Marie Maes-Voreis, RN MA,
Director Health Care Homes
Health Reform in Minnesota
Minnesota’s Three Reform Goals
• Healthier communities
• Better health care
• Lower costs
Institute of Medicine’s Triple Aim
MN Health Reform
Health Reform Goals
Action
2012 Results
Statewide Health
Improvement Program,
Diabetes Prevention
Program (DPP)
Fighting obesity and tobacco –
Schools, workplaces,
communities, clinics
Health Care Homes /
Community Care Teams
Quality Incentive Payments
Medicaid Health Care
Delivery System
Demonstration(HCDS)
HCHs serving 2.4 million, Implemented
pay for performance for state
programs and public employees /
Medicaid HCDS Demo has contracts
with 6 health systems
Transparency
Statewide Quality Improvement
Program, Provider Peer Groups,
Health Insurance Exchange
Statewide quality measures, developing
provider cost and quality comparisons to be
incorporated into the Health Insurance
Exchange
Health IT,
Administrative
Simplification
Office of Health Information
Technology
Implemented common billing/coding and eprescribing, developing statewide EHR
exchange
Prevention/
Public Health
Care Redesign
Payment Reform
Health Care Home
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
Health Care Home is:
• Population clinical care
redesign
• Transformed services to meet a
new set of patient-and familycentered standards to achieve
triple aim
• Foundation to new payment
models such as ACOs
• Community partnerships that
build healthy communities
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 their 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.
Uses a registry to track visits and tests and
does 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. Patients /
families are partners in quality work.
HCH Certification Updates
# Certified Clinics: 226 Total
31% of Primary Care Clinics in
Minnesota (6 in border states)
Certified Clinicians:
3000
Approximately 2.7 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.
Welcome to New Certified HCH’s
Nine Newly Certified Health Care Homes since the last
quarterly meeting include:
Sanford – Pelican Rapids, Perham & Detroit Lakes
Burnsville Family Physicians
United Family Medicine
Essentia Health – Baxter, Brainerd, Moorhead, West
Duluth Clinic
Distribution of Providers Across Planning Regions
% of Health Care Home
Providers
% of MN Clinics
Southwest
7%
Southwest
2%
Southeast
9%
Northwest
11%
Southeast
25%
Minneapolis/
St. Paul
54%
Minneapolis/
St. Paul
54%
Northeast
6%
Central
13%
Northwest
5%
Northeast
2%
N=214 HCH’s
Central
12%
% NP and PA Providers by Planning Region
Minneapolis/ St.
Paul, 24%
N=214 HCH’s
Southwest, 60%
Central,
27%
Northeast, 31%
Southeast, 43%
Northwest, 23%
Certification as HCH is Voluntary
• Certification requirements are met at certification.
Recertification occurs annually on a rolling 15 months
rolling schedule thereafter.
• At recertification if there is some type of hardship a
clinic may extend recertification by 6 -12 months.
• Overtime clinics are recertified based on benchmarks.
When a clinic is superior in their benchmarks they
may request a variance for superior outcomes.
