Minnesota’s Health Care Home Initiative in Context

NASHP Learning the ABCs of APCs and Medical Homes

October 5, 2010Ross Owen, MPA

Minnesota Builds on a Solid Foundation for Reform:

• Consistently ranked as one of the healthiest state populations• Relatively low rate of uninsured• Collaborative, non-profit health plan culture• Highly integrated delivery system

…But…We Share the Same Challenges:• State budget pressures on the safety net• Lack of coordination of care, particularly for chronic conditions• Uneven quality, uncertain value

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2008 State Health Reform Cornerstones

• Population Health (Prevention, Determinants)• Market Transparency and Enhanced

Information• Care Redesign and Payment Reform: Health

Care Homes

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Health Care Home (HCH) Components

“Real Transformation”• Statewide certification process with Learning

Collaborative support

“Real Reimbursement”• Multi-payer payment methodology

“Real Results”• Measurement of “Triple Aim” outcomes with

provider accountability

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Key Design Feature #1: Statewide Scope and “Critical Mass” of Payment

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Key Design Feature #1 (contd.): Statewide Scope and “Critical Mass” of Payment

SOURCE: Adapted from MDH Health Economics Program, Medicare enrollment data and SEGIP enrollment data

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Key Design Feature #2: Complexity-Tiered Payment

• PMPM payment = sum of previously non-billable care coordination services provided by the HCH Team

• 5 Tiers of Patient Complexity: Populations will differ

• Provider assessment of patient complexity Administrative standard for billing

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Key Design Feature #2 (contd.): Complexity-Tiered Payment

• Rate structure based on informed estimates of the actual work required in each Tier

• In Medicaid FFS, payment for Tiers 1-4 (all patients with one or more major chronic condition) range from $10-$61 PMPM

• Deliberate inclusion of lifestyle/psychosocial complexity factors

• Overall requirement of budget neutrality

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Key Design Feature #3: Patient- and Family-Centered Care Principles

• Required patient and family involvement in HCH practice QI efforts

• Patient/family involvement in policy work– Certification site visits, both as clinic reps and reviewers– Patient/family seats on steering committees and work

groups– Standing HCH Consumer/Family Council

• Measurement of patient experience outcomes co-equal to health and cost outcomes

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Looking Ahead to Federal Reform• “Health Homes” in PPACA

– Apparent concordance with requirements of 90% FFP– Interest in developing “community health team” concept

further• MAPCP Demonstration

– Federal partnership an important piece of “critical mass”– Incentive for rural practices to seek certification

• Effective, empowered, and appropriately-incented primary care is a necessary foundation of ACO models

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Thank you New Orleans!

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