Marie Maes-Voreis RN MA
Director, Health Care Homes
Minnesota Health Reform Timeline
2008 Comprehensive Legislation
• Public health investment, SHIP
• Market transparency, Quality Rule / PPG
• Care redesign and payment reform, HCH
• Consumer engagement
• Administrative Simplification and HIT
2010 Health Care Delivery System Medicaid Model
2011 Governor Dayton’s Health Reform Structure
• Access / Health Insurance Exchange
• Care Integration and Payment Reform
• Prevention and Public Health
• Workforce
• Citizens Engagement
Health Care Home
A health care home is not:
• A nursing home or
home health care.
• A restrictive network.
• A service that only
benefits people living
with chronic or
complex conditions.
A health care home is:
• An approach to population
clinical care redesign.
• Primary care clinic that has
transformed its services to
meet a new set of patientand family-centered
standards that improves
patient experience, quality
and reduces costs.
• Foundation to new payment
models such as ACO’s.
• Requires community
partnerships to build healthy
communities.
Health Care Home Standards
• Access: facilitates consistent communication among
the HCH and the patient and family, and provides the
patient with continuous access to the patient’s HCH
• Registry: uses an electronic, searchable registry that
enables the HCH to identify gaps in patient care and
manage health care services
• Care coordination: coordination of services that
focuses on patient- and family-centered care
• Care plan: for selected patients with a chronic or
complex condition, that involves the patient and the
patient’s family in care planning
• Continuous improvement: in the quality of the
patient’s experience, health outcomes, costeffectiveness of services
Primary Care Population Based
Care Delivery Redesign, What is different?
Today’s Care
Patients are recipients of services by
providers and clinics.
Patients are those who make
appointments to see providers.
Care is determined by today’s
problem and time available today.
Care varies by memory or skill of the
provider.
Patients are responsible to coordinate
their own care.
It’s up to the patient to tell us what
happened to them.
Clinical operations center on meeting
the doctor’s and clinic’s needs.
I know I deliver high quality care
because I’m well trained.
Health Care Homes
Patients and families are partners in the
provision and planning of care.
Patients have agreed to participate and
understand how to contact our HCH. There
is 24/7 access to the HCH.
Proactive care planning is done with patients
and family’s to anticipate patient’s needs and
set patient centered goals.
Care is standardized with evidence-based
guidelines and planned visits.
A team, including the care coordinator,
coordinates care with patients and families
between clinic visits.
We use a registry to track visits and tests
and we do follow-up after referrals to
specialists, ED and hospital visits.
Clinical operations are designed as patient
and family centered and focused on patient’s
preferences and values.
We measure our quality outcomes and make
ongoing changes to improve it. We include
patients / families in quality work.
Patient- and Family-Centered Care at Work
We spoke with a physician in a large
urban clinic who said that health care
home was his “miracle in his practice.” He
had left primary care to work at the
hospital and had now come back and his
practice was totally different, focused on
the patients and their families!
The power of stories!
Health Care Home Consumers Perspective
• Welcoming – Anyone can use, and benefit from, a HCH.
• Personalized – A HCH puts you at the center of your health care.
• Relationship-based – Your providers and specialists are aware
of your health history and your care team works closely with you
to improve your health.
• Unrestricted – A HCH can help you choose the best provider and
specialists for your needs and helps you share information
with your care team.
• Organized – A HCH coordinates services and shares
information to minimize confusion and prevent duplication and
gaps in care.
• Comprehensive – A HCH is designed to help you meet all of
your health care needs, from preventive care and common
illnesses, to urgent care and treatment of chronic and complex
conditions.
Patient- and Family-Centered Care at Work
We spoke with a truck driver from southern Minnesota
who described how the HCH had changed his life. He
worked out his driving schedule so he could talk with us
while on his break.
He described the new access standards that let him
schedule appointments when he could come,
His relationship with his new team, care coordinator &
PCP.
