Minnesota – Medical Homes
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.
Medicaid received state plan amendment approval from the Centers for Medicare & Medicaid Services (CMS) in July 2010 to begin making health care homes payments. The Health Care Homes program includes 11 participating insurers in addition to Medicaid:
- Medicare, through the Multi-payer Advanced Primary Care Practice Demonstration
- State employee group insurance
- Blue Plus (Blue Cross Blue Shield of Minnesota)
- Itasca Medical Care
- Metropolitan Health Plan
- Preferred One
- Primewest Health
- South County Health Alliance
- UCare Minnesota
According to a January 2014 report to the Minnesota Legislature, as of December 31, 2013, the state’s 322 certified Health Care Homes (HCHs) include 43% of all primary care clinics in the state and serve over 3 million Minnesotans. These practices 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.
- Minnesota is one of six states selected in February 2013 by the Centers for Medicare and Medicaid Innovation (CMMI) to receive a State Innovation Model (SIM) Model Testing Award. Minnesota received $45 million to implement and test its State Health Care Innovation Plan, which builds on the state’s Health Care Homes program and Medicaid Accountable Care Organizations, profiled on the Minnesota page of NASHP’s State Accountable Care Activity Map.
- 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.
- Minnesota has received a planning grant from the Centers for Medicare & Medicaid Services (CMS) to develop a state plan amendment to implement Section 2703 of the Affordable Care Act (ACA), establishing health homes for Medicaid enrollees with chronic conditions. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
- 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: April 2014
The Minnesota Departments of Health and Human Services hosted many meetings to develop the Health Care Homes Program. Stakeholders in attendance included representatives of:
|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:
|Aligning Reimbursement & Purchasing||
As per Minnesota law, state-regulated payers (including Medicaid managed care plans) 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:
In order to receive enhanced reimbursement, practices must actively identify patients as qualifying members of their panel. According to the state plan amendment authorizing the Medicaid payment methodology, payments are tiered based on the number of “major condition groups” (i.e., cardiovascular, respiratory, neurologic, renal, etc.) within which a patient has a severe, chronic condition requiring a care team.
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%.
Health care homes in Minnesota are receiving a variety of supports:
Payers are providing data feedback to support health care homes in measuring progress and identifying areas for improvement.
Minnesota’s Evaluation of Health Care Homes: 2010-2012, released by the Minnesota Department of Health in January 2014, produced a number of positive findings on the program’s impact on quality of care, utilization, and cost:
Minnesota’s Outcomes Measurement Work Group previously developed recommendations for the state’s evaluation, proposing to focus evaluation efforts 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).