Director's message - Measuring & Moving Ahead
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I am happy to report that the Patient-Centered Outcomes Research Institute (PCORI) has accepted a letter of intent from HealthPartners Institute in Minneapolis for a project in partnership with Health Care Homes. The proposal, due April 24, 2019, will focus on evaluating and comparing approaches to care coordination for complex patients in certified primary care clinics. The study has potential to be of significant value to our program and stakeholders.
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Another program assessment effort underway is from a contract awarded to the University of Minnesota School of Public Health to design a HCH program evaluation. The design will include research questions to determine HCH effectiveness in meeting quadruple aim outcomes, program reach and implementation, administrative processes, mechanisms that contribute to program success, and effect of external factors on the program. The U of M will complete the evaluation framework by June 30, 2019.
While it is exciting to be planning a 3-year study with HealthPartners Institute and an evaluation with the University of Minnesota, it is also vitally important that HCH engage in continuous quality improvement. A major effort this fiscal year is work with a partner, Management Analysis and Development (MAD), a consulting service within state government, to accomplish two main activities: 1) facilitate community listening sessions around Minnesota and compile recommendations for advancing HCH standards; and 2) assess program processes and generate recommendations to improve customer experience. The customer experience assessment has included asking clinics to participate in focus groups and surveys – thank you for providing input!
Finally, work continues on amending the HCH rule with a new framework that builds on current certification standards and adds two levels of progression beyond current requirements, recognizing clinics that are advancing their model to reduce disparities, improve value, and address population health.
I hope this update adequately informs stakeholders on activities underway at HCH, but please reach out any time with questions or suggestions. We value hearing from you!
~ Bonnie
Don't miss Learning Days!
April 9-10, 2019 in St. Paul
Register by March 29, 2019 to attend this annual get together for health care homes care teams and community partners. Network with your peers, learn from each other and acquire take home skills you can use!
- Enjoy Hippocrates Café, our opening event with Dr. Jon Hallberg, Mill City Clinic, and MPR medical commentator
- Honor your peers at the HCH Innovation Awards!
- Draw inspiration from guest speaker: Dr. Joneigh Khaldoun, Director and Health Officer for the City of Detroit Health Department
- Connect with participants as an exhibitor or sponsor – space still available!
- Share your success stories on the Health Care Home Wall of Fame
Visit the Health Care Homes website for an online brochure, information about the conference and registration instructions.
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HealthFinders Collaborative - Ensuring Access for All
HealthFinders Collaborative (HFC) is a community health center and certified Health Care Home that provides a comprehensive primary access point to health services for the families of Rice County and the surrounding area who have limited health care alternatives. Through primary medical and dental care, medication assistance, patient education and advocacy, and community-based wellness programming, HFC works across the continuum of wellness to collaborate with and engage communities in their own health. HFC believes in the inherent capacity of their patients and communities to support health and wellness.
Established in 2005 in a church basement in Dundas MN, HFC has used their free clinic roots to innovate; unbound by traditional healthcare reimbursement mechanisms and free to improve the health and wellness of the community in unique and holistic ways. Built on a robust foundation of partnership and community engagement, HFC grew with the community, responding to health needs and building on community strengths. In 2013, HFC grew out of its original site expanding services to two clinic locations in Northfield and Faribault, with additional satellite and outreach locations throughout the county. Volunteers are a big part of HFC’s workforce, utilizing over 75 volunteers, 25 interns and many students in addition to 23 paid staff. A core staff of clinicians are supported by over a dozen volunteer medical and dental providers.
HFC’s mission is to meet the health needs of underserved populations in their community. In 2005, HFC saw 400 patients twice weekly in clinics. In 2017, they saw over 3,500 unique patients across two sites and dozens of community-embedded medical, dental, wellness, and community programs. HFC cares for a large Latino/Hispanic and Somali patient population, making up over 70% of HFC’s patient population. Rice County is home to twice the state average of Latino immigrants, and one of the largest Somali communities outside the Twin Cities.
HFC’s unique model of care prioritizes community-engaged health on the community’s terms. Organizing efforts identified extreme rates of teen pregnancy among Latino teens; in response they launched a program to support families in their context, as a result cutting the teen pregnancy rate in half. In 2014, HFC opened a dental program in response to patient feedback; they now see over 1,000 patients each year including specialty care. HFC is intentionally engaging underserved groups in their community to find out how they define their needs and building a unique model of care coordination to connect care across these contexts. This approach has had an impact, with initial evaluation results showing improvements in diabetes and cardiovascular disease outcomes, and community partners referring more patients to their community-clinical care coordination hub each month.
For more information, HealthFinders Collaborative.
HCH clinics outperformed non-HCH clinics
MDH Health Economics Program (HEP) investigated whether Health Care Homes had better performance than non-Health Care Home clinics on the Optimal Diabetes Care (ODC) measure from Minnesota’s Statewide Quality Reporting and Measurement System. The ODC measure assesses whether a diabetic patient met five clinical goals: HbA1c less than 8.0 mg/dL; blood pressure less than 140/90; taking statins if recommended; taking daily aspirin if recommended; not using tobacco. Patients must meet all five goals to be counted as having received optimal diabetes care.