How he was connected to community resources for
weight loss and how his HgbA1C had come down to
nearly his goal.
He was so thrilled about the change in his life!
The power of stories!
What Makes Minnesota’s HCH Approach Unique?
• Statewide approach, public/private partnership
• Standards for certification all types of clinics can achieve
• Support from a statewide learning collaborative
• Development of a payment methodology
• Integration of community partnerships to the HCH
• Outcomes measurement with accountability
• Focus on patient- and family-centered care concepts
HCH Certification Updates
# Certified Clinics: 170
25% of Primary Care
Clinics in Minnesota
Certified Clinicians:
1766
Approximately 2
million patients
receiving care in a
certified HCH.
• Applicants are from all over
the state.
• Variety of practice types
such as solo, rural, urban,
independent, community,
FQHC and large
organizations.
• All types of primary care
providers are certified,
family medicine, pediatrics,
internal medicine, med/peds
and geriatrics.
HCH vs. Disease Management
Health Care Home CC
Disease Management CM
•
• Case manager is often 3rd party
vendor
• Case management is telephonic
only
• Often has no relationship with
your primary care doctor
• Typically fewer than 20% of
eligible people opt-in for the
service
• Promotes patient education and
involvement
• Only involved after the patient
has a chronic disease
•
•
•
•
•
Care Coordinator is a part of the
primary care clinic
Coordination is face-to-face,
supplemented with phone calls
Is on the same team as your
primary care doctor
If you’re a patient at the clinic, you
have the benefits of HCH, no need
to opt-in
Promotes patient education and
involvement
May delay and/or prevent the
onset of a chronic disease through
preventive care measures
Effectiveness in Medicare Populations
• Timely data on patients enabled care coordinators to be
most effective
• Team-based care, especially those that included
pharmacists, appeared to have fewer hospital admissions.
• When CC had face-to-face interaction with both the doctor
and the patients, cost reductions were more likely to occur
“Lessons from Medicare’s Demonstration Projects on Disease
Management, Care Coordination, and Value-Based Payment,”
Congressional Budget Office, Issue Brief, January 2012
Cost Savings for
Families and Payers
• Families with children with special health care needs
(CSHCN) are less likely to report financial problems if
their children receive care in a health care home
• Children who received HCH care coordination services
had 32% lower out-of-pocket costs than those who did
not receive care coordination
• Nearly 1/3 of care coordination encounters were found
to reduce health service use
“Medical Home and Out-of-Pocket Medical Costs for
CSCHN,” Pediatrics, Porterfield and DeRigne, October 17,
2011
Evidence for Health Care Home
There is now even stronger evidence that
investments in primary care can bend the cost curve,
with several major evaluations showing that patient
centered medical home initiatives have produced a
net savings in total health care expenditures for the
patients served by these initiatives.
- Grumbach and Grundy 2010
- Outcomes of Implementing PCMH Interventions
- http://www.pcpcc.net/files/evidence_outcomes_in_
pcmh.pdf
What We Know About Care in a Patient & FamilyCentered (Health Care) Home:
• Patient and family-centered care is increased
• Family worry and burden are reduced
• Care coordination and chronic condition
management lead to:
• Reduction in emergency room use
• Reduction in hospitalizations
• Reduction in redundancy
• Efficiency and effectiveness are increased
Center for Medical Home Improvement
Parting Thought
“ …when we looked across the landscape at
what we wanted to buy for our patients, we
couldn’t find it.”
- Dr. Paul Grundy, IBM; President, Patient-Centered
Primary Care Collaborative (PCPCC)
Minnesota has defined and is recognizing this
transformed, high-value model of primary
care so that consumers and purchasers can
find it and buy it.
Health Care Homes Contacts:
[email protected]
http://www.health.state.mn.us/healthreform/homes/index.html
651-201-5421
Marie Maes-Voreis, RN MA
HCH Program Director
[email protected]