The Health Care Access Commission and the Health Care Reform Review Council met last month to hear updates from the Minnesota Department of Health (MDH) and Department of Human Services on the progress of implementing the significant reform measures passed by the legislature in 2008. Assistant Commissioner of Health Scott Leitz provided an overview of the legislation, which contained a number of key elements including: public health improvement, health care coverage and affordability, chronic care management and the health care home model, payment reform and pricing transparency, and administrative efficiency.

Given the state of Minnesota's economy, there were questions over how budget constraints may delay the reform implementation. Minnesota's Commissioner of Health, Dr. Sanne Magnan, acknowledged that she did not know what final impact the budget would have on the process, but until such information was available the Department of Health would keep moving forward as planned. She reminded the group that the reform measures being discussed play a role in solving the budget problem through better value and affordability. To that end, affordability and access must be addressed simultaneously, rather than sequentially. According to Leitz, "the state is on schedule to meet statutory timelines." In his State of the State address this week, Governor Tim Pawlenty reiterated that the rate of growth in health care spending is unsustainable and must be reduced. More specific information will be available after the Governor unveils his budget proposal on January 27, 2009.

On the national level, former Senate Majority Leader Tom Daschle has been nominated by President-elect Barack Obama to be Secretary of Health and Human Services. Daschle's 2008 book, "Critical: What We Can Do About the Health Care Crisis ," provides an excellent window into the new administration's approach to reforming the national health care system.

Quality and Incentive Payment System

The Department of Health has contracted with MN Community Measurement for four years to implement the Quality and Incentive Payment System (QIPS). QIPS is designed to identify quality measures for reporting, develop an incentive payment system, and collect and report on standardized quality measures. The Department of Health will be holding public meetings with stakeholders to develop recommendations on a set of quality measures for public reporting this winter and spring. MDH will specify the quality measures and incentive payment system on July 1, 2009. It will then adopt administrative rules to implement the system, which is scheduled to be used by the State Employee Group Insurance Program (SEGIP) in 2010.

Baskets of Care

Julie Sonier, Director of the Department of Health's Health Economics Program, presented to the group on the progress of creating incentive payment systems, provider peer grouping, and developing "baskets of care." In all of these areas, the most immediate need is for more information and the state is currently working publicly with stakeholders to build the necessary knowledge base to successfully implement these reforms. Given the aggressive timelines set for these reforms, departments are simultaneously collecting data while deciding which data is necessary. The Departments of Health and Human Services are working together and with other agencies to ensure that state-of-the-art measures are used to analyze payment and provider reforms, and as a result some of the practices may evolve over the life of the project.

The Department of Health will execute a contract to facilitate a steering committee and seven working groups to examine baskets of care. The steering committee will identify episodes of care to include in the baskets as well as identify issues related to implementation and general oversight. The working groups are charged with identifying the health care services and outcomes to include in each basket as well as defining the quality measures for each of the baskets of care. They are currently soliciting members to serve on the steering committee and working groups. Any interested parties can sign up to participate on http://www.health.state.mn.us/healthreform/baskets/index.html. Working groups will meet from January 2009 to April 2009, at which point MDH will write their rules defining baskets of care.

Health Care Homes

The health care home model received a lot of attention during the 2008 session. Representative Tom Huntley, Chair of the House Health Care and Human Services Finance Division Committee, led the push to establish a comprehensive and coordinated health care delivery system. Using national examples as well as St. Mary's Duluth Clinic Heart Center program in Duluth, advocates emphasized the patient-centered approach that is measured on outcomes more than on process.

Dr. Jeff Schiff, Medical Director, Minnesota Health Care Programs, for the Department of Human Services, and Patricia Adams, Assistant Commissioner of Health, presented on the status of the Health Care Homes (HCH). The Department of Health has been collaborating with the Department of Human Services on the public-private arrangement. A combination of grant contracts and state funding has been used to help integrate HCH into the rest of the health care reform legislation. As the process is in its early stages, much of the current focus is on the program's general framework and how best to evaluate it in the future. Dr. Schiff emphasized that ideally Minnesota's initiative would draw upon other state and federal models, while maintaining enough flexibility to make adjustments or to test different ideas. In addition, it is the department's goal that health care homes be measured in terms of their actual outcomes and not only their processes.

To that end, in November 2008 the Institute for Clinical Systems Improvement (ICSI) was awarded a contract to recommend both outcomes and goals that will be used to guide the evaluation of health care homes. Their recommendations were due to the department by December 31, 2008. Working groups were also set to convene December 18 to develop standards and learn best practices from leading national organizations. The working groups will present their recommendations to the Health and Human Services commissioners in late January 2009.

From a more operational perspective, DHS does not envision that health care homes will be limited to just primary care services, a concept that will require some cultural adjustments within the public's mindset. As one review council member put it, "we must be sure that HCH are not just additional clinics...they must belong to the patient, not the institution."

Currently all of these efforts are on schedule to meet their statutory 2010 deadlines. Please visit http://www.health.state.mn.us/healthreform/ for more information regarding the health care reform legislation, timelines, work groups, or any additional background material.

Wisconsin Health Care Model

In addition to reports from working groups and status updates on pilot projects, the Health Care Access Commission heard testimony from the Wisconsin Department of Health Services. Angela Dombrowicki, Director of the Bureau of Enrollment Management, discussed the major components of their new BadgerCare Plus program via conference call. According to Dombrowicki, an additional 95,000 people have received health insurance coverage since it began last February. It includes all children, covers pregnant women at up to 300% of the federal poverty level, parents and caretaker relatives at up to 200% and certain self-employed parents and farmers with incomes at up to 200%. The new program combines SCHIP and other Medicaid programs for children and families into one comprehensive, streamlined program with online applications, electronic employer verification of health insurance, and simplified financial and non-financial eligibility policies. According to Dombrowicki, much of the expanded coverage was achieved by streamlining administrative procedures. Costs were not immediately available, although she said it was clear that the state had achieved tremendous savings through their new, streamlined system.

You can read a summary of the health care reform legislation on the Department of Health's website at http://www.health.state.mn.us/divs/opa/08reformsummary.html. Or for additional reform information, go to http://www.house.leg.state.mn.us/hrd/pubs/hcrefmtime.pdf.