton. He also served on the Minnesota Inter-Agency
Work Group working on implementation of the Patient Protection and Affordable Care Act, including co-chairing the Exchange subgroup. This subgroup was charged with reviewing the affordable care act provisions on exchanges and identifying what actions were needed to ensure Minnesota complied with the federal law, while at the same time building upon existing Minnesota reforms.

Munson-Regala started in his new position Oct. 10, after leaving his former position as the deputy director of the health insurance exchange at the Minnesota Department of Commerce.

Comments sought for prevention and public health recommendations

Public input is requested on the draft recommendations (PDF: 986KB/11 pages) of the Prevention and Public Health Work Group. Please direct your responses to HealthReform.MN@state.mn.us and mention Prevention and Public Health in the subject field. Comments are requested by noon on Friday, September 7.

Family's experience highlights value of health care home

Minnesota's "health care homes" have played a part in the care of nine-year-old Melanie Gates, who has a mitochondrial disorder affecting her cells' ability to power her bodily organs. At Mayo, a nurse care manager is the first point of contact, and helps determine the correct medical response. Team members write nutrition IV orders, oversee administration of Melanie's 30-plus drugs and support mom Amber Gates in her 24-hour family caregiver role. Read the full story at The Rochester Post-Bulletin.

Learn more about health care homes at what's new at the health care home website.

Minnesota's statewide quality reporting systems seeks comments on measures

On August 13, MDH published proposed amendments to Minnesota Rules Chapter 4654 (the Minnesota Statewide Quality Reporting and Measurement System) in the State Register. MDH posted the proposed changes, including changes to the rule’s appendices, at Health Care Quality Measures – Proposed Rule Amendment. The publication of the proposed amendments initiated a formal 30-day comment period. Comments must be submitted by 4:30 p.m. on September 12, 2012. MDH is required to annually review and publish any proposed amendments to Minnesota Rules Chapter 4654 by August 15 of each year.

State gets federal approval for innovative health care payment reform

Minnesota can continue forward on effort to improve care for Medicaid enrollees while saving taxpayer dollars.

The Minnesota Department of Human Services (DHS) in August announced federal approval to implement changes to the way it pays health care providers under the state’s Medicaid program.

These changes place increased emphasis on quality of care, health care cost and overall value.

The Health Care Delivery System (HCDS) demonstration, approved by the Centers for Medicare and Medicaid Services (CMS), is another step by the Dayton Administration to improve the way health care is purchased for Medicaid in Minnesota.

“Minnesota is moving full steam ahead when it comes to reforming our health system so that we'll pay for quality of care and outcomes for our clients, not just the quantity of procedures,” said Human Services Commissioner Lucinda Jesson. “I’d like to thank our federal partners for their cooperation and support in this effort to provide better care for Minnesotans and greater savings to taxpayers.”

Historically, publicly-funded health care programs in Minnesota have been either fee-for-service paying providers per procedure) or managed care (paying a health insurance company to provide coverage). The HCDS demonstration projects will contract directly with providers in a new way that allows them to share in savings for improving quality of care and patient experience and reducing the total cost of care for Medicaid enrollees.

In this new model, people enrolled in Minnesota Health Care Programs will receive more coordinated care to improve their overall health, and health care providers will be paid based on the quality of care they provide to their patients and their ability to reduce the cost of care. This encourages providers to be innovative in how they provide care and allows them to focus on the quality of care versus the amount of care they provide.

“A key factor in reforming our health care system is working with doctors, hospitals and other providers to better coordinate care for patients. We need to look at patient care as a team effort with one overall shared goal of a healthy patient outcome,” said CMS Acting Administrator Marilyn Tavenner.

What Minnesotans are saying about improving health care

Minnesotans who participated in a series of community conversations this summer want an affordable health care system, more information to make choices, and communities that support healthy choices.

The Bush Foundation and Citizens League  recently completed a Citizen Solutions initiative around health care that involved  about 40 community conversations with more than 1,000 Minnesotans, as well as online discussions with more than 4,100 Minnesotans. The results of the four-month initiative, funded by the Bush Foundation, were shared with the Governor’s Health Care ReformTask Force on August 6. Those who attended the community conversations held a range of political beliefs,  according to the report’s appendix.

Participants said they wanted to be co-creators and co-managers of their health care, and they needed better information to succeed at that task, according to the report, “Public Conversations & PublicSolutions: Making Health and Health Care Better in Minnesota.”

They were willing to make trade-offs.  When asked about rights and responsibilities, less than one percent suggested unfettered access to care should be part of a citizen’s health rights. Participants reached the greatest consensus on the points that citizens have the right to affordable care and that they are responsible for practicing healthy behaviors.

