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.