Transcript Update on Recent Health Reform Activities in Minnesota Health Reform Activity • 2007 Legislative changes • Other ongoing initiatives • Further study/development.

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:
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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
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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:
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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)