Minnesota 'Health Care Homes' Model Shows Promise

Public health policy advocates looking for model primary care programs that are designed to expand coverage, improve care, and lower costs should look to Minnesota.

The state reported this month that the primary care delivery model that was begun in July 2010 has grown to 170 "health care homes," with 1,764 clinicians at the end of 2011.

The "health care home" is Minnesota's version of patient-centered primary care, with the patient always the focus of care decisions.  The Minnesota Department of Health certifies these health care homes using a set of criteria with mandates that include 24-hour access to care, patient history tracking, ongoing monitoring of quality metrics, and care coordination and planning with patients.

These state-certified homes provide care more than 2 million of Minnesota's 5.3 million residents. That patient population includes more than 135,000 Medicaid enrollees, or roughly 18% of those in the program who use primary care. In part, that's because chronically ill Medicaid enrollees are incentivized to join health care homes through medical assistance payments of $10 to $60 a month, depending upon the complexity of their health issues. 

In addition, Medicare has approved Minnesota as one of eight states that can align with the state program to pay for health care homes. As a result, more than 225,000 Medicare enrollees are expected to be served by health care homes during the three-year project.

A big focus of the Minnesota program is preventive medicine that involves patients and teaches them to better manage chronic diseases such as hypertension and diabetes. In addition, health care home patients are encouraged to adopt health goals that include physical exercise, improved diet, weight loss, and smoking cessation.

The program is new, so state officials concede that it may be difficult right now to gauge or demonstrate its impact on controlling costs and improving quality. There are early indications that they may be on the right path, but reports are mixed.

For example, Medica, the nonprofit health insurance provider that participates in the pilot program, has designed payment models for health care homes that reward improved outcomes.

The insurer reports that at least one large urban provider with a health care home in the Twin Cities has seen per member costs drop by 5% in the past year. However, Medica also reports that a similar large urban health system in the same area saw a 2.6% increase in costs for the same period. Medica did not identify the providers.

As for improved outcomes, the HealthPartners Research Foundation has been studying health care homes and said that preliminary findings indicate that they "have significantly better performance scores for diabetes and cardiovascular disease than non-health care home clinics."

Contrast the progress seen in the Minnesota health care homes pilot with ongoing problems in access to healthcare. For example, a recent survey from the Centers for Medicare and Medicaid Services found that one-in-five ED patients who were sick but did not need an inpatient bed said their primary care doctor told them to go to the ED for care. 

Coordinated, wellness- and prevention-oriented services provided at health care homes in Minnesota and in other states won't eliminate needless and expensive trips to the ED. However, it's a good bet that those patients walking into the ED for non-emergent care won't be coming from health care homes.