MN Health Reform
In 2008 MN legislature passed health reform
legislation that takes a comprehensive
approach.
• Public health investment
• Market transparency
• Care redesign and payment reform
• Consumer engagement
Framework for Minnesota’s Vision:
IHI’s Triple Aim
•
Improve population health
•
Improve the patient/consumer experience
•
Improve the affordability of health care
Minnesota Starts from a Good Place:
Strong Primary Care Base
MN HCH Capacity
Assessment: 707
primary care
clinics
Cumulative percent change
Cumulative Health Care Cost Growth vs. Other
Economic Indicators
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2000
Health care cost
2001
2002
MN Economy
2003
2004
Per capita income
2005
2006
Inflation
2007
Wages
Note: Health care cost is MN privately insured spending on health care services per person, and does not include enrollee
out of pocket spending for deductibles, copayments/coinsurance, and services not covered by insurance.
Sources: Minnesota Department of Health, Health Economics Program; U.S. Department of Commerce, Bureau of Economic
Analysis; U.S. Bureau of Labor Statistics, Minnesota Department of Employment and Economic Development
What is a health care home?
• Also known nationally as the patient centered
medical home or federally as APC, advanced
primary care or a “health home”.
• A health care home is an approach to primary
care in which primary care providers, families
and patients work in partnership to improve
health outcomes and quality of life for individuals
with chronic or complex health conditions.
• Reimbursement for care coordination –
something that is not paid for now
Primary 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 me.
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.
I know I deliver high quality care because
I’m well trained.
It’s up to the patient to tell us what
happened to them.
Clinical operations center on meeting the
doctor’s needs.
Health Care Homes
Patients and families are partners in the
provision and planning of care.
Patients have agreed to participate in our
HCH and understand how to contact our HCH.
Proactive care planning is developed with the
patient / family to anticipate patient’s needs.
Care is standardized with evidence-based
guidelines and planned visits.
A team, including the care coordinator,
coordinates care with patients and families.
We measure our quality and outcomes and
make ongoing changes to improve it. We
include patients / families in our quality work.
We use a registry to track visits and tests and
we do follow-up after ED and hospital visits.
A multidisciplinary team works at the top of
our licenses to serve patients.
What We Know About Care in a Patient &
Family-Centered (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
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, cost-effectiveness of services
Health Care Home Certification
• The health care home rule was adopted and
published on January 11, 2010.
• Clinics complete the application process online.
• Clinics may apply for certification on behalf of
individual clinicians, departments, entire clinics or
several clinics in an organization.
• There is flexibility for innovation built into the
application process.
Certification Updates
• Forty three clinics consisting of 354 clinicians
have requested access for application.
• Clinic applicants are from all over the State with
a variety of different clinic types such as solo
practitioners, rural, urban, community clinics, and
large organizations.
• All types of primary care providers are applying,
family medicine, pediatrics, internal med,
med/peds and geriatrics.
• We plan to do our first site visit in May 2010.
What Makes Minnesota’s 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 consistent payment methodology,
per-person payment for care coordination
• Integration of community partnerships to the HCH
• Outcomes measurement with accountability
• Focus on patient- and family-centered care concepts
Definitions: HCH team
• Subp. 23. Health care home team or care
team. “Health care home team” or “care team”
means a group of health care professionals who
plan and deliver patient care in a coordinated
way through a health care home in collaboration
with a participant. The care team includes at
least a personal clinician or local trade area
clinician and the care coordinator, and may
include other health professionals based on the
participant’s needs.
Teams listen to each other and are
committed to building trust.
We have focused on patient-and familycentered care as one of our core
principles!
What is Patient-and family-centered care?
• Patient- and family-centered care is an
innovative approach to the planning, delivery,
and evaluation of health care that is grounded in
mutually beneficial partnerships among health
care patients, families, and providers.
• Patient- and family-centered care applies to
patients of all ages, and it may be practiced in
any health care setting.
Institute for Family-Centered Care
What are the core concepts of patientand family-centered care?
Dignity and Respect.
• Health care practitioners listen to and honor
patient and family perspectives and choices.
• Patient and family knowledge, values, beliefs
and cultural backgrounds are incorporated into
the planning and delivery of care.
What are the core concepts of patientand family-centered care?
Information Sharing.
• Health care practitioners communicate and share
complete and unbiased information with patients
and families in ways that are affirming and useful.
• Patients and families receive timely, complete, and
accurate information in order to effectively
participate in care and decision-making.
What are the core concepts of patientand family-centered care?
• Participation
Patients and families are encouraged and
supported in participating in care and
decision-making at the level they choose.
What are the core concepts of patientand family-centered care?
Collaboration.
• Patients and families are also included on an
institution-wide basis.
• Health care leaders collaborate with patients and
families in policy and program development,
implementation, and evaluation; in health care
facility design; and in professional education, as
well as in the delivery of care.
Improving healthcare
“Making patients and their families truly the
force that drives everything else in health
care is perhaps the most revolutionary tool
of all. It’s importance is evident at the
system level, but it comes though even
more strongly at the personal level.”
– Donald Berwick, CEO The Institute for Healthcare Improvement
Why have Patient/family Partners?
• Patients with chronic health care needs and
their families have a unique expertise based on
their experiences of being service consumers.
• They bring the perspective that providers and
policy-makers do not have - the perspective of
someone very close to the system but not
constrained by the traditions of the system.
Minnesota’s Vision for
Health Care Homes:
Transformational change in
care delivery
•Changes in clinic / community
infrastructure and culture
•Creation of a patient- and familycentered care system
Measurement focused on
“IHI Triple Aim”
Payment blends payments for
services and coordination of care
Health Care Homes Contacts:
[email protected]
http://www.health.state.mn.us/healthreform/homes/index.html
651-201-3769
Cherylee Sherry, MPH, CHES
HCH Senior Planner
[email protected]