Tuesday, March 1, 2016

Percent of Minnesotans without health insurance drops to historic low

A new report from the Minnesota Department of Health (MDH) and the University of Minnesota finds that Minnesota cut its uninsured rate nearly in half between 2013 and 2015, and the rate of Minnesotans without health insurance has now reached an all-time low.

The report cites recent health reform efforts and an improved economy as key factors that drove down the state’s uninsured rate, as more than 200,000 Minnesotans – including 35,000 children – gained health insurance coverage between 2013 and 2015.

“Minnesota has a history of leading the nation in providing health insurance for our residents and workers,” said Minnesota Commissioner of Health Dr. Ed Ehlinger. “Even so, 2015 marked an unprecedented advancement for the health and security of Minnesota families – particularly those who had previously been lost in the gaps of our system.”

The percent of Minnesotans without health insurance fell to 4.3 percent in 2015 – the lowest rate in state history – according to the survey conducted by MDH and the University of Minnesota’s State Health Access Data Assistance Center.

“The drop in the number of Minnesotans without health insurance is great news for our state,” said Minnesota Department of Human Services Commissioner Emily Johnson Piper. “These findings demonstrate that efforts in our state to improve the quality and affordability of health care for the people of Minnesota are making a difference.”

During the same time, a decade-long decline in the rate of Minnesotans who receive health insurance through an employer was halted. The percent of Minnesotans who have employer coverage remained steady, while the percent of Minnesotans purchasing health insurance on their own rose slightly. About 10 percent of Minnesotans reported getting their coverage through MNsure.

“Today’s news confirms that more Minnesotans are getting health insurance coverage. This is great news for Minnesota,” said MNsure CEO Allison O’Toole. “However, our work is not done yet.

Today’s report shows 22 percent of Minnesota’s uninsured are potentially eligible for advanced premium tax credits available only through MNsure. We do not want Minnesotans to leave money on the table, and will do everything we can to make sure they are getting the coverage they need and can take advantage of the financial supports available to make it affordable.”

All groups of Minnesotans, regardless of income, racial or ethnic group or age, reported increases in health insurance coverage. For example, uninsured rates for Hispanic/Latino Minnesotans fell by nearly 200 percent from 34.8 percent in 2013 to 11.7 percent in 2015. However, Commissioner Ehlinger notes the disparity in insurance coverage persists between white Minnesotans and American Indians and Minnesotans of color.

“While it is encouraging to see across-the-board progress in reducing the total number of people who go without health insurance, we still see troubling gaps among racial and ethnic groups,” Commissioner Ehlinger said. “These disparities threaten the health of our communities and our state as a whole, and we need to continue to work on reducing them. All Minnesotans deserve an equal opportunity to be healthy, and access to quality health care services is an important part of that.”

Health insurance is designed to provide access to health services and protection from high medical bills. In 2015, more than three-quarters of Minnesotans with health insurance reported their insurance protected them from high medical bills, and 93 percent of Minnesotans felt confident they could get the health care they need. Nonetheless, two in 10 Minnesotans still reported not getting needed care because of cost in the past year, a rate unchanged from 2013.

“Monitoring the extent to which health insurance access translates into access to health care will be important as more Minnesotans gain coverage,” said Kathleen Call, a lead researcher on the study and professor at the University of Minnesota School of Public Health.
The MDH report is available online from the Health Economics Program.

U of M evaluation finds Health Care Homes saved $1 billion over 5 year period

A new University of Minnesota evaluation of Health Care Homes found that over a five year evaluation period the model – emphasizing collaboration among care providers, families and patients – saved Medicaid and Medicare approximately $1 billion. At the same time, clinics participating in a health care home model of care outperformed other clinics on quality measures.

The results come from a Minnesota Department of Health (MDH) funded evaluation of health care homes done in collaboration with the Minnesota Department of Human Services (DHS) led by investigator Douglas Wholey, Ph.D., professor of health policy and management from the University of Minnesota School of Public Health Division of Health Policy & Management.
A summary of the 2016 U of M evaluation can be found at Health Care Homes, Five Year Program Evaluation (PDF).

The complete 2016 U of M evaluation can be found at Evaluation of the State of Minnesota's Health Care Homes Initiative Evaluation Report for Years 2010-2014 (PDF).
Additional findings suggest potentially significant savings if the Medicaid, Medicare, and Dual Eligible patients who were not in a health care home during this period were in a health care home.

“Having had the opportunity to closely observe Minnesota’s Health Care Home initiative during our evaluation of it, I am impressed by the positive results, thorough planning, and effective implementation,” said Wholey.

The health care home program is a cornerstone of Minnesota’s 2008 bipartisan health reform efforts. Within a health care home, primary care providers, families, and patients work in partnership to improve health outcomes and quality of life for patients, including those with chronic conditions or disabilities. The Health Care Homes program is an effort to transform primary care. Certified health care homes strive to place patients and families at the center of their care and provide the right care at the right time and right place. Health care homes use a team approach that gives patients and caregivers access to health care services and support.

Currently, MDH has certified 361 clinics or 54 percent of all primary care clinics in Minnesota. To be certified, clinics meet a rigorous set of requirements related to their ability to provide care that is coordinated, patient-centered, and team-based. About 3.6 million Minnesotans receive care in clinics certified as health care homes.

