Tracking Reform
The gears of health care reform are grinding away at the Capitol with policy makers pulling together about a dozen work groups that during the next two years will issue reports and recommendations that will affect how Minnesota physicians practice medicine.
To keep track of their progress, Minnesota Medicine will update readers monthly about what is happening regarding the key components of the 2008 Health Care Reform Act—payment reform, health care homes, quality improvement, public health, and coverage expansion. Additional information will be available online at www.mmaonline.net.
Payment reform
Watch for More on “Baskets of Care”
According to the new law, the state must develop a pay-for-performance plan that will go into effect in July 2010, establish a care-coordination fee for health care homes, and create a voluntary alternative to fee-for-service payments called the “baskets of care” model.
The idea behind baskets of care is that providers may set a price for all services associated with a procedure. Payers (excluding the government) must pay the set price, and providers must agree to charge all patients covered by employer-sponsored health plans that price. State law directs the commissioner of health to establish at least seven baskets of care.
In November, George Isham, M.D., chief health officer for HealthPartners, and Mayo Clinic cardiologist Doug Wood, M.D., were named as co-chairs of a steering committee that will work to define the baskets of care by early summer 2009.
Quality improvement
MN Community Measurement Leading Effort to Create Standard Measures
The new law calls for the Department of Health to develop a standard set of measures to assess the quality of care provided by hospitals and physicians. A subset of the measures will serve as the basis for a statewide standardized payment incentive program.
The health department has awarded a $3 million contract to MN Community Measurement to devise this new quality measurement and incentive payment system. MN Community Measurement will enlist the Minnesota Hospital Association, Stratis Health, the Minnesota Medical Association, and the University of Minnesota School of Public Health to help with its development.
Public health
Grants to Target Obesity and Smoking
The 2008 reform legislation earmarked $47 million for grants to be issued to community health boards and tribal governments starting in July 2009 to fight obesity and tobacco use. The question is whether the money will evaporate as lawmakers seek ways to cover a budget deficit that’s expected to run in the billions.
Coverage expansion
Budget Woes May Thwart MinnesotaCare Expansion
The new law includes a provision that modestly expands the MinnesotaCare subsidized insurance program to about 13,000 Minnesotans. Again, the projected budget deficit may affect whether lawmakers seek to roll back the expansion or limit further eligibility changes.
Health care homes
Workforce Shortage Group Wraps Up Its Work
A work group was created to determine whether legal barriers are preventing nurses, physician assistants, and nurse practitioners from fully using their skills. These providers are key players in the medical home or health care home model, which focuses on providing coordinated care for patients with chronic and complex conditions. The group considered issues such as the number of physician assistants a doctor should be allowed to supervise and whether nurse practitioners should have independent prescribing rights.
The group is scheduled to finish its work this month and submit its final report to Commissioner of Health Sanne Magnan, M.D., who will present it to the Legislature in January.
Physicians serving on the work group include Randy Rice, M.D., a family physician in Moose Lake, who represents the MMA, and family physician David Thorson, M.D. Rice says he hopes the group’s recommendations will support the health care home model and promote teamwork among providers.
Grading and Certifying Health Care Homes
With the state committed to implementing the health care home model of care delivery, it wants to make sure it will get a return on its investment in care coordination. To that end, the Minnesota Department of Health has given the Institute for Clinical Systems Improvement (ICSI) the job of defining a set of financial benchmarks and patient outcomes that should be considered when evaluating the success of health care homes. ICSI must submit its recommendations to the commissioner of health by December 31.
In addition, a work group must make draft recommendations about health care home certification standards by February of next year.