Tracking Reform
Health Care Homes
State Finalizes Certification Standards
The Minnesota Department of Health has finalized its criteria for health care home certification. To receive certification, a clinic or provider must:
- Provide patients with access to designated clinic staff, an on-call provider, or a phone triage system at all times;
- Offer same-day appointments during the work week using an established protocol;
- Maintain a patient registry that includes patient medical record information that can be accessed at all times by the health care home team;
- Act as a first point of contact for preventive, acute, and chronic care;
- Have someone on the team who has dedicated time and space to coordinate care and to work with patients to achieve treatment goals;
- Have a documented process for tracking referrals, admissions, and discharges to and from hospitals and nursing homes;
- Establish a quality improvement team, and measure, analyze, and track at least one quality indicator selected by the practice;
- Participate in a health care home learning collaborative;
- Incorporate principles of patient-centered care and shared decision-making; and
- Use an electronic registry to manage patient reminders and previsit planning and to identify gaps in care needs. To learn more, go to www.mmaonline.net/HHHcertification.
MMA Comments on Payment Methodology
The MMA informed the Minnesota Department of Health in December that it was generally supportive of the proposed methodology for determining health care home payments. The proposal calls for monthly payments to vary according to the complexity of a patient’s care coordination needs. The methodology calls for creating illness complexity tiers.
The MMA said it supports the ability of provider groups to determine which patients will fit each complexity tier but wants the process to be flexible, as some providers may want to work directly with payers to help identify eligible patients. The Department of Health has yet to identify which patients will qualify for health care home care coordination payments or announce specific payment rates.
Quality Improvement
MMA Raises Concerns about Peer Grouping
The MMA has raised concerns about the peer-grouping system the state is developing as a requirement of Minnesota’s 2008 health care reform act. Peer grouping is an effort to compare the cost and quality of care provided by physicians. The initiative will initially focus on six conditions: diabetes, coronary artery disease, pneumonia, asthma, congestive heart failure, and total knee replacement.
In comments submitted to the Minnesota Department of Health late last year, the MMA expressed reservations about both the schedule for releasing data to the public and the potential use of the data being gathered, particularly in light of the fact that the analytical tools being proposed to calculate the cost and quality measures have not yet proven to be scientifically sound. Providers will receive their cost and quality scores in June; the scores are scheduled to be released to the public in September.
The MMA would like to see the timeline changed in a way that gives physicians a chance to improve their cost and quality scores before they are made public. The MMA also would like to see the emphasis of the project shifted to ensure it has quality-improvement focus. In the comments it submitted, the MMA urged the Department of Health to do the following:
- Acknowledge quality improvement as an important goal of Minnesota’s health care reform activities and support peer-grouping implementation that is consistent with that goal;
- Produce private provider reports during the first year of measurement, allowing providers adequate time to address and resolve the inevitable and likely complicated issues that will arise;
- Convene an advisory group composed of stakeholders and technical experts to provide ongoing consultation and advice to the department and the analytical contractor throughout the development of the provider peer-grouping project;
- Require that statistical reliability testing be incorporated for each measure, be transparently calculated, and be disclosed;
- Clarify how providers will access the underlying data and the mechanism for appeals; and
- Oppose the Provider Peer Grouping Advisory Committee’s recommendations to develop episode analysis at the individual provider level—a recommendation that is counter to the standard previously set in the community.