Tracking Reform
Health care homes
State Releases Health Care Home Payment Framework
At a public meeting November 16, the Minnesota departments of health and human services unveiled a proposed framework for billing and paying for health care home services. Specific payment rates, which patients will qualify for payments, and how private health plans will adopt the payment system have yet to be decided.
The proposal calls for varying monthly health care home payments according to the complexity of a patient’s care-coordination needs. Complexity will be determined by the number of major Aggregated Diagnosis Groups (ADGs) a patient has. ADGs are part of the Adjusted Clinical Groups risk-adjustment model developed at Johns Hopkins University. ADGs are groupings of diagnostic codes for conditions that are similar in terms of severity and likelihood of persistence. There are eight major ADGs that are characterized as having high severity, high diagnostic certainty, and high likelihood of requiring specialty care. Patients will be assigned to one of five tiers that correspond to the number of major ADGs they have, ranging from tier zero (no major ADGs) to tier four (four or more major ADGs).
By July 1, 2010, or upon federal approval, the state will begin making health care home payments for Medical Assistance enrollees served by clinics that are certified as health care homes.
Public comments were being accepted on the proposed recommendations through December 4, 2009. Final recommendations will then be submitted to the commissioners of health and human services for final decisions.
Health Care Home Micro-Grants Available
The Minnesota Department of Health is offering grants of up to $2,000 to help clinics improve their ability to be patient-centered health care homes.
The micro-grants can be used for projects involving patients and families in clinic redesign and to assist clinics in implementing health care home standards. Projects need to be implemented between December 2009 and May 2010.
The application deadline is December 15. For more information, contact Kathy Cairns at the Minnesota Chapter of the American Academy of Pediatrics, cairns@mnaap.org.
Quality improvement
Peer Grouping Report Released
A Minnesota work group recently released a report that is a road map for creating a peer-grouping system for comparing the cost and quality of health care providers.
The peer grouping provision of the 2008 Minnesota Health Care Reform Act requires the health department to create a combined measure of providers’ (clinics and hospitals) risk-adjusted cost and quality.
The 16-member Peer Grouping Advisory Committee met throughout the summer and fall of 2009 to advise the Commissioner of Health on a methodology that would meet the state’s requirements. The MMA appointed four of the committee’s members.
The advisory committee’s recommendations call for quality and cost measurement for six specific conditions (diabetes, coronary artery disease, pneumonia, asthma, congestive heart failure, and total knee replacement) and for total care (all physician, hospital, ancillary, and pharmacy services incurred by a patient over a period of time).
The report sought to address a variety of important, technical issues associated with developing the analysis, including how to attribute services and costs to providers, how to adjust for differences in risk across providers, which provider types/specialties should be included in the analysis, and which quality metrics should be included.
The MMA is holding a forum December 9 to give physicians an opportunity to better understand the proposed methodology and the chance to provide input to health department staff. Public comments are being accepted until December 15.
The MMA has expressed concerns about both the timeline and the expected usage of the data as outlined in the legislation. In particular, the law provides for physicians to have access to their performance data by June 1, 2010, with it being released to the public by September 1, 2010. Health plans, local units of government, and the state employee health plan may use that data to create incentives for patients to choose high-quality, low-cost providers.