They would like to see employers, families, communities and state decision makers support them in assuming ownership of their health. Suggestions included improving environments so that physical activity is more accessible and making healthy food more accessible and affordable.

Participants also supported policies that would help citizens experience the true costs of their behaviors, such as taxes on sodas, tobacco, or other unhealthy choices that contribute to preventable disease.

They also wanted an affordable health care system but they understood that the health care system alone does not define good health.

As for the health care system, they identified the lack of affordability as the biggest challenge, followed by the fact that the system is complicated and confusing, and doesn’t focus enough on healthy living and prevention.

In terms of cutting costs, participants prioritized cutting administrative costs, preventing avoidable conditions and unnecessary care, and improving the coordination of care.

When asked what they saw as the most effective way to create change, about one-third of attendees picked focusing on making Minnesotans more knowledgeable health consumers and one-fourth of attendees suggested focusing on community-based strategies that make healthy choices easier.

State insurance exchange contractor selected

Minnesota has selected Maximus, a Virginia-based company, to develop the technology to support the state’s health insurance exchange.  The exchange’s technology will include elements such as “eligibility determination, account administration, display of benefit plan costs and options, and health care provider information.”  The $41 million contract is excepted to run through 2014 and exchange’s technology will include elements such as eligibility determination, account administration, display of benefit plan costs and options, and health care provider information. Through the contract with Maximus, the exchange will be “a user friendly tool that will help more than 1.2 million Minnesotans choose the quality coverage they need at a price they can afford, ” said Commerce Commissioner Mike Rothman.

Minnesota sees smallest year-to-year health care cost increase in more than a decade

Total health care spending in Minnesota increased 2.2 percent to $37.7 billion in 2010, which was the slowest growth rate observed since 1997, according to a report released by the Health Economics Program at the Minnesota Department of Health (MDH).

Governor Dayton reaffirms Minnesota’s commitment to Minnesota-made health insurance exchange

Governor Mark Dayton reaffirmed Minnesota’s commitment to designing and developing a state-based health insurance exchange for Minnesota. Governor Dayton declared his commitment to that effort in a letter to HHS Secretary Sebelius (PDF: 2.46MB/2 pages). In addition, the Minnesota Health Insurance Exchange Outreach, Communications and Marketing Work Group also recently posted some preliminary Minnesota market research presented July 10.

Health Care Reform Task Force discusses access and work force issues

The Health Care Reform Task Force approved a set of working recommendations for improving Minnesota's health care workforce at its meeting July 12. The presentations and working recommendations are available under meeting materials.

CMS gives Essentia Health ACO nod

%he Centers for Medicare & Medicaid Services announced Essentia Health, along with 88 other organizations, to a list of accountable care organizations (ACOs). ACOs that succeed in reducing the rate of growth in the cost of care while continuing to provide high quality care will share the savings with Medicare.  Located in Duluth, Essentia Health is comprised of a combination of ACO group practices, critical access hospitals, and a rural health clinic, with 1,404 physicians. The new ACO will serve Medicare beneficiaries in Minnesota, North Dakota, and Wisconsin. The complete list of recently approved ACOs is available online.

MDH certifies new clinics as Health Care Homes

The Minnesota Department of Health has certified 2 new clinics as health care homes. The newly certified clinics are AALFA Family Clinic, White Bear Lake, and Sanford Health, Mahnomen. These clinics and providers have met the standards to become certified as Health Care Homes in the State of Minnesota. For more information, or to find a health care home near you, go to: http://www.health.state.mn.us/healthreform/homes/index.html

Supreme Court ruling statement released

Human Services Commissioner Lucinda Jesson, Commerce Commissioner Mike Rothman, and Health Commissioner Ed Ehlinger released the following statement on June 27 after the Supreme Court ruling to uphold the Affordable Care Act: 

“We are pleased with the Supreme Court’s decision to fully uphold the Affordable Care Act. This ruling is an affirmation of the reform efforts currently underway in Minnesota to improve health and lower the cost of care. The ruling signifies real progress and important protection for citizens across Minnesota: affordable insurance for small business, young people can stay on their parents insurance until age 26, and guaranteed coverage for those with pre-existing conditions. Minnesota has always been a national leader in health care and the administration will continue efforts to increase quality and improve access to insurance and affordable care will continue.”

Commissioner seeks members for provider peer grouping advisory committee

Commissioner of Health Dr. Ed Ehlinger is seeking members to serve on a new provider peer grouping advisory committee.  As required by legislation passed this year, the commissioner will include among his appointees representatives of health care providers, health plan companies, consumers, state agencies, employers, academic researchers, and organizations that work to improve health care quality in Minnesota.   

