Health Care Homes: Better Health, Better Care, Lower Cost Marie Zimmerman, State Medicaid Director, Minnesota

Launched in 2009 to: Strengthen primary care foundation Increase care coordination Improve care experience Lower costs

SNAPSHOT 415 Health Care Homes 163 = Integrated Health Partnerships 30% = independent medical groups 55 % of primary care clinics are certified as health care homes 40% served are MA enrollees MA beneficiaries getting most of their primary care at a HCH is 40%  (416,774 out of 1045767 - excludes only non-users), based on PCP attribution

Practice Types

Certification Standards Validates: Strong partnerships, Improved experience and Lower costs Through rigorous Documentation and Site visits

Payment Structure Alignment to promote transformation Adjustment for medical and non-medical complexity Tiered payment based on majority condition groups range from $10-60 PMPM 15% add-on for Severe Mental Illness and English is not primary language • Tier 1: 1-3 major condition groups• Tier 2: 4-6 major condition groups• Tier 3: 7-9 major condition groups• Tier 4: 10 or more major condition groups DHS has a online tool to assist providers with tiering, but most still use paper

RESULTS file:///C:/Users/pwemc03/Desktop/hchbusinesscase.pdf

RESULTS Improved Health Indicators Increased Access for Disparate Populations file:///C:/Users/pwemc03/Desktop/hchbusinesscase.pdf INCREASED SATISFACTION 60% of HCH patients felt positive about shared decision making about medication 50% of HCH patients felt positive about attention to mental health and follow-up visits Higher job satisfaction Greater morale

Challenges Payment/billing is complex; revenue less predictable Only 25% of HCHs are billing for care coordination services Payment only for chronic conditions Lack of Multi-payer support Participation in MAPCP difficult Commercial payers: co-pays and ACO arrangements Insufficient upfront funding for capacity-building point 1 point 2 Point 3 Billing – DHS conducted a survey 2 years ago about billing and payment issues; providers were split between adjusting tiering and fixing billing -Medicare: high volume of Medicare Advantage Enrollees

Looking Ahead: Practice Transformation Leveraged SIM dollars to provide practice transformation grants to providers for HCH certification ($6 mil total; range $20-50k) Alignment with new Behavioral Health Homes launched in 2016

Looking ahead: Payment Reform Value-based tracks for different providers: Track 1: care management/coordination payment, at risk for cost/quality (independent HCHs) Track 2: Same as 1 with total cost of care upside/downside risk (smaller HCH systems/partnerships) Track 3: Larger care management payment and responsibility, greater total cost accountability, prospective assignment/enrollment (larger HCH systems and partnerships across different provider types) INTO THE FUTURE MACRA, national health care reform supporting value-based, coordinated care Continued certification and recertification of HCH Evolution of IHP Evolution of HCH to support efforts

Questions? Marie Zimmerman State Medicaid Director MN Department of Human Services marie.zimmerman@state.mn.us