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 Staff at HCH, along with members of the Financial Sustainability Work Group and other stakeholders, have been working on a number of different fronts to advance the financial sustainability of the HCH model:
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Close coordination with the Department of Human Services (DHS) around the new Integrated Health Partnerships (IHP) 2.0 model. HCH (or comparable) certification is now a requirement for new IHP participants. A track specifically aimed at smaller providers has been added that addresses a number of key concerns. Participants in this new track receive support for care coordination, infrastructure, and other care delivery reform needs through a Population Based Payment (PBP) for their Medicaid population. No risk sharing is required for this track and no minimum patient population. While applications for this round were due on August 1, 2017 for contracts starting January 1, 2018, DHS anticipates that new systems will be able to join on an annual basis in 2018 and beyond. For further information, please visit the DHS website.
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HCH is gathering information on commercial payer approaches to HCH reimbursement. The aim is to determine how best to demonstrate value as well as establish more robust working relationships and strengthen insurer support for the HCH model. Current efforts include surveying members of the Minnesota Council of Health Plans and meeting individually with health plan leadership.
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HCH is using data from reports created by the Health Economics program as well as the University of Minnesota HCH evaluation to build a business case for our model. HCH is focusing on improvements in utilization measures strongly linked to cost savings.
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The Center for Medicare and Medicaid Innovation provided information, at HCH's request, on how other PCMH programs around the nation have garnered financial support and measured success, and results achieved. HCH has identified a number of state models that may provide insight into how to meet our sustainability goals. In the coming months, staff will be reaching out to other state programs to discuss issues such as payment alignment and employer/purchaser engagement.
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CMS recognized HCH certification under the MIPS program and will award full points in the Clinical Practice Improvement Activities category to all certified providers and groups. CMS is developing a process for clinics to receive this benefit and will likely be unveiling it at the end of 2017 or beginning of 2018.
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Statewide Quality Reporting and Measurement System Changes
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 During the 2017 session, the Minnesota Legislature enacted a number of changes to the Statewide Quality Reporting and Measurement System (SQRMS) requiring that MDH work with a broad range of stakeholders to develop a measurement framework by mid-2018 that, among other objectives, articulates statewide quality improvement goals. Notable changes include:
- Aligning physician clinic measures with those used in the federal Merit-based Incentive Payment System (MIPS) unless a particular diagnosis, condition, service, or procedure is not reflected in the federal measures in a way that meets local needs, as determined through multi-stakeholder consultation; and
- Limiting the number of quality measures for which physician clinics must submit data to 6 for single-specialty physician practices, and 10 for multi-specialty physician practices.
Another change implemented by the Legislature restricts MDH from requiring providers to use a vendor to administer or collect data to meet SQRMS requirements. To align with CMS requirements and recognized best practices, MDH has required providers to use a vendor certified by CMS to administer patient experience of care surveys. Due to this restriction, MDH will remove these measures from SQRMS.
As the HCH program moves to align with these changes, HCH will work with SQRMS, the HCH Advisory Committee, its Measurement and Evaluation Work Group and other stakeholders to receive recommendations for future HCH measurement. MDH will provide updates on the SQRMS framework initiative - including opportunities for input - through SQRMS announcements and its website (http://www.health.state.mn.us/healthreform/measurement).
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Care Coordination Quality Improvement Grants RFP
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To expand efforts to support implementation of best practices of care coordination services across the state, the MDH Children and Youth with Special Health Needs (CYSHN) section will provide funding to primary and specialty care practices to plan and implement quality improvement projects related to care coordination for the pediatric and young adult population.
The Request for Proposal, Children and Youth with Special Health Needs Care Coordination Quality Improvement Grants, is on the MDH CYSHN website.
Applications must be submitted by email to health.cyshn@state.mn.us by October 4, 2017 at 12:00 p.m. (noon) (CST). No applications will be accepted for consideration after this time.
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 Todd County Health and Human Services and CentraCare Health - Long Prairie Clinic are working together on shared goals to improve community health outcomes through a learning community established in early 2017. The project is funded by a State Innovation Model grant to advance the work of public health and primary care partnerships.
The group started its work by learning about each other and identifying areas to explore, and used data to identify community health priorities and develop goals and a plan to address it. In reviewing data, they discovered that tobacco use in their community was almost double the Minnesota average. The group used quality improvement methods to study the problem, and developed a logic model outlining a partnership strategy and process to target and refer tobacco users to cessation resources.
The partnership is currently testing a two-way referral system between local public health and primary care with an eye toward sustainability. Outcomes will be available later in 2017.
 The HCH program will be launching a new Learning Management System (LMS) by the end of 2017. The first e-learning course will focus on certification and recertification, with further educational programming to "roll out" as the year progresses. Stay tuned, as more information will be coming this fall!
Evidence Supporting Primary Care Practice Transformation
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 The 6th annual Patient-Centered Primary Care Collaborative (PCPCC) report, Impact of Primary Care Practice Transformation on Cost, Quality, and Utilization, 2016-2017, confirms the value of the HCH model of care delivery, known nationally as a patient centered medical home (PCMH). The review of PCMH research from 2016 found positive overall results in cost, quality and utilization although not always uniformly.