  

In 2008, the Minnesota Legislature passed a groundbreaking law charging the Commissioner of Health with developing a system – provider peer grouping - that would provide consumers, payers and providers with greater transparency about value in health care.  Over the past three years, MDH staff, contractors and community advisors have made important gains in developing key aspects of the state’s provider peer grouping (PPG) system. The 2011-2012 Legislature recognized and affirmed the importance of moving forward with the development and implementation of PPG by enacting changes in the PPG statute that would ensure robust community engagement in this work and set timelines that allow for adequate provider review of confidential results. Commissioner Dr. Ehlinger is strongly committed to realizing the state’s vision to move towards reporting of measures of value, with an emphasis on scientific rigor, actionable results and transparency of approach.

In the next step forward, the Commissioner of Health is appointing an advisory committee to consult on further refinements to the PPG system.  As required by legislation, the Commissioner will include among his appointees representatives of health care providers, health plan companies, consumers, state agencies, employers, academic researchers, and organizations that work to improve health care quality in Minnesota.

The tasks on which the Commissioner will consult with the advisory committee include: defining peer groups; reviewing quality and cost scoring methodologies; adopting patient attribution methods; selecting risk adjustment models; choosing service dates for cost and quality reporting; recommending inclusion or exclusion of other costs; and considering whether adjustments are necessary for facilities that provide medical education, Level 1 trauma services, neonatal intensive care, or inpatient psychiatric care.  Given the analytic complexities of this work, the Commissioner is seeking individuals with strong methodological expertise in quality and cost measurement, as well as a thorough understanding of the policy rationale for cost/quality measurement generally and PPG specifically.    

Nominations for appointments to the advisory committee should be forwarded by July 11, 2012 via e-mail to Stefan Gildemeister, Director of the MDH Health Economics Program, at stefan.gildemeister@state.mn.us.   Initial appointments are made for two calendar years. The PPG advisory committee will meet at minimum three times per year, with three meetings planned between August and November of 2012. 

Minnesota groups awarded funds to reduce costs

In June, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the recipients of 81 new Health Care Innovation Awards including seven that involve Minnesota. The awards were made possible by the federal health care reform law, the Affordable Care Act.


The awards will support innovative projects nationwide designed to deliver high-quality medical care, enhance the health care workforce, and save money. Combined with the awards announced last month, HHS has awarded 107 projects that, according to awardees, intend to save the health care system an estimated $1.9 billion over the next three years.

Institute for Clinical Systems Improvement

Project Title: “Care management of mental and physical co-morbidities:  a TripleAim bulls-eye"

Summary: The Institute for Clinical Systems Improvement (ICSI) of Bloomington, Minnesota is receiving an award to improve care delivery and outcomes for high-risk adult patients with Medicare or Medicaid coverage who have depression plus diabetes or cardiovascular disease.  The program will  use care managers and health care teams to assess condition severity, monitor care through a computerized registry, provide relapse and exacerbation prevention, intensify or change treatment as warranted, and transition beneficiaries to self-management. The partnering care systems include clinics in ICSI, Mayo Clinic Health System, Kaiser Permanente in Colorado and Southern California, Community Health Plan of Washington, Pittsburgh Regional Health Initiative, Michigan Center for Clinical Systems Improvement, and Mount Auburn Cambridge Independent Practice Association with support from HealthPartners Research Foundation and AIMS (Advancing Integrated Mental Health Solutions).

Over a three-year period, ICSI and its partners will train the approximately 80+ care managers  needed for this new model.

• Geographic Reach: Minnesota, Wisconsin, Iowa, Pennsylvania, California, Michigan, Washington, Colorado, Massachusetts
• Funding Amount: $17,999,635
• Estimated 3-Year Savings: $27,693,046

Mayo Clinic

Project Title: “Patient-centric electronic environment for improving acute care performance”

Summary: The Mayo Clinic, in collaboration with US Critical Illness and Injury Trials Group and Philips Research North America, is receiving an award to improve critical care performance for Medicare/Medicaid beneficiaries in intensive care units (ICUs).  Data shows that 27% of such Medicare beneficiaries face preventable treatment errors due to information overload among ICU providers.  The Mayo Clinic model will enhance effective use of data using a Cloud-based system that combines a centralized data repository with electronic surveillance and quality measurement of care responses.  As a result, Mayo expects to reduce ICU complications and costs. Over a three-year period, the Mayo Clinic will train 1440 existing ICU caregivers in four diverse hospital systems to use new health information technologies effectively in managing ICU patient care.

