Viewpoint
Building Health Care Homes
When the Minnesota Legislature passed the health care reform act in 2008, I was most enthused about the portion of the law that encouraged the development of health care homes (or medical homes) throughout the state. As a primary care physician, I am all too familiar with the fragmented nature of care delivery and the difficulty it poses for patients. For that reason, our practice, Family Health Services Minnesota, decided to add health care home services. We are currently conducting pilots at two of our clinics.
I am excited about implementing the health care home model and strongly believe in its benefits, but I would feel a lot more comfortable forging ahead if I knew that all of Minnesota’s payers were fully committed to financially supporting our efforts. We want to provide care coordination services, the foundation of health care homes, to all of our patients, but we are only paid for services we provide to those who are insured by a state-sponsored health plan and have one or more complex, chronic conditions. This is a problem.
Medicare will begin paying for care coordination services for patients later this fall as part of a federal demonstration project. But private health insurers are another story. State law says insurers that serve the fully insured small-group market should pay for the services, but it is not clear that they have been. And more than 40 percent of Minnesotans are covered by companies that self-fund their health plans; these plans are regulated by federal law and, therefore, are not required to support the health care home model outlined in state law.
Although I and other physicians believe Minnesota’s private health plans support the concept of health care homes, we are concerned about whether they are marketing it to employers so that these services can become a standard benefit.
As a clinic leader pushing for this change, I was glad to learn that the MMA, along with the Minnesota Academy of Family Physicians, the MN Chapter of the American Academy of Pediatrics, and the MN Chapter of the American College of Physicians, recently met with Commissioner of Health Ed Ehlinger, M.D., to discuss some of the challenges facing health care home development. During that meeting, we learned that some lawmakers are also concerned about private-payer support for health care homes and that earlier this year, the Commissioners of Health and Human Services wrote a letter to all health plans in Minnesota asking for specific information about state certified health care homes in their networks, the number of commercial enrollees in those health care homes, and their payments to health care homes. I look forward to see the results and am glad the MMA is keeping the pressure on the state, the private health plans, and employers to make health care homes a benefit for all.
In summary, I am excited about the changes we are making in our practice. As physicians, we can improve the care experience for our patients and reduce unnecessary visits, tests, and procedures. We believe becoming a health care home is one way to do this. But we can’t do it alone. We need the financial support not only of the state and federal governments but also of the commercial payers to really make it happen.