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.