• Geographic Reach: Minnesota, Massachusetts, New York and Oklahoma
• Funding Amount: $16,035,264
• Estimated 3-Year Savings: $81,345,987 

Sanford Health

Project Title: “Sanford One Care:  transforming primary care for the 21st Century”
Summary: Sanford Health is receiving an award to transform health care delivery through the full integration of primary and behavioral health care in South Dakota, North Dakota and Minnesota clinics.  Sanford's enhanced fully integrated medical home model features patient‐centered collaborative teams of primary and behavioral health professionals. The Medicare, Medicaid and CHIP beneficiaries along with the Native American and multicultural populations will benefit significantly from this award.  This model of workforce development and rapid process redesign, along with the integration of behavioral health and primary care, will improve clinical outcomes and drive efficient utilization of resources. Key aims include transforming the role of Primary Care, integrating RN Health Coaches and Behavioral Health Triage Therapists, fully integrating behavioral health care into the medical home model, maximizing Information Technology and standardizing transparent clinical metrics. Tele-health technology will allow patients at remote clinic sites to access enhanced clinical services including psychologists and psychiatrists.  Over a three-year period, Sanford Health’s program will train an estimated 425 health care providers creating enhanced clinical and patient engagement skills, as well as create an estimated 23 jobs in the areas of clinical services, behavioral health, and information technology.

• Geographic Reach: South Dakota, North Dakota, Minnesota, Iowa
• Funding Amount: $12,142,606
• Estimated 3-Year Savings: $14,135,429

Courage Center   

Project Title: “Courage Center”
Summary: Courage Center is receiving an award to test a community-based medical home model to serve 300 adults with disabilities and complex health conditions, particularly complex neurological conditions, in Minneapolis - St. Paul metropolitan area. The intervention will coordinate and improve access to primary and specialty care, increase adherence to care, and empower participants to better manage their own health. Over 50 Independent Living Skills Specialists, Peer Leaders, and other health professionals will be trained with enhanced skills to fulfill the medical home mission. This community-based and patient-centered approach is expected to reduce avoidable hospitalizations, lower cost, and improve the quality of care for this vulnerable group of people with an estimated savings of over $2 million over the three year award.

• Geographic Reach: Minnesota
• Funding Amount: $1,767,667
• Estimated 3-Year Savings: $2 million

 TransforMED    

Project Title: “Multi-community partnership between TransforMED, hospitals in the VHA system and a technology/data analytics company to support transformation to PCMH of practices connected with the hospitals and development of “Medical Neighborhood”

Summary:  TransforMED, in partnership with 12 VHA-affiliated hospitals throughout the county, is receiving an award for a primary care redesign project to support care coordination among Patient-Centered Medical Homes (PCMH), specialty practices, and hospitals, creating “medical neighborhoods.”  The project will use a sophisticated analytics engine to identify high risk patients and coordinate care across the medical neighborhood while driving PCMH transformation in a number of primary care practices in each community.  Truly comprehensive care will improve care transitions and reduce unnecessary testing, leading to lower costs with better outcomes.

Over a three-year period, TransforMED’s program will train an estimated 3,024 workers and create an estimated 22 jobs.  The new workers will include an innovation project manager, project control specialists, project managers, an implementation team, a project team, an integration architect, an application trainer, and a population health management advisor.

• Geographic Reach: Alabama, Connecticut, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Mississippi, Nebraska, Oklahoma, West Virginia
• Funding Amount: $20,750,000
• Estimated 3-Year Savings: $52,824,000

YMCA   

Project Title: “Delivery on the promise of diabetes prevention programs"
Summary: The National Council of Young Men's Christian Associations of the United States of America (Y-USA), in partnership with 17 local Ys currently delivering the YMCA’s Diabetes Prevention Program, the Diabetes Prevention and Control Alliance, and 7 other leading national non-profit organizations focused on health and medicine, is receiving an award to serve 10,000 pre-diabetic Medicare beneficiaries in 17 communities across the U.S.  The intervention will focus on community-based diabetes prevention through a national diabetes prevention lifestyle change program, coordinated and taught by trained YMCA Lifestyle Coaches.  The goal is to prevent the progression of pre-diabetes to diabetes, which will improve health and decrease costs associated with complications of diabetes, hypercholesterolemia, and hypertension. The investments made by this grant are expected to generate cost savings beyond the three year grant period.

Over a three-year period, Y-USA and its partners will train an estimated 1500 workers and create an estimated eight jobs.  The new jobs will include communication specialists, a program manager, an administrative manager, a workforce development manager, evaluation specialists, training specialists, and administrative coordinators.

• Geographic Reach: Arizona, Delaware, Florida, Indiana, Minnesota, New York, Ohio, Texas
• Funding Amount: $11,885,134
• Estimated 3-Year Savings: $4,273,807

Dartmouth College Board of Trustees

Project Title: “Engaging patients through shared decision making:  using patient and family activators to meet the triple aim”


The Dartmouth College Board of Trustees is receiving an award to collaborate with 15 large health care systems around the country to hire Patient and Family Activators (PFAs).  The PFAs will be trained to engage in shared decision making with patients and their families, focusing on preferences and supplying sensitive care choices.  PFAs may work with patients at a single decision point or over multiple visits for those with chronic conditions.  It is anticipated that this intervention will lead to a reduction in utilization and costs and provide invaluable data on patient engagement processes and effective decision making—leading to new outcomes measures for patient and family engagement in shared decision making.

