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

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

3. 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 excludes only non-users), based on PCP attribution

4. Practice Types

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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. Questions? Marie Zimmerman State Medicaid Director MN Department of Human Services