ross owen - minnesota’s health care home initiative in context
Post on 27-Jun-2015
504 Views
Preview:
DESCRIPTION
TRANSCRIPT
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
2
2008 State Health Reform Cornerstones
• Population Health (Prevention, Determinants)• Market Transparency and Enhanced
Information• Care Redesign and Payment Reform: Health
Care Homes
3
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
4
Key Design Feature #1: Statewide Scope and “Critical Mass” of Payment
5
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
6
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
7
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
8
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
9
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
10
Thank you New Orleans!
11
top related