Over a three-year period, the Dartmouth College Board of Trustees-sponsored program will train 5,775 health care workers and create 48 positions for patient and family activators.

• Geographic Reach: California, Colorado, Iowa, Idaho, Massachusetts, Maine, Michigan, Minnesota, New Hampshire, New Jersey, New York, Oregon, Texas, Utah, Vermont, Washington
• Funding Amount: $26,172,439
• Estimated 3-Year Savings: $63,798,577

For more information on the awards announced today, go to: innovations.cms.gov/initiatives/innovation-awards/project-profiles.html.

Comments sought for essential health benefits

The U.S. Department of Health and Human Services (HHS) is soliciting comments on Essential Health Benefits and entities for the accreditation of Qualified Health Plans. The proposed rule would establish data collection standards necessary to support the definition of essential health benefits and establish a process to recognize accrediting entities for the purposes certifying qualified health plans.

The proposed rule can be found at the Office of Federal Register. Minnesota submitted comments in January 2012 on Essential Health Benefits. Minnesota welcomes public comments on the Essential Health Benefits and entities for the accreditation of Qualified Health Plans regulations.

Your comments will be reviewed and will assist the Minnesota Departments of Commerce, Human Services and Health in preparing a formal response to HHS. Comments must be received by 3 p.m. central time Friday, June 22. Send your comments to HealthReform.MN@state.mn.us (please write “Essential Health Benefits” in the subject line). Click here, for more details about commenting.

Minnesota "Pay for Performance" Program Updated

In May, the Minnesota Department of Health released its second final 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 and is s 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.

During the open comment period, one stakeholder noted that the Department had not included its risk adjustment methodology for the “depression remission at six months” measure; thus the report was revised to include this explanation.

The final framework can be found at Quality Incentive Payment System. 

Clinics certified as health care homes now serving 2 million Minnesotans

More than 2 million Minnesotans are served by clinics certified as health care homes - a new primary care model showing promise as a way to improve the quality of care, reduce costs, and be more responsive to people's needs, according to a report to the Minnesota Legislature.

"Enhancing and transforming primary care is central to Minnesota's health care reform efforts," said Minnesota Commissioner of Health, Dr. Ed Ehlinger. "This is a significant milestone in our efforts to help clinics adopt an approach that puts the patient at the center of a care team dedicated to meeting the patient's health goals."

A health care home is a primary care clinic or provider that makes better health easier to achieve. It puts patients at the center of care decisions, whether they are seeking care for common, acute, or chronic conditions.

The Minnesota Department of Health (MDH) certifies clinics as health care homes. To qualify, a clinic must provide 24-hour access, maintain a method of tracking patient health histories, monitor and report the clinic's quality performance, and provide care planning and coordination to patients. MDH has certified 170 health care homes and 1,764 clinicians. These providers care for over 2 million Minnesotans. The figure of 2 million Minnesotans served by health care home clinics comes from patient population figures submitted by the clinics during the certification process. The tally was included in the annual health care homes report that MDH and DHS submitted in May to the Minnesota Legislature.

All patients can benefit from a health care home. The designation indicates a clinic has the tools to help patients meet their health goals, such as losing weight or quitting smoking. A health care home particularly benefits patients with chronic diseases or complex illnesses by coordinating the different kinds of care and services needed.

Recognizing this value, the Minnesota Department of Human Services (DHS) offers care coordination payments of $10 to $60 a month for each patient with a chronic condition who is enrolled in a state health program, such as Medical Assistance. The payment amount depends on the complexity of the patient's health problems.

DHS Commissioner Lucinda Jesson stated, "We are committed to supporting health care homes as the crucial delivery model of a new health system. In this practice, model health care is integrated at the primary care site for all medical care. Even beyond these health care services, health care homes are the right partners to integrate medical and community services to provide care for the people and families we serve."

DHS estimates that approximately 135,000 Medicaid recipients are served by a certified health care home. Minnesota is also one of eight states where the federal Medicare program has aligned with the state program to pay for health care homes. More than 225,000 Medicare beneficiaries are expected to be served by health care homes during the three-year project.

Improved quality and reduced costs 
There is promising evidence that the health care home approach is making better health easier for Minnesotans to achieve by improving the quality of primary care clinics and reducing costs.

For example, Medica has entered into reimbursement contracts with some primary care clinics that encourage a health care home model to manage chronic diseases and prevent illness. One large provider in the Twin Cities used the health care home model to decrease per member costs by 5 percent over one year, while other comparable large system clinics saw a 2.6 percent increase in costs during the same time period.

