Tracking Reform
Health Care Homes
Physicians Comment on Health Care Home Standards
In March, the MMA and several state specialty societies sent comments to the Minnesota departments of Health and Human Services regarding proposed standards for certifying clinics and providers as health care homes.
The comments were based on feedback from about 80 physicians who attended a health care home summit in February. The summit was sponsored by the MMA, the Minnesota Academy of Family Physicians, the Minnesota chapter of the American Academy of Pediatrics, and the Minnesota chapter of the American College of Physicians.
At that summit, the Minnesota Department of Health distributed five draft standards that included more than 25 criteria for certifying and recertifying health care homes.
In general, physicians thought the state should scale back the requirements to encourage more clinics to become certified as health care homes and allow a broad range of patients with chronic conditions to qualify for care coordination services.
The following is a summary of some key criteria in the Department of Health’s draft standards and comments that were included in a letter sent to Health Commissioner Sanne Magnan, M.D., Ph.D., and Human Services Commissioner Cal Ludeman.
According to the Minnesota Department of Health, to receive certification as a health care home, a clinic or provider must:
- Provide patients access to an on-call provider at all times. Physicians were concerned that this would limit the ability of some small or rural practices to become health care homes.
- Offer same-day appointments using an established protocol. Health and Human Services officials were asked in the letter to clarify this standard so clinics could qualify as long as they had a protocol for same-day care for urgent or specified acute conditions.
- Maintain a patient registry that can be accessed at all times by the health care home team. No one contested the need for maintaining patient registries. However, physicians would like to see 24-hour access be a goal rather than a requirement because many clinics do not have interoperable electronic health record systems, and state law doesn’t require them until 2015.
- Act as a first point of contact for preventive, acute, and chronic care. State officials were asked to explicitly clarify that the health care home would be a first point of contact, but not an insurance gatekeeper charged with preauthorizing care.
- Include someone on the team who has dedicated time and space to coordinate care and to work with patients to achieve treatment goals. Physicians said they liked the flexibility of this requirement.
- Have a documented process for tracking referrals, admissions, and discharges to and from hospitals and nursing homes. Physicians supported the idea of making the health care home responsible for tracking referrals that it made or had knowledge of, rather than all referrals.
In order to be recertified as a health care home each year, a clinic or provider must:
- Demonstrate that it has tried to improve the quality of care it provides to patients with chronic diseases.
Health and Human Services officials were urged in the letter to minimize administrative burdens and capitalize on existing quality measures rather than create new ones for health care homes.
- Incorporate principles of patient-centered care and shared decision-making. Physicians called for the state to better define expectations regarding shared decision-making and whether it would be a requirement for certification or recertification.
- Use an electronic database to manage patient reminders and previsit planning and to identify gaps in care. Physicians requested more detail about what types of data would be required.
The Department of Health is expected to make the complete list of regulations—known as rules—available for public comment at the end of April. Physicians and the public will have 30 days to comment. Visit www.mmaonline.net for updates.