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At Issue: An umbrella of coverage

Published (3/21/2008)
By Patty Ostberg
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Hospitals and providers would be rewarded for keeping people healthy under HF3391, the health care transformation bill. A Health Care 
Transformation Commission would develop a payment and reward system for providers.

About 93 percent of Minnesotans have insurance, but they aren’t getting their money’s worth, and the other 7 percent don’t have insurance. Whatever percentage you fall under, changes could be just around the corner.

HF3391, sponsored by Rep. Thomas Huntley (DFL-Duluth), would set aggressive timelines to how the state pays providers for health care and how they manage chronic diseases.

“About 75 percent of the money spent on people in health care is spent on those with chronic diseases,” Huntley said. The Governor’s Health Care Transformation Task Force says the state could manage the diseases better and save about 20 percent in approximately five years.

On Huntley’s own admission, the timelines set out in the health care transformation bill are hard to attain. “This is a work in progress … and I’m not sure some of the timelines are completely realistic, … I’m trying to end up with a bill that the governor will sign.”

The House Health Care and Human Services Finance Division approved the bill March 17, and sent it to the House Finance Committee. A companion bill, SF3099, sponsored by Sen. Linda Berglin (DFL-Mpls), awaits action by the full Senate.





Universal coverage and costs

Universal coverage goals are set in the bill at 94 percent of Minnesotans covered by 2009 and gradually increasing to 98 percent by 2013.

The affordability standard would be increased for people to qualify for MinnesotaCare coverage, and inpatient hospital services caps would increase from $10,000 to $20,000. Affordability standards would be created for individuals and families with incomes of no more than 400 percent of the federal poverty guideline. Affordability is defined as the sum of premiums, deductibles and other out-of-pocket costs paid by a person or family. For example, a family at 375 percent to 400 percent of the guideline would pay 8 percent of their gross monthly income on health care expenses.

How to pay for the added coverage and other costs in the bill has yet to be decided. Huntley said monies could come from the Health Care Access Fund and through savings of managing chronic diseases better. “I guarantee you when this bill gets to the floor we’ll have defined, perfect fiscal notes,” he said.

It would be hard to determine exactly how much money would be available to cover the uninsured, said Rep. Laura Brod (R-New Prague). “You’re either going to have to find another source of revenue, or you’re going to have to chuck them all off. … It just doesn’t work.”



Payment restructure

The only way to ensure health care cost control is through restructuring payments to providers, said David Wessner, chief executive officer of Park Nicollet Health Services. He supported an amendment by Huntley that would allow a newly created Health Care Transformation Commission to develop a system to pay providers based on innovation and improved costs and quality. “It is the only real cost control mechanism,” he said.

The idea is to pay providers for their performance of keeping people healthy, instead of rewarding for the number of visits and treatments, Huntley said.

Providers would submit bids for the total cost of care based on their prices for a facility and “must reflect the providers’ commitment to manage their risk-adjusted patient population within this total cost.” The health and human services commissioner would be required to implement this payment system by Jan. 1, 2011.

While the change could benefit large insurance companies, it could leave individual providers, like those in rural areas, unable to keep up, said Rep. Steve Gottwalt (R-St. Cloud). “It’s a great global idea,” but it’s untested and we don’t know what will happen to small providers, he said, noting they potentially would have to hire more staff to report on the data required for quality measurements.



Measures and insurance

“Our payment system doesn’t reward people for doing the right thing,” Huntley said. Instead, we should shift the focus to a health care system that tries to keep people out of the hospital.

The governor’s task force found that between 2001 and 2007, employer-sponsored coverage fell from 68 percent to 62.5 percent. Enrollment in public insurance programs rose from 21.1 percent to 25.2 percent, and the uninsured rate increased from 6.1 percent to 7.2 percent.

A Health Care Transformation Commission would be created to establish a set of performance-evaluation measures that health care providers could use to set goals, and to track the progress of meeting those goals. By Dec. 15, 2008, the commission is to provide the Legislature with their recommendations.

A Minnesota Health Insurance Exchange would also be created to provide “greater access, choice, portability, and affordability in health insurance products,” according to the bill. Health plans would be sold through the exchange to individuals and employers.

By offering a state-created insurance plan and rewarding providers for keeping patients healthy, health costs would go down, Huntley said. “Think about what would happen in Minnesota’s economy if we had 20 percent lower costs for health care.”



Medical homes

People with chronic diseases can see improvement in overall health when treated in a health care home scenario. The bill calls for the state to pay providers to coordinate care in public programs resulting in long-term cost savings that could pay for the uninsured, Huntley said.

By July 1, 2009, the health commissioner would be required to have state program enrollees and those with chronic diseases select a primary care clinic or medical group and undergo an initial health assessment to identify preventable health care needs. The homes would coordinate care and develop a comprehensive plan for each enrollee.



Cooperation

The uninsured sometimes wait until a crisis to seek medical care, which tends to be more costly than continued care to keep up with medical needs. After treatment they often end up off of medical assistance until another crisis occurs.

Provisions in the bill seek to automate and increase the cooperation between public programs to decrease the turnover rate. By July 1, 2009, the health commissioner is instructed to improve coordination between state health care and social service programs, and set up an automated process to send out state program renewal forms in various languages.

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