"At Medica, we see efforts like health care homes as a key part of our strategy to increase the quality of our members' health and lower health care costs by rewarding providers for not only treating, but preventing illness," said Dr. Jim Guyn, M.D., Medica medical director of provider relations.

Dr. Leif Solberg, M.D., of the HealthPartners Research Foundation, has been studying health care homes in Minnesota and preliminary findings indicate that, "On average, health care home clinics have significantly better performance scores for diabetes and cardiovascular disease than non-health care home clinics," Solberg said.

The 2011 report and those from previous years are available online at http://www.health.state.mn.us/healthreform/homes/legreport/index.html.

Citizens engage in health reform: Citizen Solutions Forums

Join Citizen Solutions to engage with other Minnesotans in a conversation about what's important to the future of health and healthcare in our state. Additional forums will be held throughout the state. In August, the Bush Foundation and Citizens League will deliver a report to the Health Care Reform Task Force on the values and priorities that have been heard from people and businesses across the state.



Scheduled Forums:
April 24: Northfield
April 26: Eden Prairie
May 1: Moorhead
May 2: Maple Grove
May 7: Bemidji

More clinics report quality of depression care

The number of clinics reporting on the quality of their depression care has more than doubled due to a requirement of Minnesota's Statewide Quality Reporting and Measurement System that was included in Minnesota's 2008 Health Care Reform Act.

According to Minnesota Community Measurement's annual 2011 Health Care Quality Report, 258 clinics are now publicly reporting on depression care compared to 116 in 2010. This year’s report also includes a section displaying risk adjusted rates compared to MNCM reported unadjusted rates for five measures: Optimal Diabetes Care, Optimal Vascular Care, Depression Remission at Six Months, Optimal Asthma Care, and Colorectal Cancer Screening.

Provider Peer Grouping bill passes

Legislation signed by Gov. Mark Dayton April 5 will change Minnesota’s provider peer grouping program by giving providers more time to review their data and by making health plan use of the data optional rather than mandatory.

The provider peer grouping program was passed as part of Minnesota’s 2008 Health Care Reform Act in order to increase the transparency of Minnesota’s health care system by providing patients and consumers data comparing the cost and quality of Minnesota’s clinics and hospitals.

The act originally required health plans, the Department of Human Services, and the State Employee Group Insurance Plan to incorporate provider peer grouping data into at least one health plan offering that would include incentives for patients to use high quality, low-cost providers.

With this recent legislative change, health plans now may use the data but are not mandated to do so.

In addition, the change gives clinics and hospitals more time, 120 days rather than 90 days, to review their data before it is publicly released. The amendment also establishes a streamlined appeals process and a committee comprised of representatives from hospitals, clinics, and other stakeholders that will advise the commissioner of health about scoring methodologies and the dissemination and sharing of the data.

“This is a good compromise that will allow this important work to move forward, while also providing us with a more formal way to work closely with clinics and hospitals to make sure the data is accurate and helps patients make informed health care choices,” said Ellen Benavides, assistant commissioner, Minnesota Department of Health.

The changes go into effect July 1, 2012.

Proposal for Medicare, Medicaid integration comments due April 19

The Department of Human Services invites public comment on a proposed demonstration to further integrate Medicare and Medicaid coverage for more than 93,000 Minnesota seniors and people with disabilities. The proposal (pdf) seeks more administrative integration, including provider payments and consumer materials, and greater accountability among providers and payers for total cost of care and health outcomes for people with both types of coverage.

Recommendations sought for Statewide quality reporting

The Minnesota Department of Health (MDH) invites interested stakeholders to submit recommendations on the addition, removal, or modification of standardized quality measures to MDH by June 1, 2012.

The Commissioner of Health Dr. Ed. Ehlinger will take these recommendations into consideration in determining what, if any, changes should be made to the Statewide Quality Reporting and Measurement System.

Recommendations must be submitted to MDH at health.reform@state.mn.us by 4:30 p.m. on June 1, 2012, to be considered. Click here to learn more about submitting comments.

The Minnesota Department of Health established and annually updates a core set of standardized health care quality measures for physician clinics and hospitals. These measures include care for diabetes, coronary artery and heart disease, asthma, and depression. Measures are developed in consultation with health care providers and are based on medical evidence. Providers are required to submit data on these measures and MDH publicly reports this information.

Healthcare reform saves millions for taxpayers

Federal and state taxpayers received a savings of $73 million in April thanks to the voluntary 1% cap on profits agreed to last year between Commissioner of Human Services Lucinda Jesson, HealthPartners, Medica, UCare, and BlueCross BlueShield.

This return of taxpayer dollars is the latest in a series of reforms to Minnesota’s health care system, focused on providing better taxpayer value at a better price.

