Health Care Homes (aka Medical Homes) - Payment Methodology Development
The Minnesota Department of Human Services (DHS) and the Minnesota Department of Health (MDH) convened a steering committee and several work groups to help develop a system of per-person care coordination payments to certified health care homes. Minnesota’s health reform legislation required DHS, in coordination with MDH, to develop the payment system by January 1, 2010.
Payment Methodology
The payment methodology was implemented on July 1, 2010. Certified clinics are now able to submit claims for payment.
Training on the payment methodology is now available. This package includes:
- A description of the rationale for the risk-stratification used in the methodology
- A draft tool to evaluate health care home patients and place them in appropriate complexity tiers for care coordination payments
- Care coordination rates proposed by the Department of Human Services (DHS) for the fee-for-service Minnesota Health Care Programs (MHCP) population
This framework is the culmination of robust, thoughtful stakeholder input. The goal for the health care homes initiative is to move toward a community standard that can be used by all payers and clinics.
Health Care Home Payment Methodology: Structure and Design (PDF: 518KB/29 pages)
Complexity Tier Assignment Tool, Version 1.0 (PDF: 133KB/4 pages)
MHCP Fee-for-Service Care Coordination Rate Methodology (DHS Web site - PDF)
Health Care Homes Payment Methodology - Expanded Diagnosis Clusters (EDCs) (PDF: 59KB/3 pages)
Health Care Homes condition categories, drill down list. Adapted from the John Hopkins ACG tool.
From the Institute for Clinical Systems Improvement (ICSI) health care homes initiative:
- ICSI Health Care Homes Clinical Process and Payment Work Flows Updated 9-21-10 (PDF: 756KB/31 pages)
Steering Committee
The steering committee provides strategic direction on the development of the payment methodology through partnership with a diverse group of providers, payers and consumers.
Steering Committee Membership (PDF: 15KB/1 page)
All meetings will take place at the Minnesota Department of Health's Snelling Office Park location:
Minnesota Department of Health
Snelling Office Park
1645 Energy Park Drive
Saint Paul, MN 55108
Google map
2012 meetings
|
10:00 a.m. – 12:00 Noon 10:00 a.m. – 12:00 Noon 10:00 a.m. – 12:00 Noon 10:00 a.m. – 12:00 Noon |
Red River Room Red River Room Red River Room Red River Room |
2011 meetings
- March 24, 2011
- June 20, 2011
- September 30, 2011
- December 16, 2011
2010 meetings
- June 4, 2010
- September 10, 2010
- December 17, 2010
2009 meetings
- June 24, 2009
- August 3, 2009
- August 26, 2009
- September 23, 2009
- November 6, 2009
- November 23, 2009
- December 21, 2009
Work Groups
MDH and DHS also convened work groups to focus in greater detail on the issues of:
- Clinic processes for health care home payment
- Clinician identification and enrollment of eligible patients
- Coding and billing for payment
- Patient risk stratification and payment rates
- Defining eligible patient groups
- Defining the work of care coordination
- Non-medical complexity information
- Consumer/patient payment considerations
- Deductibles/out-of-pocket exposure
- Affordability
- Establishing a partnership with a health care home
These work groups provided regular updates to the steering committee on their work. The steering committee helped MDH and DHS select members of the work groups. The agencies also solicited nominations from the public.