Ross Owen - Minnesota’s Health Care Home Initiative in Context

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NASHP conference session Learning the ABCs of APCs or Medical Homes

NASHP conference session Learning the ABCs of APCs or Medical Homes

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  • 1. Minnesota’s Health Care Home Initiative in Context NASHP Learning the ABCs of APCs and Medical Homes October 5, 2010 Ross Owen, MPA
  • 2.
    • 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
  • 3. 2008 State Health Reform Cornerstones
    • Population Health (Prevention, Determinants)
    • Market Transparency and Enhanced Information
    • Care Redesign and Payment Reform: Health Care Homes
  • 4. 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
  • 5. Key Design Feature #1: Statewide Scope and “Critical Mass” of Payment
  • 6. 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
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. Thank you New Orleans!