Health Care Delivery System Reform in Minnesota Scott Leitz Assistant Commissioner Minnesota Department of Human Services February 14, 2012
Overview Minnesota s health system Highlight current directions 2008 building blocks for delivery reform Health care delivery system and payment restructuring Status of current efforts Future directions Next steps
We start from a reasonably good place in Minnesota We rank high in overall population health Non-profit environment, both plan and provider High concentration of integrated delivery systems Both urban and rural Among nation s lowest level of uninsured, with a high level of employer-sponsored coverage History of collaboration Including between payers and providers Investment in community assets such as ICSI and Minnesota Community Measurement We generally look pretty good in the Dartmouth work But: Increasing uninsured Budget challenges Even quality
2008 Reform Building Blocks for comprehensive delivery reform Statewide Health Improvement Program EHR mandate and electronic exchange of common administrative transactions required Statewide Quality Measurement System Health Care Homes Provider Peer Grouping
Medicaid ACO Demonstration: Health Care Delivery System and Payment Reform Demo The Minnesota Department of Human Services shall develop and authorize a demonstration project to test alternative and innovative health care delivery systems, including accountable care organizations that provide services to a specified patient population for an agreed-upon total cost of care or risk/gain sharing payment arrangement. (Minnesota Statutes, 256B.0755, passed in May 2010)
Process and Timeline Spring 2011 Gather input through Request for Information Summer and Fall 2011 June 30: RFP issued Proposals received and scored Seek federal authority, as necessary RFP responses due November, 2011 9 responses received, broadly representative of geographic and organizational structure
RFP Responses: approximately 150,000 enrollees in proposals overall Proposer Georgraphic area CentraCare Children s Hospital Essentia Health Fairview FQHC Urban Health Network (10 FQs) Mayo North Memorial Alllina/HealthPartners Park Nicollet Central MN, north of Minneapolis/St. Paul Minneapolis/St. Paul Duluth/NE MN Minneapolis/St. Paul Minneapolis/St. Paul Southeast MN Minneapolis/St. Paul Minneapolis/St. Paul Minneapolis/St. Paul
Process and Timeline, continued Individual negotiations starting in February Planning work continues on actuarial services, data analysis, and federal authority for fee for service Expectation that all 9 demos will start operation during 2012 Three respondents are also Pioneer ACOs Working to match up models Expectation of some variation in design across the demos, but core set of expectations
Model 1: Virtual HCDS (one RFP response) Primary care organizations not affiliated with a hospital or integrated system (or any HCDS serving 1,000-2,000 attributed enrollees) Savings achieved beyond the minimum threshold are shared between the payer and delivery system 50/50
Model 2: Integrated HCDS (8 RFP responses) Integrated delivery systems providing a broad spectrum of care as a common entity Delivery system pays back a prenegotiated portion of spending above the minimum threshold Savings achieved beyond the minimum threshold are shared between the payer and delivery system at pre-negotiated levels
Accountability for Total Cost of Care (TCOC) Medicaid enrollees attributed to HCDS for inclusion in TCOC calculations Both fee-for-service (FFS) and managed care (MCO) enrollees attributed using past provider encounters Provisional Population Communicated to HCDS Initially, Updated to Reflect Changes During Performance Period Defined core set of services included in TCOC; HCDS may Elect to Include Additional Services Existing provider reimbursement continues during the Demo, with risk-/gain-sharing payments made annually based on TCOC performance
A few of the key design elements Payment model agreements Quality measures to be included Populations served under demo Duals not initially included; later wave of RFPs Minimum patient size Attribution methodology Role of MCOs Data feedback to providers
A few lessons learned so far Work on the foundational elements needed for providers to take on risk: Better data to manage total costs Actuarial expertise Free up provider resources to reform care delivery Iterative Change and Testing; flexibility key Medicaid populations less stable than Medicare Risk adjustment and social complexity Quality measures, while on a relative scale robust in Minnesota, still need additional work on functional status
Moving Forward: Expansion to additional populations (duals) Strong emphasis on integration of acute care and other care settings and HCBS/social services More global community responsibility Patient choice versus provider interest in assignment Working to align purchasing with state employee group and with large self-insured Minnesota puchasers Watching CMMI and CMS for additional federal opportunities Goal: determine our state direction, then match to federal opportunities Learning lessons from the Hennepin Health demo
Contact Scott Leitz Assistant Commissioner Minnesota Department of Human Services St. Paul, MN Phone: (651) 431-2102 Scott.leitz@state.mn.us