Minnesota’s Health Care Home Initiative in Context NASHP Learning the ABCs of APCs and Medical Homes October 5, 2010 Ross ...
<ul><li>Minnesota Builds on a Solid Foundation for Reform: </li></ul><ul><ul><li>Consistently ranked as one of the healthi...
2008 State Health Reform Cornerstones <ul><li>Population Health (Prevention, Determinants) </li></ul><ul><li>Market Transp...
Health Care Home (HCH) Components <ul><li>“ Real Transformation” </li></ul><ul><ul><li>Statewide certification process wit...
Key Design Feature #1:  Statewide Scope and “Critical Mass” of Payment
Key Design Feature #1 (contd.):  Statewide Scope and “Critical Mass” of Payment SOURCE:  Adapted from MDH Health Economics...
Key Design Feature #2:  Complexity-Tiered Payment <ul><li>PMPM payment = sum of previously non-billable care coordination ...
Key Design Feature #2 (contd.):  Complexity-Tiered Payment <ul><li>Rate structure based on informed estimates of the actua...
Key Design Feature #3:  Patient- and Family-Centered Care Principles <ul><li>Required patient and family involvement in HC...
Looking Ahead to Federal Reform <ul><li>“ Health Homes” in PPACA </li></ul><ul><ul><li>Apparent concordance with requireme...
Thank you New Orleans!
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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

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

  1. 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. 2. <ul><li>Minnesota Builds on a Solid Foundation for Reform: </li></ul><ul><ul><li>Consistently ranked as one of the healthiest state populations </li></ul></ul><ul><ul><li>Relatively low rate of uninsured </li></ul></ul><ul><ul><li>Collaborative, non-profit health plan culture </li></ul></ul><ul><ul><li>Highly integrated delivery system </li></ul></ul><ul><li>… But …We Share the Same Challenges: </li></ul><ul><ul><li>State budget pressures on the safety net </li></ul></ul><ul><ul><li>Lack of coordination of care, particularly for chronic conditions </li></ul></ul><ul><ul><li>Uneven quality, uncertain value </li></ul></ul>
  3. 3. 2008 State Health Reform Cornerstones <ul><li>Population Health (Prevention, Determinants) </li></ul><ul><li>Market Transparency and Enhanced Information </li></ul><ul><li>Care Redesign and Payment Reform: Health Care Homes </li></ul>
  4. 4. Health Care Home (HCH) Components <ul><li>“ Real Transformation” </li></ul><ul><ul><li>Statewide certification process with Learning Collaborative support </li></ul></ul><ul><li>“ Real Reimbursement” </li></ul><ul><ul><li>Multi-payer payment methodology </li></ul></ul><ul><li>“ Real Results” </li></ul><ul><ul><li>Measurement of “Triple Aim” outcomes with provider accountability </li></ul></ul>
  5. 5. Key Design Feature #1: Statewide Scope and “Critical Mass” of Payment
  6. 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. 7. Key Design Feature #2: Complexity-Tiered Payment <ul><li>PMPM payment = sum of previously non-billable care coordination services provided by the HCH Team </li></ul><ul><li>5 Tiers of Patient Complexity: Populations will differ </li></ul><ul><li>Provider assessment of patient complexity  Administrative standard for billing </li></ul>
  8. 8. Key Design Feature #2 (contd.): Complexity-Tiered Payment <ul><li>Rate structure based on informed estimates of the actual work required in each Tier </li></ul><ul><li>In Medicaid FFS, payment for Tiers 1-4 (all patients with one or more major chronic condition) range from $10-$61 PMPM </li></ul><ul><li>Deliberate inclusion of lifestyle/psychosocial complexity factors </li></ul><ul><li>Overall requirement of budget neutrality </li></ul>
  9. 9. Key Design Feature #3: Patient- and Family-Centered Care Principles <ul><li>Required patient and family involvement in HCH practice QI efforts </li></ul><ul><li>Patient/family involvement in policy work </li></ul><ul><ul><li>Certification site visits, both as clinic reps and reviewers </li></ul></ul><ul><ul><li>Patient/family seats on steering committees and work groups </li></ul></ul><ul><ul><li>Standing HCH Consumer/Family Council </li></ul></ul><ul><li>Measurement of patient experience outcomes co-equal to health and cost outcomes </li></ul>
  10. 10. Looking Ahead to Federal Reform <ul><li>“ Health Homes” in PPACA </li></ul><ul><ul><li>Apparent concordance with requirements of 90% FFP </li></ul></ul><ul><ul><li>Interest in developing “community health team” concept further </li></ul></ul><ul><li>MAPCP Demonstration </li></ul><ul><ul><li>Federal partnership an important piece of “critical mass” </li></ul></ul><ul><ul><li>Incentive for rural practices to seek certification </li></ul></ul><ul><li>Effective, empowered, and appropriately-incented primary care is a necessary foundation of ACO models </li></ul>
  11. 11. Thank you New Orleans!

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