Health Care Home Standards
Access
Registry
Care
Coordination
Care plan
Continuous
improvement
• Facilitates consistent communication between the HCH and patients
and families, and provides the patient with continuous access to the
HCH
• Uses an electronic, searchable registry that enables the HCH to
identify gaps in patient care and manage health care services
• Coordination of services that focuses on patient- and family-centered
care
• For selected patients with a chronic or complex condition, that
involves the patient and the patient’s family in care planning
• In the quality of the patient’s experience, health outcomes, costeffectiveness of services
Consumer Perspective:
Better Health Made Easy
Welcoming
• Anyone can use and benefit from HCH
Relationship Based
• Providers are aware of your health history and
works closely with you to improve your health
Organized
• HCH coordinates services and shares
information to minimize confusion and prevent
duplication and gaps in care
Unrestricted
Comprehensive
• HCH can help choose the best provider and
specialists and helps work with your team
• HCH is designed to help you meet your health
care needs, from preventive care to treatment
of chronic and complex conditions
Legislative Requirements for HCH Care
Coordination Payment
[256B.073]
- DHS and MDH develop a system of per-person care
coordination payments to certified HCHs by January 1, 2010
- Fees vary by thresholds of patient complexity
- Agencies consider feasibility of including non-medical
complexity information
- Implemented for all public program enrollees by July 1, 2010
Payment Methodology Resources:
http://www.health.state.mn.us/healthreform/homes/paymen
t/index.html
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Multi-Payer Investment in HCH’s
Primary Care Transformation
SOURCE: Adapted from MDH Health Economics
Program, Medicare enrollment data and SEGIP
enrollment data
MAPCP Demonstration: CMS Goals
• CMS joined state-led, multi-payer medical
home initiatives in progress by adding
Medicare FFS enrollees to those initiatives
• Evaluate the impact of advanced primary care
on quality, utilization, and expenditures
• Ensure budget neutrality.
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Analysis of HCH Payment Process
• DHS is conducting, with assistance of a consultant,
an assessment of tier tool, billing/payment process ,
and methodological issues, barriers, and potential
solutions
• Will specifically look at how any potential changes
will impact the Medicaid program, and MAPCP
• Solutions considered by DHS for Medicaid will be
coordinated with MDH and take other payers into
consideration
Analysis of HCH Payment Process (cont.)
• The implementation of any changes will be delayed until the
broader review is complete
– CMS also needs to approve any changes to HCH payment
under the MAPCP demonstration; they have requested
changes be submitted for review as a bundle
• Goal in developing potential solutions to HCH payment issues
is to consider:
– Provider burden
– Use of the HCH tier tool and its application
– Challenges for the participation of other payers
– Original intent and goals of the program
– Coordination with development of “behavioral health
home” and other payment reform initiatives/SIM
Capacity Building Activities / Practice
Facilitation
• Statewide Regional HCH Nurses Support Technical
Assistance
• Grants: Safety Net Transformation & Community
Care Team Planning.
• Technical Support / Learning Collaborative
• Mini-Grants to support certification
• MAPCP Demonstration Workgroups
• Purchaser / BHCAG Contract
• Grant Applications
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We’re looking forward to seeing you and
your HCH team at the
Spring Learning Days
• May 1, 2013
– 1:00pm-4:30pm
• May 2, 2013
– 8:00am-4:45pm
• Marriott Minneapolis Northwest
– 7025 Northland Drive, Brooklyn Park, MN 55430
HCH Evaluation:
• Minnesota Statute §256B.0752 directs the
commissioners to complete a comprehensive
evaluation report of the HCH model three and five
years after implementation.
• The first HCH evaluation legislative report is due to
the legislature December 15, 2013
• Second HCH evaluation legislative report is due to
the legislature December 15, 2015.
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Early Evidence Supporting HCH
Transformation in MN
• Medica Study: 5% reduction in costs for patients whose
care is paid for by Medica, that compares with a 2.6%
increase in other clinics. 2011
Dr. Jim Guyn
• AHRQ TransforMN Study, HealthPartners Research
Foundation: Preliminary studies show on average HCH
clinics have significantly better performance scores for
diabetes and cardiovascular disease than other clinics.
2011
Dr. Leif Solberg
State Innovation Model Grant (SIM)
$45 million grant to boost reform efforts
• 2/21/2013 (CMS) announced MN as the
winner of SIM grant to help drive Minnesota's
efforts to provide better care at a lower cost.
• Minnesota was one of six states to receive the
highest level of the award.
• Minnesota's winning grant proposal was for its
Minnesota Accountable Health Model.
• DHS / MDH are partners with the community
in implementation.
Health Care Home As Foundation to ACO’s or
Total Cost of Care Payment Methods
52
Health Care Homes Contact Information
[email protected]
http://www.health.state.mn.us/healthrefo
rm/homes/index.html
654-201-5421