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:

  1. Medicare, through the Multi-payer Advanced Primary Care Practice Demonstration
  2. State employee group insurance
  3. Blue Plus (Blue Cross Blue Shield of Minnesota)
  4. HealthPartners
  5. Itasca Medical Care
  6. Medica
  7. Metropolitan Health Plan
  8. Preferred One
  9. Primewest Health
  10. South County Health Alliance
  11. 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.
Going forward, the state hopes to develop accountable care organization (ACO) models built on the health care home model.
Federal support: Minnesota is receiving several types of federal support:
  • 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

Forming Partnerships
The Minnesota Departments of Health and Human Services hosted many meetings to develop the Health Care Homes Program. Stakeholders in attendance included representatives of:
  • providers and their professional associations
  • health plans
  • patients and families
  • patient advocates
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:
  1. Access and communication
  2. Participant registry and tracking participant care activity
  3. Care coordination
  4. Care plan
  5. Performance reporting and quality improvement
  6. Patient- and family- centered care
  7. Team-based care delivery
  8. Submission of quality data to Minnesota Community Measurement
The certification rule is available hereAdditional information for practices is also available.
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:
  1. State employee group insurance
  2. Blue Plus (Blue Cross Blue Shield of Minnesota)
  3. HealthPartners
  4. Itasca Medical Care
  5. Medica
  6. Metropolitan Health Plan
  7. Preferred One
  8. Primewest Health
  9. South County Health Alliance
  10. UCare Minnesota
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.
  • Tier 1 (1-3 major condition groups): $10.14 per-member per month (PMPM) payment
  • Tier 2 (4-6 major condition groups): $20.27 PMPM
  • Tier 3 (7-9 major condition groups): $40.54 PMPM
  • Tier 4 (10+ major condition groups): $60.81 PMPM
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%.
Supporting Practices
Health care homes in Minnesota are receiving a variety of supports:
  • In select areas of the state, community care teams (CCTs) have been funded to support health care homes in, “coordinating seamlessly with a broad range of health and community service providers,” to better serve patients and families. Further information is available in the CCT request for proposals.
  • Practice coaching is available through several state-funded health care homes regional nurse consultants.
  • The Institute for Clinical Systems Improvement (ICSI) has been selected to lead a statewide health care home learning collaborative.
  • Minnesota maintains a resource guide of materials that may help practices in undertaking transformation.
Payers are providing data feedback to support health care homes in measuring progress and identifying areas for improvement.
Measuring Results
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:
  • Clinical Quality: The report found that health care home practices performed better than non-health care home practices on a variety of clinical quality measures, including (* indicates statistically significant difference):
    • Colorectal cancer screening*,
    • Asthma care*,
    • Diabetes care*,
    • Vascular care* (percentage of patients with Ischemic Vascular Disease who have optimally managed modifiable risk factors), and
    • Depression follow-up.
  • The report notes that all statistically significant results indicated that clinical quality at health care home practices was higher than clinical quality at non-health care home practices. Asthma care showed the largest difference in quality of care (over 20%) between health care homes and non-health care homes.
  • Utilization: Medicaid enrollees attributed to health care home practices had significantly fewer emergency department visits than those attributed to non-health care home practices in 2010, 2011, and 2012.
  • Cost: Over the three-year evaluation period, the average per-member cost for Medicaid enrollees attributed to health care homes was $2,588, compared to $2,850 for enrollees attributed to non-health care home practices. This represents 9.2% net cost savings.
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).