Payments were calculated based on 2011 financial reports submitted to the Minnesota Department of Health by health insurance companies. In accordance with Governor Dayton’s Executive Order 11-06 issued on March 23, 2011, these reports will be independently audited and verified by vendors contracted by the Minnesota Department of Commerce. Repayments from the health plans will be credited towards this biennium’s budget.

The estimated repayments for each plan are:

HealthPartners: $31 Million

Medica: $25 Million

BlueCross BlueShield: $9 Million

UCare: $8 Million

The Dayton administration negotiated 1% voluntary caps with the health plans for profits earned in 2011. This cap applies to the profit earned by the managed care companies under contracts negotiated prior to the Dayton Administration. For 2012 and beyond, the Dayton Administration implemented competitive bidding for public managed care contracts in the metro area. These competitively bid contracts, in concert with other managed care reforms, will generate over $500 million in savings to taxpayers over the next biennium.

"Local lunch day" shows benefits of 2008 health reforms

In March, Commissioner of Health Dr. Ed Ehlinger visited Woodland Elementary School in Eagan to get an on-the-ground look at some of the effects of Minnesota’s landmark health care reform law passed in 2008.

Back in 2008, Minnesota policy makers recognized that in order to contain spiraling health care costs, investments in prevention were needed. With bipartisan support, Minnesota passed a ground-breaking health reform law that included SHIP. Two-year SHIP grants were awarded on July 1, 2009 to all 53 community health boards and nine of 11 tribal governments. Grants were awarded through a competitive process for statewide investments of $20 million in 2010 and $27 million in 2011.

That effort has resulted in significant changes in places like Dakota County and Woodland Elementary School in Eagan.



Woodland Elementary School in Eagan is one of the many schools partnering with the Minnesota Department of Health to improve the local economy and school lunches by using locally grown foods. The school has taken advantage of several state initiatives, such as Great Trays, Farm to School, and Safe Routes to School.

These programs have helped the school to improve its lunches. Ehlinger joined second-graders for the school’s “local lunch day,” that included fruits, broccoli, and a serving of wheat berry salad made from whole-grain wheat grown locally by Indian Harvest of Bemidji. He visited a classroom to talk about nutrition and to watch a presentation by Indian Harvest Chef Coleen Donnelly, who created the wheat berry salad recipe and specializes in making healthy meals that are popular with kids.

The SHIP program recently filed a report with the Legislature that found that during the program’s first two years, Farm to School efforts are increasing access to local produce in at least 367 schools and 22 school districts across Minnesota, serving more than 200,000 students.

In addition, at least 117 schools serving 77,000 students, across the state are actively engaged in implementing Safe Routes to School, which increases opportunities and support for youth to walk or bike to school.

With childhood obesity rates tripling over the past three decades, action is needed and improving school lunches is key strategy for fighting this epidemic.

“Obesity is one of the most urgent health challenges facing our state and nation today,” Ehlinger said. “To fight, obesity we need to invest in children’s nutrition, and Woodland school is a great example of the health department, local public health officials, and schools working together to provide children nutritious food that tastes great.”

MN AARP conducts Minnesota health insurance exchange survey

In March, AARP Minnesota released the findings of a public opinion poll showing broad support in Minnesota for a state designed health insurance marketplace.

The survey found that two‐thirds of Minnesotans support the creation of a state run health insurance exchange and 74% want that exchange to negotiate competitive prices for consumers.

Here are some of the top-line results of the survey.

• 83% of respondents feel the Governor and state legislators should work to ensure that all Minnesotans have access to affordable health care coverage,
• 74% want consumers to make up the majority of the governing board, and 
• 74% support an exchange that negotiates on behalf of individuals and small businesses.

The Governor's Health Care Reform Task Force is currently working with the Citizens League and the Bush Foundation to engage citizens and businesses around Minnesota to help define the values and priorities for health reform in Minnesota, including discussions about a health insurance exchange.The Citizens League will hold a series of online-forums and in-person workshops around the state this spring and summer.

The Minnesota Department of Commerce is currently conducting exchange-related activities including regular meetings of advisory and technical workgroups.

States have until January 1, 2013 to create their own health insurance exchanges or the federal government will establish one, to be available to consumers beginning in 2014.  The Minnesota Health Insurance Exchange Advisory Task Force will advise on the design and development of a Minnesota-made Health Insurance Exchange.

Help Minnesota define Minnesota's insurance exchange - March 14

The Citizens League and the Bush Foundation are leading an effort to engage citizens and businesses around Minnesota in defining values and priorities for health reform in our state.  In the spring and summer of 2012, they will be traveling around the state to bring citizens into this discussion with a series of in-person workshops and online forums.

The first test workshop is on March 14, 2012.

See the Citizens League website for more information on registration.

