Tracking Reform
Public Health
MDH Accepting Grant Applications
The Minnesota Department of Health is now accepting applications from community health boards and tribal governments seeking public health grants to reduce tobacco use and prevent obesity.
The 2008 Health Care Reform Act appropriated $47 million over two years in public health funds for the program, named the Statewide Health Improvement Program. Gov. Tim Pawlenty has proposed reducing this amount to $24 million over four years in his current budget plan. The Legislature has not yet acted on that recommendation.
Only community health boards and tribal governments are eligible for the funds. The application deadline is April 13. A copy of the request for proposals is available at www.health.state.mn.us/healthreform/ship.
Health Care Homes
Drafting Health Care Home Standards
On February 28, the MMA cosponsored a health care home summit as a forum for physicians to comment on and help define the health care home standards the state is currently developing as part of the 2008 Health Care Reform Act.
Other sponsors included 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.
Payment Reform
Developing Statewide Pay-for-Performance System
MN Community Measurement, which is under contract with the state to develop a statewide quality-improvement and reporting system, released 11 preliminary recommendations in February for how a statewide pay-for-performance system should work.
MN Community Measurement partnered with the University of Minnesota School of Public Health to craft the recommendations. They advised that a pay-for-performance mechanism for clinics should:
- Institute payments that are a percentage of a clinic’s revenue, noting that research has indicated that 1 percent to 3 percent may be sufficient to yield results;
- Use MN Community Measurement performance measures for diabetes, vascular care, asthma management, cancer screenings, and health information technology implementation;
- Implement a two-tiered approach that would reward clinics for both improving their scores and reaching community benchmarks;
- Use a point system that would aggregate scores across all performance measures to weigh some more heavily than others when determining financial awards;
- Risk-adjust case mixes, possibly by allowing the exclusion of certain populations from the group of patients whose results are being measured; and
- Study whether advanced statistical risk-adjustment methods might yield data more representative of clinical quality.
For hospitals, MN Community Measurement recommended using Hospital Compare measures and methods.
You can find a complete list of the recommendations at www.health.state.mn.us/healthreform/measurement/publicmeetings.html. The Minnesota Department of Health is accepting comments from the public about them until March 13. Email your thoughts to comments@mnhealthcare.org.
Defining Baskets of Care
Committees started meeting in February to define seven “baskets of care,” conditions or services that have defined sets of services associated with their treatment or delivery. The idea behind baskets of care is to test alternatives to the fee-for-service payment system, as clinics will set a standard price for each basket. All payers must pay that price. Physicians were appointed by the MMA to serve on the committees that are defining baskets for the following services or conditions:
- diabetes without comorbidities except for hypertension and hyperlipidemia,
- preventive services for children,
- preventive services for adults,
- asthma care for children,
- obstetrical care,
- total knee replacement,
- low-back pain.