Tracking Reform
Health care homes
Rules for Health Care Homes Finalized
The Minnesota Department of Health approved the final rules for certifying clinics as health care homes in January. The rules establish the criteria that clinics must meet to receive health care home payments for patients in public health insurance programs. The final rules can be found at www.mmaonline.net/HCHcertification. The Minnesota Department of Human Services was scheduled to announce the rates clinics would receive from the state on March 5.
Quality improvement
Bill to Change Peer-Grouping Goal Introduced
In February, the MMA worked with lawmakers to introduce legislation that would refocus the state’s peer-grouping project on quality improvement. If the bill passes, it would create a quality-improvement program that would help clinics and hospitals improve their performance, extend the timeline for releasing quality data to the public by one year, and repeal the language that precludes providers who score in the bottom 10 percent on quality measures from treating patients covered by state-sponsored health insurance programs.
Payment reform
Pay-for-Performance Program to Begin
The state’s new pay-for-performance program, which is scheduled to begin in July, could pay clinics that achieve certain outcomes up to $100 extra per patient, according to a Minnesota Department of Health report released in January. The payments would be available to providers who treat state employees or patients enrolled in state safety-net programs.
The report describes both the methodology and the quality measures that will be used during the first year by the Minnesota Quality Incentive Payment System, a pay-for-performance system created by the state’s 2008 Health Care Reform Act.
Incentive payments would be awarded for optimal diabetes and vascular care in an ambulatory setting and appropriate care for acute myocardial infarction, heart failure, and pneumonia in a hospital setting.
The report recommends that providers receive $100 per patient for reaching certain target goals and $50 per patient for achieving improvement goals. Although the program is scheduled to be implemented by the Minnesota Department of Human Services and the State Employee Group Insurance Program by July 1 of this year, the state has yet to commit to these payment amounts. The target goals are for 30 percent of a clinic’s patients with diabetes and 46 percent of patients with vascular disease to receive optimal care for their disease. Currently, 18 percent of patients in the state receive optimal care for diabetes and 34 percent for vascular disease.
Hospitals and clinics can reach improvement goals by achieving at least a 10 percent reduction in the gap between the defined improvement target goal and their scores from the previous year.
The report also details a process for risk-adjusting results based on a clinic’s mix of patients with public and private insurance. The data used to determine whether hospitals and clinics are meeting their goals will come from the Statewide Quality Reporting and Measurement System, which is currently being created.
Although the MMA is not convinced that paying for performance results in better outcomes for patients, the approach outlined in the report is consistent with items that the MMA has lobbied for such as using well-established quality measures, risk adjusting for patient variation, and rewarding physicians for making quality improvements over time.
Public health
SHIP Report Released
The Minnesota Department of Health released a report to the Legislature in February about the status of the State Health Improvement Project (SHIP), the goal of which is to reduce tobacco use and obesity by making communities healthier. The report can be found at www.mmaonline.net/shipreport. Shortly after the report’s release, Gov. Tim Pawlenty proposed cutting $10 million from the $47 million that was originally budgeted for the program.