Update on Recent Health Reform Activities in Minnesota

Health Reform Activity

• 2007 Legislative changes

• Other ongoing initiatives

• Further study/development

2007 Legislative Changes

2007 Legislative Changes:

• Insurance coverage

• Information technology:– Administrative simplification– E-health

• Mental health system reform

• Primary care payment system reform

Insurance Coverage• Public programs:

– MinnesotaCare benefits and eligibility expanded• By 2010-11, estimated increase of 54,000 additional enrollees (44,000

families with children)• Single adults without children eligible for MNCare up to 215% of

FPG in 2009

– Outreach to inform of public programs– Simplified enrollment/renewal for public programs

• Private insurance:– Expanded definition of “dependent” to include all children

through age 24

• Goal of universal coverage by 2011

E-Health: Administrative Exchanges

• Uniform Electronic Transaction and Implementation Guide Standards– Three health care administrative transactions must

be exchanged electronically using a single standard for content and format starting in 2009

• Eligibility Verification

• Claims

• Payment and Remittance Advice

– Applies to all providers and group purchasers

E-Health: Clinical Exchanges

• All hospitals and health care providers must have an interoperable electronic health records system by January 1, 2015

• The Commissioner shall develop a statewide plan to meet the mandate, including uniform standards for sharing patient data

• Electronic Health Records Grant and Loan Program– $7,000,000 in Grants– $6,300,000 in Interest-Free Loans– Program Focus: Providers in Rural and Underserved

Urban Areas

Mental Health System Reform

• Universal Model Benefit Set

• Integrated Service Networks

• Infrastructure development

Universal Model Benefit Set

• Same mental health benefits for clients in all of the state’s health care programs

• Treats mental illness as a chronic illness no longer requiring a “disabled” status to get services

• Uses evidence base to create the benefit set

Integrated Service Networks

• Three pilot county/health plan partnerships

• Includes:– Co location and integration with primary care– Consultation– Partnership with social services– Care coordination– Addresses current and future workforce issues

Infrastructure support

• Recognizes the difficulties with insurance/enrollment for those with mental illness

• Recognizes the state as the payer and provider of uncompensated care for those who do not receive timely treatment

• Provide support to counties to develop, expand or enhance the array of community-based services for children and adults with mental illnesses.

Primary Care/ Payment system Reform

• Provider Directed Care Coordination

• CAPS- Medicaid Transformation Grant

• Q care pay for performance

• Patient incentives

• Health care payment system reform report and pilots

Provider Directed Care Coordination

• Payment on a Per member per month basis for:– Patients in the Fee for service population whose

health needs are above a defined level of complexity

– Cared for in clinics that provide a set of care coordination / medical home services

CAPS – Communication and Accountability in Primary Care

System• Creates a two way electronic interface

directly between DHS and providers and patients

• Primarily to support care coordination• Also to support the mental health initiatives/

prior authorization/ medication therapy management

• Federal funding

Q care pay for performance

• Payment for meeting quality targets for Diabetes care and Cardiovascular disease

• Payments for both– Clinic level aggregate performance– Individual level optimal care

• Patient incentive program also being developed

Health Care Payment Reform Report and Pilots

• DOER/DHS/Commerce/MDH• Report changing payment rates and

methods to reward:– Cost effective primary and preventive care– Evidence based care

• Pilot grants to support innovation in care coordination efforts

Other Ongoing State Initiatives

Other Ongoing State Initiatives

• Health care data exchange

• Smart Buy Alliance

• QCare: Quality Care and Rewarding Excellence

• Pay for performance– Bridges to Excellence

Health Care Data Exchange• E-Health Advisory Committee

– Public-private collaborative to accelerate the adoption and use of health information technology in order to improve health care quality, increase patient safety, reduce health care costs and improve public health

• Minnesota Administrative Uniformity Committee– Develops agreement among Minnesota payers and providers on

standardized administrative processes when implementation of the processes will reduce administrative costs

• Center for Health Care Purchasing Improvement– Aids the state in developing and using more common strategies for

health care performance measurement and health care purchasing, to promote greater transparency of health care costs and quality, and greater accountability for health care results and improvement

• Federal Medicaid Transformation Grant– Phase I – Received– Phase II – Application submitted

Smart Buy Alliance

• Coalition of public and private purchasers, formed in November 2004• Pool purchasing power to drive value in the health care delivery

system• Improve quality and lower cost by:

– Reducing inappropriate and unnecessary care– Encouraging evidence-based medicine and use of highest-performing

providers– Reducing administrative costs through common reporting requirements

• Key strategies:– Reward or require “best in class” certification– Adopt and utilize uniform measures of quality and results– Empower consumers with easy access to information– Require better use of information technology

QCare

• QCare = Quality Care and Rewarding Excellence

• Build on and leverage community standards and initiatives in Minnesota to achieve rapid improvement in health outcomes– Achieve cost savings as health care quality and delivery improves

• Sets goals and standards for health care performance and quality outcomes:– Diabetes care, cardiovascular care, hospital care, and preventive

care

• Identify and reward superior quality care

Pay for Performance

• Minnesota’s Medicaid program is the first in the nation to implement pay for performance using the Bridges to Excellence approach

• QCare standards incorporated into state health care purchasing

• In addition to provider incentives, patient incentive program being developed by DHS

Further Study/Development

Further Study/Development

• Health Care Transformation Task Force (report due 2/1/2008)

• Legislative Commission on Health Care Access (report due 1/15/2008)

• Health insurance exchange study (due 2/1/2008)• Payment system reform plan (due 12/15/2007)• Purchasing pool study group (report due 2/1/2008)