Innovative Models:Medicare’s Health Care Home

Age and Disability Odyssey Conference6/20/11

John SelstadMinnesota Board on Aging

MN Health Reform

In 2008 MN legislature passed health reform legislation that takes a comprehensive approach.

• Public health investment• Market transparency• Care redesign and payment reform• Consumer engagement

What is a health care home?

• Also known nationally as the patient centered medical home or federally as APC, advanced primary care or a “health home”.

• 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 or complex health conditions.

• Reimbursement is made for care coordination – something that is not paid for now

Primary Care Delivery Redesign,

What is different?Today’s Care Health Care Homes Patients are recipients of services by providers and clinics.

Patients and families are partners in the provision and planning of care.

Patients are those who make appointments to see me.

Patients have agreed to participate in our HCH and understand how to contact our HCH.

Care is determined by today’s problem and time available today.

Proactive care planning is developed with the patient / family to anticipate patient’s needs.

Care varies by memory or skill of the provider.

Care is standardized with evidence-based guidelines and planned visits.

Patients are responsible to coordinate their own care.

A team, including the care coordinator, coordinates care with patients and families.

I know I deliver high quality care because I’m well trained.

We measure our quality and outcomes and make ongoing changes to improve it. We include patients / families in our quality work.

It’s up to the patient to tell us what happened to them.

We use a registry to track visits and tests and we do follow-up after ED and hospital visits.

Clinical operations center on meeting the doctor’s needs.

A multidisciplinary team works at the top of our licenses to serve patients.

What We Know About Care in a Patient & Family-Centered (Health Care) Home:

• Patient and family-centered care is increased

• Family worry and burden are reduced• Care coordination and chronic condition

management lead to:• Reduction in emergency room use • Reduction in hospitalizations • Reduction in redundancy• Efficiency and effectiveness are increased

Center for Medical Home Improvement

Health Care Home Certification

• The health care home rule was adopted and published on January 11, 2010.

• HCH certification is voluntary for clinics / clinicians.• Providers who provide the full scope of primary care

services can apply, including geriatricians. • There is flexibility for innovation built into certification.• Clinics are recertified annually. Over time based on

improvements in outcomes measures.

Health Care Home Standards

• Access: facilitates consistent communication among the HCH and the patient and family, and provides the patient with continuous access to the patient’s HCH

• Registry: uses an electronic, searchable registry that enables the HCH to identify gaps in patient care and manage health care services

• Care coordination: coordination of services that focuses on patient and family-centered care

• Care plan: for selected patients with a chronic or complex condition, that involves the patient and the patient’s family in care planning

• Continuous improvement: in the quality of the patient’s experience, health outcomes, cost-effectiveness of services

MN Health Care Home Rule, Community Partnerships

• Patient’s team is defined by the patient’s needs.

• Care planning is done with extended community partners. Goal, one comprehensive care plan.

• HCH’s required to establish partnerships with community referral resources.

HCH Certification Updates

# Certified: Clinics: 134# Certified Providers: 1,651

Patients receiving health care in a certified clinic: 1,797,230.

May 16, 2011

• Applicants are from all over the State

• Variety of practice types such as solo, rural, urban, independent, community, FQHC and large organizations.

• All types of primary care providers are certified, family medicine, peds, internal med, med/peds and geriatrics.

Certified Clinicians / Clinics(Examples)

• Allina Medical Clinics• Bluestone Physician Service• CentraCare Health System• Children’s Clinics• Christopher J. Wenner, MD• Fairview Clinics• HealthPartners• Lakewood Health Clinics• Mankato Clinic, Pediatrics• Mayo Health System-Austin

Medical Center, FM

• Mayo Health System - Owatonna Pediatrics

• Mayo Clinic -Employee Community Health Clinics

• North Metro Pediatrics• NorthPoint Health & Wellness• Park Nicollet, St. Louis Park,

Minneapolis, Eagan & Plymouth Clinics

• SMDC Pediatric Clinic• United Hospital District Clinics • University of Minnesota

Physicians Clinics

MN’s Population by Insurance Status: The Payment Reform “Critical Mass”

Challenge

SOURCE: Adapted from MDH Health Economics Program, Medicare enrollment data and SEGIP enrollment data

MAPCP Demonstration: CMS Goals

• Join state-led, multi-payer medical home initiatives in progress by adding payment for Medicare FFS enrollees to them

• Evaluate the impact of advanced primary care on quality, utilization, and expenditures

• Ensure budget neutrality

Demo Sites Awarded in November 2010

New YorkNorth Carolina

MaineMichigan

MinnesotaMinnesotaPennsylvaniaRhode Island

Vermont

MN MAPCP Demo: Quick Facts

• All certified HCHs will be eligible to participate by billing for their eligible Medicare patients

• The demo will last 3 years• Over 200,000 MN beneficiaries are projected

to participate• Dollars will go from Medicare directly to the

practices using a similar rate structure to FFS Medicaid (est. to start October 2011)

MN’s Unique HCH Payment System

• Monthly per-person care coordination payment to clinics, adjusted by the level of patient complexity

• 5 Tiers of Patient Complexity: Populations will differ

• Provider assessment of patient complexity Administrative standard for billing

MAPCP Further Opportunities

• Fostering partnerships between HCHs and community resources focused on Medicare beneficiaries

• Engaging providers (esp. rural) who would not otherwise have considered being a HCH

• Linkage between MN and the CMS Center for Innovation

Health Care Homes Contacts:

health.healthcarehomes@state.mn.us

http://www.health.state.mn.us/healthreform/homes/index.html

651-201-5421 651-431-4228

Marie Maes-Voreis, RN MA Ross Owen

HCH Program Director Care Delivery Reform-Mgr.

marie.maes-voreis@state.mn.us Ross.Owen@state.mn.us