Tracking Reform
Quality Improvement
MMA Comments on Peer Grouping
The MMA submitted comments last month to the Minnesota Department of Health about its plan to develop a peer-grouping system. As part of the 2008 health care reform legislation, the state is supposed to develop a system, known as peer grouping, for comparing the performance of providers based on the cost and quality of the care they give. The health department will convene an advisory group in June to develop such a system by October. The comments are intended to serve as reference materials for the group. The MMA suggested that a peer-grouping system should focus on information that is useful to patients and consumers; assess providers at the medical group level and not at the individual physician level; use both process and clinical outcome measures, as well as patient satisfaction measures, to judge provider performance; and use risk-adjusting techniques to account for differences in patient caseload.
The MMA also asked the Department of Health to include a process for evaluating whether the peer-grouping system actually provides a benefit.
Public Health
Health Boards Apply for Grants
The 2008 Health Care Reform Act established a process through which community health boards and tribal governments could apply for grants to fund community projects. The bill included $47 million for projects aimed at addressing tobacco use and obesity. All 53 of the state’s eligible community health boards and eight of the 11 eligible tribal governments submitted proposals. Grant money will be awarded in time for the projects to begin in July. Although Gov. Tim Pawlenty proposed a nearly 50 percent reduction in funds for these projects, the Legislature has yet to change the current appropriation.
Health Care Homes
Readiness Survey Sent
Surveys were sent to more than 700 primary care practices in mid-April to assess whether they are ready to become health care homes. The Minnesota Academy of Family Physicians, Stratis Health, and the Minnesota chapter of the American Academy of Pediatrics’ Foundation are conducting surveys on behalf of the Minnesota Department of Health. If your practice received a survey, please complete it in order to indicate your degree of readiness.
Certification Rules Expected
The official rules for certifying providers as health care homes are expected to be published by mid-May. The next step in the process of creating health care homes is the development of a payment methodology.
Payment Reform
MMA Submits Comments on Baskets of Care
The MMA submitted comments to the Institute for Clinical Systems Improvement (ICSI) in April regarding its recommendations for defining seven baskets of care, groups of services or treatments associated with a particular condition or preventive visit.
ICSI is currently under contract with the state to define a set of services for each basket of care as part of a process outlined in the 2008 Health Care Reform Act. The baskets-of-care model is being tested as an alternative to the fee-for-service payment system, as clinics will set a standard price for each basket.
Committees 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 prenatal care,
- total knee replacement, and
- low-back pain.
The MMA’s comments were primarily focused on payment, delivery of care, and legal and administrative issues. For example, the MMA is concerned that current federal and state antitrust laws will make it difficult for nonintegrated hospitals and clinics to work together to manage basket payments. The MMA also wanted to know who will buy the baskets—individual patients, employers, or health plans, whether providers will have access to data about the severity of their patients’ illnesses before setting a price for a basket, and what to do if a patient does not need all of the services offered in a basket.
The MMA also stated that the baskets should be designed so that both large integrated practices and small rural ones can offer them to patients.
ICSI and the Department of Health are expected to convene additional workgroups this summer that will wrestle with such implementation issues.