Minnesota's SHIP program looks back on first two years

Minnesota's nationally recognized Statewide Health Improvement Program (SHIP) has shown progress towards improving conditions linked to better health by partnering with hundreds of schools, clinics and workplaces across Minnesota, according to a report submitted by the Minnesota Department of Health (MDH) to the Legislature in March.

In communities across the state local SHIP efforts have launched new partnerships with businesses, farmers, schools, community groups, chambers of commerce, hospitals, health plans, city planners, county boards, tribal officials and more. These partners have successfully implemented changes in schools, health care systems, workplaces and at the broader community level that help assure the opportunity for better health for more Minnesotans. Click here to see the entire report, The Minnesota Statewide Health Improvement Program SHIP Progress Brief - Year 2

"We are impressed by how Minnesota's businesses, schools, and communities have partnered with us and rallied around SHIP's goal of improving health by fostering and encouraging healthy choices for kids and adults alike," said Dr. Ed Ehlinger, Commissioner of Health. The report reviews the program's first two years that ended June 30, 2011. SHIP was included in Minnesota's bipartisan health care reform legislation passed in 2008 as a strategy for curbing rising health care costs through prevention efforts.


SHIP's Year Two Highlights

• SHIP has helped over 870 employers lead worksite wellness initiatives, reaching over 138,000 employees across the state.
• Farm to School efforts are under way to increase access to local produce in at least 367 schools and 22 school districts across Minnesota, serving more than 200,000 students.
• Farmers markets increase access to fruits and vegetables, a key component of healthy eating. During the first two years of SHIP, 160 new farmers markets have opened in Minnesota, an increase of 95 percent.
• Over 110 schools, serving more than 77,000 students, are actively engaged in Safe Routes to School efforts that increase opportunities and support for youth to walk or bike to school.
• 31 post-secondary schools are working to have tobacco-free campuses.
• Approximately 255 cities are working to improve walkability and bikeability in their communities.
• Over 500 child care sites have worked to improve nutrition, serving over 8500 children.
• Over 900 child care sites are working on implementing practices to increase physical activity, serving over 20,000 children.
• To prevent tobacco smoke exposure, six cities have adopted tobacco-free parks policies, and 14 additional cities are currently working on this strategy.
• 227 apartment buildings have adopted smoke free policies. Another 142 are working toward it. 

Health Care Reform Task Force launches engagement effort

The Health Care Reform Task Force is partnering with Minnesota foundations, businesses, and community organizations to engage Minnesotans about the future of health care in Minnesota.

The Citizens League will manage much of the process, hiring staff and consultants to coordinate the project, and taking responsibility for building a broader coalition. The Minnesota Chamber of Commerce and

TakeAction Minnesota have already been recruited to participate in the project, which will include regional meetings across the state this summer and continue through 2014.

Funding for this work will be provided by a group of Minnesota-based foundations including the Bush Foundation, the Blandin Foundation and the Minneapolis Foundation. Click here to read more.

Health plans, providers, and citizens comment on essential benefit set

The Departments of Health, Commerce, and Human Services received more than 70 pages of comments from a wide range of stakeholders regarding establishing an essential benefit set as part of health care reform. The Minnesota departments requested comments in response to an Essential Health Benefits Bulletin released by the U.S. Department of Health and Human Services in December.

How will health care home outcomes be measured in 2012?

On January 14, 2012, the Commissioner of Health issued a letter that describes the Health Care Home outcome measures for 2012. Medical groups participating as certified health care homes will continue to submit measurement data to Minnesota Community Measurement (MNCM). This data will be used for benchmarking, re-certification and for overall evaluation of the health care homes initiative.
Health care homes are expected to participate in data collection for the following measurement activities in 2012:

• Optimal Vascular Care
• Optimal Diabetes Care
• Depression Remission at 6 months
• Optimal Asthma Care
• Colorectal Cancer Screening
• Patient Experience Survey

These measures are aligned with the Minnesota Statewide Quality Reporting and Measurement System with the addition of Health Care Home specific risk tiering data where applicable.
In addition, the cost measure - 30-day, All Cause Hospital Readmission - has been approved. Initially, cost data will be provided through Medicaid and Medicare claims. This measure will eventually be aligned with the CMS national standards and, where appropriate, with the work of the Reducing Avoidable Readmissions Effectively (RARE) collaborative.
These measures are part of the Health Care Home Outcome Measurement system recommended by the Health Care Homes Performance Measurement Advisory Work Group, a public-private stakeholder group.
The work group’s recommendations are available online the week of February 6, 2012 at http://www.health.state.mn.us/healthreform/homes/outcomes/index.html.  For more information, contact Cherylee Sherry, planner for the Health Care Homes Initiative at 651-201-3769 or Cherylee.Sherry@state.mn.us.