“These findings show the value of focusing on care coordination and disease management within the broad context of a patient’s life and community,” said Minnesota Commissioner of Health Ed Ehlinger, M.D. “Taking this approach can help us achieve the goal of improving quality while also reducing costs.”
The University of Minnesota study of Health Care Homes is the second of two legislatively mandated reports. The initial report at U of M evaluates health care homes, finds better access to care, higher quality and lower costs was released in February 2014.


The report, which evaluates the health care home initiative from 2010 through 2014, analyzed Medicaid and Medicare claims data comparing the use and cost of services between certified health care home clinics and non-health care homes. Results include:
  • Medical costs for enrollees who could be attributed to a health care home clinic were 9 percent less than enrollees who did not have a health care home as their primary care clinic.  
  • Health care homes cost 12 percent less for Medicaid, 3 percent less for Dual Eligible enrollees, but were cost neutral for Medicare enrollees.
  • Health care homes were less expensive in four categories of healthcare spending: inpatient hospital admissions, hospital outpatient visits, skilled nursing facilities, and pharmacy.
  • Racial disparities were significantly smaller for Medicaid, Medicare, and Dual Eligible beneficiaries served by health care homes versus non- health care homes for most measures, with the exception of African American-White differences in Medicare, which tended to be slightly larger in health care homes.
  • On a broad range of clinical quality measures, HCH clinics outperform non- health care homes clinics.
The University of Minnesota relied on analysis of claims data from the Medicaid and Medicare programs, analysis of data from the Statewide Quality Reporting and Measurement System (SQRMS) collected by Minnesota Community Measurement, interviews with key stakeholders and certified Health Care Homes to assess the effect of the health care homes program on access, cost, quality, and patient experience and the transformation of clinics to being a health care home.

Innovative reform initiative now serves more than 340,000 Minnesotans in public health care programs

The Integrated Health Partnerships (IHP), Minnesota’s groundbreaking approach to delivering quality health care more efficiently for low-income people, continues to grow across the state, now encompassing 19 provider groups and more than 340,000 enrollees in Medical Assistance, the state’s Medicaid program and MinnesotaCare, a program for residents who do not have access to affordable health care coverage.
“Our nation-leading Integrated Health Partnerships initiative shows that it’s possible to lower the cost of care while maintaining and improving quality of care for patients,” said Commissioner Emily Johnson Piper. “It’s encouraging to see such strong interest from providers across Minnesota, both those who are joining and those who are continuing to participate in this initiative.”
This month, three new provider groups joined the Department of Human Services’ IHP initiative, including providers serving people in medically underserved or high-need areas, providers serving children with complex medical conditions, and providers serving rural areas in Greater Minnesota. Contracts with the three new provider groups began on Jan. 1, 2016.
Also this year, six Integrated Health Partnerships provider groups that helped launch the program in 2013 opted to continue for a second three-year cycle. North Memorial, one of the original providers, expanded its participation to include affiliate partners and clinics. With the addition of new provider systems and growth in the 16 provider groups who joined before 2016, the IHP now covers more than 340,000 Medical Assistance enrollees. This growth puts DHS well on its way to a goal of extending the IHP and comparable value-based reforms to half of all Medical Assistance and MinnesotaCare enrollees – about 500,000 people – by the end of 2018.
The new providers include:
  • Allina Health, Allina and its subsidiaries provide a full range of primary and specialty health care services across a wide geographic range, with more than 750 practitioners who also assist patients with preventative health by identifying health risks, managing chronic illness and achieving overall better health. Allina Health participated in part in earlier rounds of the IHP program through the Northwest Alliance in partnership with HealthPartners, and with their Courage Kenny Rehabilitation Institute serving people with complex neurological conditions. Beginning in January 2016, the full Allina system joined the IHP initiative.
  • Gillette Children’s Specialty Healthcare, an independent, non-profit children’s hospital serving children who have complex conditions such as cerebral palsy, rare disorders such as osteogenesis imperfecta, and traumatic injuries to the brain and spinal cord. In an effort to save families the time and expense of frequent travel to St. Paul, Gillette operates 18 outpatient clinics throughout Greater Minnesota. These clinics give families access to many of the specialized services they need, in their home communities.
  • Integrity Health Network (IHN), a multispecialty independent practice association comprised of clinics and facilities throughout a mostly rural service areas.
The IHP initiative has already delivered significant savings to Minnesota taxpayers. In its first two years, savings totaled more than $76 million, benefiting taxpayers and providers. Preliminary results for 2015, the initiative’s third year, will be announced later this year.
About the Integrated Health Partnerships Initiative
The IHP demonstration prioritizes the delivery of higher quality and lower cost health care, encouraging providers to focus on delivering efficient and effective health care and preventive services to reach mutually agreed-upon health goals. In contrast, the traditional payment system pays providers for the volume of care they deliver, rather than the quality of care they provide. In the IHP model, providers who meet a threshold for savings are eligible for a share of the savings. Beginning in the second year of participation, some providers also share the downside risk if costs are higher than projected.
The IHP initiative is a key component of a $45 million federal State Innovation Model (SIM) grant, which is helping to drive health care reform in Minnesota. Several IHP participants have also received SIM grants for their innovative efforts to improve health care