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The Minnesota Department of Health and the Minnesota Department of Human Services are jointly leading Minnesota’s Health Care Homes Project. In 2008, the state enacted legislation requiring that all state-regulated Minnesota payers begin paying for health care homes. The state then worked with a wide range of stakeholders to develop specific criteria for certifying practices as health care homes. The Health Care Homes program formally began in July 2010. As of May 2012, there were 190 certified health care homes in Minnesota serving more than 2 million Minnesotans. These practices, which together employ more than 1,750 providers, are geographically dispersed and serve a wide range of patients. Practices receive support through a learning collaborative, practice coaching, and data feedback.
 
Minnesota’s multi-payer program is unique in several respects:
  • Practices are required to have quality improvement teams that include patients/families.
  • Enhanced payment is only made on behalf of patients with at least one chronic condition.
  • In order to receive enhanced reimbursement for a given patient, the practice must actively identify him or her as qualifying member of their panel. In most other multi-payer initiatives, plans determine patient attribution.
Going forward, the state hopes to develop accountable care organization (ACO) models built on the health care home model.
 
Federal support: Minnesota is receiving several types of federal support:
  • Minnesota is one of the eight states selected to participate in the Medicare Advanced Primary Care Practice (MAPCP) demonstration program, though several Minnesota counties are being excluded from MAPCP due to participation in a Medicare 646 Quality Demonstration.
  • The state has received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate primary, acute, behavioral and long-term supports and services for dual eligibles.”
  • HealthPartners Research Foundation has a grant from the Agency for Healthcare Research & Quality (AHRQ) to study how primary care clinics in Minnesota become health care homes.
  • The federal government provides federal financial participation (FFP) for the enhanced reimbursements that Medicaid managed care organizations and Medicaid fee-for-service pay to participating practices.
Last Updated: March 2013

 

Forming Partnerships

The Minnesota Departments of Health and Human Services hosted many meetings to develop the Health Care Homes Program. Stakeholders in attendance included representatives of:

  • providers and their professional associations
  • health plans
  • patients and families
  • patient advocates

For more information, please see the 2009 Annual Report.
Defining & Recognizing a Medical Home
Definition: According to the Minnesota Health Care Homes website, 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 health conditions and disabilities.”
 
Recognition: The state-developed certification standards include expectations related to:
 
1.      Access and communication
2.      Participant registry and tracking participant care activity
3.      Care coordination
4.      Care plan
5.      Performance reporting and quality improvement
6.      Patient- and family- centered care
7.      Team-based care delivery
8.      Submission of quality data to Minnesota Community Measurement
 

The certification rule is available here. Additional information for practices is also available.
Aligning Reimbursement & Purchasing
Medicaid received state plan amendment approval from the Centers for Medicare & Medicaid Services (CMS) in July 2010 to begin making health care homes payments. As per Minnesota law, state-regulated payers are required to pay for health care home services in manners that are consistent with the Medicaid fee-for-service methodology.
 
The following payers and purchasers are making enhanced payments:
  1. State employee group insurance
  2. Blue Plus (Blue Cross Blue Shield of Minnesota)
  3. HealthPartners
  4. Itasca Medical Care
  5. Medica
  6. Metropolitan Health Plan
  7. Preferred One
  8. Primewest Health
  9. South County Health Alliance
  10. UCare Minnesota
Payments vary by the number of chronic conditions a patient has. A provider caring for a Medicare patient with one major chronic conditions receives a payment of $10.14 per member per month (PMPM); the rate increases to $45.00 PMPM for a patient with ten or more chronic conditions. The monthly PMPM payment is increased by 15% if a patient’s (or patient caregiver’s) primary language is not English or if the patient (or patient caregiver) has a severe and persistent mental illness. If both of these complexity factors are present, the PMPM is increased by 30%.
 

It should be noted that Medicaid managed care plans are required to make enhanced payments.
Supporting Practices

Health care homes in Minnesota are receiving a variety of supports:

  • In select areas of the state, community care teams (CCTs) have been funded to support health care homes in, “coordinating seamlessly with a broad range of health and community service providers,” to better serve patients and families. Further information is available in the CCT request for proposals.
  • Practice coaching is available through several state-funded health care homes regional nurse consultants.
  • The Institute for Clinical Systems Improvement (ICSI) has been selected to lead a statewide health care home learning collaborative.
  • Minnesota maintains a resource guide of materials that may help practices in undertaking transformation.

Payers are providing data feedback to support health care homes in measuring progress and identifying areas for improvement.
Measuring Results Minnesota’s Outcomes Measurement Work Group has developed recommendations for the state’s evaluation. The Work Group has proposed to focus on clinical quality (especially care for patients with asthma and vascular conditions), patient access to care and experience of care, and cost (especially rates of hospitalizations, readmissions, emergency department use, and total cost of care).

 

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