Lessons learned from the research include:
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Patients with greater comorbidity and systems with these patients may show greater early progress in improved outcomes.
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Transformed and transforming practices need time to mature before achieving significant improvements.
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The approach to implementation and evaluation of practice transformation needs to allow for regional and other differences and cannot be one-size fits all.
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Mixed results seen in the review may be due to a positive spillover effect of transformed practices onto those that have yet to transform.
The report includes a state spotlight on Minnesota HCH successes, speaking to the overall commitment and dedication of 3,660 certified primary care clinicians and their teams who provide patient-centered, coordinated comprehensive care for 3.9 million.
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 HCH established the Certification Committee to advise MDH on applicant certifications. In a recent interview with Dr. Halfen, we asked him about his early work with HCH and views on primary care clinic practice today.
As a member of the Certification Committee since MDH first certified clinics in 2010, can you share your perspective on the greatest areas of progress clinics have made?
Over the last four years some uniformity in the structure for the clinics has been developed. Certainly, there remains innovation and structural differences based on differing types of populations, but handling of the basic principles of being patient-centered, responsive to immediate patient needs, responsible for all patient needs and focused on the triple aim has become more uniform. It appears that the process of learning from the experience of others has been successfully implemented.
What prompted you to serve on the HCH Certification Committee and how have you and your practice benefited from your participation?
Since Lakewood Health Systems developed its "Medical Home" prior to HCH development, we felt obligated to share our experience with others. Now we are learning from others as we use our own experience.
You have been a proponent of the HCH Model in interviews, conference presentations, and your own book about your organization's implementation model. When addressing questions about the benefit of HCH certification with your colleagues and other non-certified clinics, what information do you share?
The results for the patients are the final measures of success. Our patients and our providers both remain highly enthusiastic about the benefits of care coordination within health care homes.
As you look to the future of primary care and the patient centered medical home model in MN and nationally, what do you see as our greatest opportunity?
The opportunities and challenges most important in further medical home development are fair reimbursement and the social determinants of health. Since the expense of medical home is immediate and the rewards of "quality improvement" and "shared savings" are delayed, there remains a difficult transition to care coordination. Also, the growth of medical homes from chronic medical disease into social and behavioral issues remains a different set of skills not commonly available to "medical clinics".
HCH extends a big THANK YOU to Certification Committee members who regularly review reports and provide recommendations to MDH on certification.
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John Halfen, Medical Director, Lakewood Health Systems
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Jen Hartmann, Social Worker, Morrison County Social Services
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Lisa Hoffman-Wojcik, Patient and Family Advocate, Open Door Health Center
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Ellen Ryan, Chief Quality Officer, First Light Health System
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Cally Vinz, Vice President, Institute for Clinical Systems Improvement
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Becky Walsh, Provider Relations and Contracting Manager, PrimeWest Health
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Melissa Winger, Patient and Family Advocate
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 The HCH Logo is available on the MDH HCH website
for use by certified HCH clinics. |
Morrison County Community-based Care Coordination Team receiving MHA award.
In 2015 CHI St. Gabriel's Health received a State Innovation Model grant for an accountable community for health (ACH) project to focus on a targeted population of patients using narcotics for chronic pain.
Hospital data showed the number one reason for emergency department visits was patients seeking narcotics for pain. St. Gabriel's Unity Family Health Care clinic created a multi-disciplinary care coordination team to treat each of these patients face-to-face, focusing on the cause of their pain. As significant medication diversion became readily apparent, local organizations also formed the Morrison County Prescription Drug Task Force to enhance community collaboration on the project. Through these efforts, the care coordination team reduced opioid prescribing by 9,000 pills each month for the first 127 patients identified as overusing opioids, and reduced hospital pharmaceutical costs by $738,000 annually for those same patients. Overall and more importantly, their efforts are providing a better quality of life for patients and a safer community.
Over the summer months, the team has been recognized for its successes:
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On June 4, the team received the Minnesota Hospital Association (MHA) Innovation of the Year Award in Patient Care.
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Following the MHA award, the team received the American Hospital Association NOVA Award on July 29th at the AHA Leadership Summit in San Diego.
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The Minnesota state legislature awarded $1,028,000 to MDH for pilot sites to replicate the Unity ACH model. The Injury and Violence Prevention Section of the Health Promotion and Chronic Disease Division will be releasing an RFP for these funds.
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The Minnesota Department of Human Services awarded Unity Family Health Care a contract to share their expertise in multi-disciplinary treatment of opioid use disorder through University of New Mexico School of Medicine Project ECHO, a video-conferencing training program for primary care clinicians.
Watch a MHA-produced video highlighting the success of the ACH project.
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Clinic Certification
Clinic Recertification
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Plan now to attend Learning Days, April 3-4, 2018 at the Continuing Education and Conference Center on the University of Minnesota St. Paul Campus. The event will feature a full day of programming followed by a half day of in-depth workshops. Stay tuned for more information via email and on the HCH website.
