At Issue: On the forefront

After nearly a year of task force and commission meetings, Minnesota might very well be setting the stage for national health reform.

Sponsored by Rep. Thomas Huntley (DFL-Duluth) and Sen. Linda Berglin (DFL-Mpls), a new law creates a statewide health improvement program focusing on reducing obesity and tobacco use; establishes criteria for health care homes and care coordination fees; allows providers to offer one-price “baskets of care” for chronic diseases in hopes of saving money; and increases the eligibility income limit to qualify an additional 12,000 people for state-assisted medical care.

Along with some General Fund revenues, the changes are projected to cost $13.5 million in Health Care Access Fund money this biennium, increasing to $129 million in the 2010-11 biennium.

Gov. Tim Pawlenty vetoed the earlier health reform bill for several reasons including that it raises too high the poverty guideline that would have allowed an additional 39,000 people on to state medical assistance.

Huntley said of the final proposal: “Most of what we started with is in this (law) ... and it will start to change the way we deliver health care in Minnesota.”

Many portions of the law are effective July 1, 2008.



Health care homes and grants

Health care homes are a centerpiece in the law to guide patients through the decision-making process of medical needs by providing comprehensive, coordinated care by physicians, advanced practice nurses, physician assistants as personal clinicians and specialists.

Huntley said 80 percent of health care costs are for people with chronic illnesses. The point of health care homes is to keep people out of hospitals by maintaining their health through continuous care, he said.

The medical homes will focus on delivering high-quality, efficient and effective health care services, while encouraging patient-centered care by providing ongoing contact with a personal clinician or team of clinical professionals.

The health and human services commissioners will be required to annually report to the Legislature on the implementation of the health care home model, along with fee for service, managed care and county-based purchasing sectors beginning Dec. 15, 2009.

Also in the new law, a workforce shortage study is required to examine the changes necessary in health professional licensure and regulation to ensure full utilization of advanced practice registered nurses, physician assistants and other licensed health care professionals in the health care home and primary care system. Recommendations are to be made to the Legislature by Jan. 15, 2009.

Grants will be awarded to communities beginning July 1, 2009, for strategies to reduce the percentage of Minnesotans who are obese or overweight and to reduce tobacco usage.



Payment reform

The human services commissioner is to implement quality incentive payments for all providers in state health care programs by July 1, 2010.

The health commissioner will develop the measures to assess the quality of health care services offered by providers. By July 1, 2009, the commissioner will develop a system of incentive quality-based payments in addition to existing provider payment levels, “based upon a comparison of provider performance against specified targets, and improvement over time.”

The payment system will reward high-quality, low-cost providers, create enrollee incentives to receive care from those providers and foster collaboration among providers to reduce cost shifting. The established standards and outcomes will be annually reported starting July 1, 2010.

The health commissioner will also develop a plan to create transparent prices and encourage providers to innovate and collaborate on “cost-effective, high-quality care delivery and reduce the administrative burden on providers and health plans.” Consumers are to be provided comparative information on costs and quality among providers.

The health commissioner will develop definitions for a minimum of seven “baskets of care” and consider specifically, “coronary artery and heart disease, diabetes, asthma, and depression.” Health care providers can then establish package pricing for baskets of care starting Jan. 1, 2010, and the commissioner will publish comparative prices and information on those “in a manner that is easily accessible and understandable to the public.”



Other provisions

A working group is to make recommendations on the design of a health benefit set for services and technologies that are “cost-effective, and provides lower enrollee cost sharing for services and technologies that have been determined to be cost-effective.” Recommendations must be submitted to the health commissioner by Oct. 15, 2009.

A 14-member Health Care Reform Review Council is established to periodically review the progress of implementing health care homes and payment reform.

Small businesses, with 11 full-time employees or less, are to establish and maintain a Section 125 plan to allow their employees to purchase individual market or employer-based health coverage with pre-tax dollars, and pay for health coverage premiums with pre-tax dollars.

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