Tracking Reform
Quality Improvement
State Forced to Change Peer Grouping Timeline
The Minnesota Department of Health announced in February that it had signed an 18-month $1.7 million contract with Mathematica Policy Research, a Princeton, New Jersey, health care research and analysis firm, to develop cost and quality measures and analyze data for the state’s provider peer-grouping initiative.
Terms of the contract alter the timeline in current law for releasing data to providers and the public, a change the MMA has pushed for. Under the agreement with the state, Mathematica proposes to complete the peer-grouping work in two stages. The first would focus on development of combined measures of cost and quality performance for “total care.” Results would be disseminated to providers by October 8, 2010, rather than June 1 (the original deadline). The second involves development of the combined measures of cost and quality performance for six conditions or procedures—diabetes, coronary artery disease, pneumonia, asthma, congestive heart failure, and total knee replacement. Those results would be shared with providers by December 13, 2010, rather than June 1 (see chart).
Mathematica also will analyze the all-payer claims data that Onpoint Health Data has been collecting since July on behalf of the Minnesota Department of Health. In addition, the firm will utilize the clinic- and hospital-reported quality data reported to MN Community Measurement to calculate cost and quality scores for clinics and hospitals.
The state intends to select a separate vendor to make the cost and quality information available to payers, the public, and other parties. The law originally called for public access to the information by September 1, 2010. Because of the changes to the timeline, department officials are planning to make the data for total care results public by January 2011 and for condition-specific results by March 2011.
The MMA has been working with the health department for more than six months to strengthen the value of the peer-grouping initiative. In addition, the MMA has worked with lawmakers to introduce a bill (H.F. 3056/S.F. 2815) that would 1) allow providers to use the results for quality improvement, which is where the greatest benefit can be obtained; 2) provide clinics and hospitals with adequate time to review, understand, and validate their results prior to making the data public; and 3) repeal a 2009 law that would prohibit providers whose cost and quality scores fall in the lowest 10th percentile from serving patients in state-sponsored health programs.
Minnesota’s Provider Peer-Grouping Project Timeline
Health Care Homes
Health Care Home Payment Rates Announced
The Minnesota Department of Human Services announced in March the amounts that it will pay health care homes for delivering care coordination services to patients with severe, chronic medical conditions who are enrolled in state- sponsored health care programs.
Those rates will range from $10 to $60 per health care home enrollee per month, depending on the complexity of the patient’s illness profile. The average payment is expected to be $31 a month per enrollee. A clinic must be certified by the state as a health care home in order to qualify for care coordination payments.
The state will start offering care coordination payments July 1 to certified health care homes.