A health care home is an approach to primary care in which primary care providers, families and patients work in partnership to improve health outcomes and quality of life for individuals with chronic or complex health conditions.
The development of health care homes in Minnesota is driven by the Institute for Healthcare Improvement’s Triple Aim, an initiative to simultaneously achieve the following goals:
- Improve the individual experience of care.
- Improve the health of the population.
- Improve affordability by containing the per capita cost of providing care.
Minnesota passes first “medical home” legislation, called “provider directed care coordination,” for patients with complex illness in the Medicaid fee-for-service population. (This is now called “primary care coordination.”) More information is online at www.dhs.state.mn.us/primarycarecoordination.
The Governor’s Health Care Transformation Task Force and Legislature’s Health Care Access Commission both endorse medical homes.
Health care reform legislation requires “health care homes” for all Medicaid, SCHIP, state employees and privately insured Minnesotans (statute 256B.0751).
The health care home is a transformative change in the delivery of primary care. The design principles for health care homes in Minnesota focus broadly on the continuum of “health” and incorporate expectations for engagement of the patient, family and community. Fundamentally, the health care home is a change in the patient-provider relationship augmented by financial structures and measurement of results. Expectations for transformative change must be sufficient to achieve these results. Among these expectations are:
- Patient- and family-centered care will be foundational to the Minnesota Health Care Home program. Patients/families/consumers will be involved in all aspects of program development.
- Quality improvement teams will be required at the practice level. A health care home will have an active practice-based quality improvement team that includes patients/families as equal team members.
- Learning collaboratives will support and foster practice-level change. Participation is required.
- Financial structures must be aligned to promote this transformation and must include adequate risk adjustment for medical and non-medical complexity.
- Recertification is based on outcomes. Minnesota will be moving to an outcomes-based system in its recertification of health care homes. In the certification and recertification process, a balance will be sought between fidelity to the model (criteria) and flexibility for innovation. A goal of the program is to maximize clinic flexibility to achieve all of the outcomes.
- Outcomes recommendations
- Capacity assessment – clinic and public
- Patient/family/consumer council
- Certification criteria
- Certification and recertification process
- Payment methodology
- Learning collaborative
- Outcome measurement
Building on local and national experiences, work is collaboratively organized by state government between the state departments of health and human services, with a strong emphasis on public-private collaboration. Work is being completed through a combination of grant contracts and state-organized processes.
- Outcomes recommendations. Outcomes were developed by a collaborative group led by the Institute for Clinical Systems Improvement. Developed at the onset of the program, these outcomes will guide the development of specific measures. More information is online at: http://www.health.state.mn.us/healthreform/homes/documents/index.html.
- Capacity assessment. A consortium of Minnesota primary care associations received a contract to do a capacity and readiness assessment. The assessment will be completed on June 30, 2009. More information is online at www.health.state.mn.us/healthreform/homes/capacity/index.html.
- Patient/ family/consumer council. The council will support involvement by patients, families and consumers in all aspects of health care home development. The council includes members from or advocating for all ages, many disease-specific groups and many cultures. The council meets independently and participates in other health care home groups.
Health care home criteria
- Criteria were developed through a process that included open public meetings, facilitated discussions and expert input, involving patients, families and all sectors of the health care community. Minnesota collaborated with leading national criteria/standards organizations. Materials from this development process are online at www.health.state.mn.us/healthreform/homes/standards/index.html.
- Recommendations for health care home certification standards were presented to the Commissioners of Health and Human Services in early February. There are five standards with measurable criteria that support each standard. The major categories for standards include:
- Patient tracking and registry functions
- Care coordination
- Care plans
- Performance reporting and quality improvement
- The standards development process is being done via Minnesota expedited rule making. The proposed rule is due to be published for public comment in June 2009.
Certification and recertification process
- A process workgroup is developing tools and processes to include in the initial certification site visits. Recertification requires the demonstration of progress towards health care home outcomes.
- A payment methodology steering committee is being created. Payment methodology is due to be completed by January 1, 2010. Primary care coordination payment methodology, approved by the Centers for Medicare and Medicaid Services, will be used as one of the starting points for health care home payment discussion. The statute requires stratification of care coordination payments by medical and non-medical complexity. More information is online at www.dhs.state.mn.us/primarycarecoordination.
- A payment methodology technical development contract has been granted to the University of Minnesota School of Public Health.
- Payment methodology subgroups include:
- Clinic and health plan processes for health care home payment
- Patient risk stratification and payment architecture
- Consumer/patient payment considerations
- Minnesota successfully completed a five-year Maternal Child Health Bureau/Minnesota Legislature-funded Medical Home Learning Collaborative in 2009 that included 24 practices and more than 7,000 patients and families. Many of the lessons from this program have been incorporated into the current health care home program development.
- Wilder research has been awarded a contract to report on learning collaborative research and implementation models.
- A measurement steering committee is being created. Measures will be structured within the framework of the outcomes recommendations and used for recertification.
- Measures will be integrated with Minnesota Community Measurement (www.mncm.org) work on quality transparency.
What do primary providers participating in the Medical Home Learning Collaborative say about medical homes?
“I personally have found that a small percentage of my patients take up a disproportionately large percentage of my time. Try as I might, I have always struggled to do a good job with their care. Medical home has helped me greatly - both to manage my schedule, and provide better care!”
Gordon Harvieux, MD
What do families of children with special health care needs say about medical homes?
“Having access to longer appointment times for the complex children is not only beneficial for the family but also to the physician because they can give a quality visit without having to run behind the rest of the day. The clinic has also gotten handicap accessible doors and a wheelchair scale, which have made our visits to the clinic less stressful and more comfortable.”
“The Medical Home Project is bringing strength, faith in the medical community and hope in what can be possible. Miriam has spent many days in hospitals, at appointments and innumerable hours in therapies and with 'ologists. The Medical Home Project is making these times smoother in transitions, appointments easier to attend for her, and a constant support for the family on the "what next" in medical care for Miriam. We have a care plan that is always with us, and the hospital and clinic are aware of the special needs…and openly give Miriam that much needed "extra" time and gentleness. All these little changes are making a significant difference not only for Miriam, but for our family.”
Jennifer, (Miriam’s Mom)
Program Manager, Health Care Homes
Minnesota Department of Health
Direct: (651) 201-3626
Fax: (651) 215-8915
Medical Director, Minnesota Health Care Programs
Minnesota Department of Human Services
Direct: (651) 431-2479
Fax: (651) 431-7420