Marie Maes-Voreis, RN MA, Director Health Care Homes

Health Reform in Minnesota Minnesota’s Three Reform Goals Healthier communities Better health care Lower costs Institute of Medicine’s Triple Aim

MN Health Reform Transparency Statewide Quality Improvement Program, Provider Peer Groups, Health Insurance Exchange Statewide quality measures, developing provider cost and quality comparisons to be incorporated into the Health Insurance Exchange Care Redesign Payment Reform Health Care Homes / Community Care Teams Quality Incentive Payments Medicaid Health Care Delivery System Demonstration(HCDS ) HCHs serving 2.4 million, Implemented pay for performance for state programs and public employees / Medicaid HCDS Demo has contracts with 6 health systems Prevention/ Public Health Statewide Health Improvement Program, Diabetes Prevention Program (DPP) Fighting obesity and tobacco – Schools, workplaces, communities, clinics Health Reform GoalsAction2012 Results Health IT, Administrative Simplification Office of Health Information Technology Implemented common billing/coding and e- prescribing, developing statewide EHR exchange

Health Care H ome is not: Health Care H ome is: Population clinical care redesign Transformed services to meet a new set of patient-and family- centered standards to achieve triple aim Foundation to new payment models such as ACOs Community partnerships that build healthy communities A nursing home or home health care A restrictive network A service that only benefits people living with chronic or complex conditions Health Care Home

Primary Care Population Based Care Delivery Redesign, What is different?

HCH Certification Updates # Certified Clinics: 253 Total 35% of Primary Care Clinics in Minnesota (6 in border states) Applicants are from all over the state. Variety of practice types such as solo, rural, urban, independent, community, FQHC and large organizations. All types of primary care providers are certified, family medicine, pediatrics, internal medicine, med/peds and geriatrics. Certified Clinicians: 2900 Approximately 2.8 million patients receiving care in a certified HCH.

Distribution of Providers Across Planning Regions % of MN Clinics % of Health Care Home Providers N=214 HCH’s

% NP and PA Providers by Planning Region N=214 HCH’s

Health Care Home Standards Facilitates consistent communication between the HCH and patients and families, and provides the patient with continuous access to the HCH Access Uses an electronic, searchable registry that enables the HCH to identify gaps in patient care and manage health care services Registry Coordination of services that focuses on patient- and family-centered care Care Coordination For selected patients with a chronic or complex condition, that involves the patient and the patient’s family in care planning Care plan In the quality of the patient’s experience, health outcomes, cost- effectiveness of services Continuous improvement

Consumer Perspective: Better Health Made Easy Anyone can use and benefit from HCH Welcoming Providers are aware of your health history and works closely with you to improve your health Relationship Based HCH coordinates services and shares information to minimize confusion and prevent duplication and gaps in care Organized HCH can help choose the best provider and specialists and helps work with your team Unrestricted HCH is designed to help you meet your health care needs, from preventive care to treatment of chronic and complex conditions Comprehensive

Legislative Requirements for HCH Care Coordination Payment [256B.073] -DHS and MDH develop a system of per-person care coordination payments to certified HCHs by January 1, Fees vary by thresholds of patient complexity -Agencies consider feasibility of including non-medical complexity information -Implemented for all public program enrollees by July 1, 2010 Payment Methodology Resources: t/index.html t/index.html 35

Multi-Payer Investment in HCH’s Primary Care Transformation SOURCE: Adapted from MDH Health Economics Program, Medicare enrollment data and SEGIP enrollment data

Analysis of HCH Payment Process DHS is conducting, with assistance of a consultant, an assessment of tier tool, billing/payment process, and methodological issues, barriers, and potential solutions Will specifically look at how any potential changes will impact the Medicaid program, and MAPCP Solutions considered by DHS for Medicaid will be coordinated with MDH and take other payers into consideration

MAPCP Demonstration: CMS Goals CMS joined state-led, multi-payer medical home initiatives in progress by adding Medicare FFS enrollees to those initiatives Evaluate the impact of advanced primary care on quality, utilization, and expenditures Ensure budget neutrality. 37

MAPCP Demo Activities Participating in MAPCP independent evaluation. Implementation of the MAPCP Resources Tool Kit for Coordination of Care and Transition Management for Elders, Resources Workgroup. Learning Collaborative Workshops for HCH’s for care coordination, behavioral health, other. DHS Medicare / Medicaid claims feedback reports.

MDH Charge Alzheimers Legislation passed in 2011(Minnesota Statutes 62U.15) directs Commissioner of Health to: 1. Review currently available quality measures for identification of people with Alzheimer’s and related dementias. 2. Develop a HCH learning collaborative curriculum which includes best practices for ID and management of Alzheimer's. 3. Review the literature to estimate differences in outcomes and costs comparing current practices to practice with “best practices” management.

Capacity Building / Practice Facilitation Regional HCH Nurses Support Technical Assistance Grants: Learning Community Grants Technical Support / Learning Collaborative Mini-Grants to support care coordination measures MAPCP Demonstration Workgroups Purchaser / BHCAG Tool Kit Building partnerships with Communities 28

Learning Collaborative Activities May 1, 2013 – 1:00pm-4:30pm May 2, 2013 – 8:00am-4:45pm – Next Date: November 2013

HCH Evaluation: Minnesota Statute §256B.0752 directs the commissioners to complete a comprehensive evaluation report of the HCH model three and five years after implementation. The first HCH evaluation legislative report is due to the legislature December 15, 2013 Second HCH evaluation legislative report is due to the legislature December 15,

Early Evidence Supporting HCH Transformation in MN AHRQ TransforMN Study, HealthPartners Research Foundation: Preliminary studies show on average HCH clinics have significantly better performance scores for diabetes and cardiovascular disease than other clinics Medical Home Transformation: A Gradual Process and a Continuum of Attainment Dr. Leif Solberg

State Innovation Model Grant (SIM) $45 million grant to boost reform efforts 2/21/2013 (CMS) announced MN as the winner of SIM grant to help drive Minnesota's efforts to provide better care at a lower cost. Minnesota was one of six states to receive the highest level of the award. Minnesota's winning grant proposal was for its Minnesota Accountable Health Model. DHS / MDH are partners with the community in implementation.

Health Care Home As Foundation to ACO’s or Total Cost of Care Payment Methods 52

Health Care Homes Contact Information rm/homes/index.html