HEP compared the performance of Health Care Homes and non-Health Care Home clinics after adjusting for patient health insurance mix to standardize this across clinics. It was found that Health Care Homes had significantly higher ODC rates (U=32298, p=.000, r=.20) (mean rank=325.6, rate=44.2%) compared to non-Health Care Homes (n=295, mean rank=257.5, rate=39.3%). Health Care Homes’ higher optimal care rates were driven by higher rates of recommended statin use and tobacco-free patients. Health Care Homes outperformed non-Health Care Homes in both urban and rural areas of Minnesota.
Diabetes management is challenging for patients and providers, and these results demonstrate that the Health Care Home model holds promise for improving diabetes care.
For more information contact Rachel Cahoon, HEP.
Engaging Stakeholders on Benchmarking: Clinics share experiences through a survey and brainstorming session
In December 2018, HCH released a survey to understand the value of the HCH Benchmarking process to our clinic stakeholders, sending surveys to 65 HCH certified organizations. The response rate was 52% with 35 responses representing 34 organizations. Urban and rural clinics responded at similar rates. Of the 35 respondents, 16 (46%) used the portal for quality improvement, and 19 (54%) did not.
The majority of respondents who reported using the Benchmarking Portal do so for HCH recertification; other uses include internal performance measurement and operational changes.
The main reasons given for not using the Benchmarking portal were the data is not timely, difficult to navigate, and that other data sources and systems are timelier and more robust when it comes to data analytics. Some said they were not yet familiar with the portal or unaware of the portal.
HCH shared survey results at a joint meeting of the Program Innovation and Measurement and Evaluation Work Groups on February 27, 2019. A benchmarking brainstorming session gave members an opportunity to react to survey results and provide guidance on the future of the benchmarking process. HCH will incorporate brainstorming session input and survey data into a final report and share it with stakeholders.
Correction: an earlier version of this article stated that 33 organizations responded to the survey with a response rate of 51%. The original error has been fixed.
Health Care Providers Can Help Minnesota Smokers Quit
Health care providers play a key role in helping smokers quit. Over 65 percent of adult smokers in Minnesota visited a health care provider in the last 12 months1, which is good news because smokers are twice as likely to quit if they receive help2. Smokers want their health care provider to bring up their smoking status, and patient satisfaction is actually higher among those who receive help3.
Unfortunately, new Minnesota Adult Tobacco Survey data shows that progress in reducing smoking rates in Minnesota has stalled. Adult smoking rates haven’t significantly decreased since the last assessment, with the current rate being 13.8 percent.1 Additionally, health care providers could be doing more to assist their patients in quitting: Rates of asking about tobacco use and advising patients to quit have slightly decreased, to 95.4 percent and 76.4 percent respectively, while rates of assisting patients in the quitting process has increased only marginally since 2014 to 55.2%.1
There are several things providers can do to better help their patients quit tobacco, including routinely discussing treatment options and available resources. Health systems and clinics can help support providers by implementing standard processes to routinely assess tobacco use status and intervene with patients that use tobacco. Implementing changes at the systems level can be an effective way to improve the delivery of tobacco dependence treatment. 4,5
There are a number of resources available to assist health systems with these types of changes. A Health Systems Change Starter Toolkit for Clinics was developed last year in partnership with ClearWay MinnesotaSM and the Institute for Clinical Systems Improvement. The toolkit provides basic steps and tools for implementing tobacco dependence health systems change. This toolkit is available on ClearWay Minnesota’s Tobacco Health Systems Change website, which also includes case studies highlighting systems changes implemented by clinics across the state.
For more information, contact Megan Whittet, MPH, Associate Director of Health Systems Change Programs at ClearWay MinnesotaSM mwhittet@clearwaymn.org
1 ClearWay Minnesota, Minnesota Department of Health. Minnesota Adult Tobacco Survey: Tobacco Use in Minnesota: 2018 Update. January 2019. Available at http://clearwaymn.org/mats/
2 Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub3.
3 Quinn, V. P., Stevens, V. J., Hollis, J. F., Rigotti, N. A., Solberg, L. I., Gordon, N., . . . Zapka, J. (2005). Tobacco-cessation services and patient satisfaction in nine nonprofit HMOs. Am J Prev Med, 29(2), 77-84. doi:10.1016/j.amepre.2005.04.006
4 Thomas D, Abramson MJ, Bonevski B, George J. System change interventions for smoking cessation. Cochrane Database Systematic Review. 2017;2:CD010742.
5 Land TG, Rigotti NA, Levy DE, Schilling T, Warner D, Li W. The effect of systematic clinical interventions with cigarette smokers on quit status and the rates of smoking-related primary care office visits. PLoS One. 2012;7(7):e41649.
Noteworthy
MDH recently made some changes to the MDH website to better serve our visitors. The site has new categories and new URLs. Please update your bookmarks and links, and search the site to find what you need. The new URL for the Health Care Homes main webpage is https://www.health.state.mn.us/facilities/hchomes/index.html
Save the date for the Minnesota e-Health Summit 2019 “Information that Works” June 13, 2019 at the Minnesota Landscape Arboretum in Chaska MN.
The Great Plains Telehealth Resource and Assistance Center 2019 Conference “Telehealth Everywhere” will be held April 28-30, 2019.
“Building a Dental Home Network for Children with Special Health Care Needs: A One-day Conference for Oral, Medical and Allied Health Professionals” is scheduled for May 3, 2019. Visit the University of Minnesota School of Dentistry website to learn more & register.
Gain a better understanding of older adult mental illness and learn new skills with this three-episode video training series. For more information, go to the Lake Superior Quality Innovation Network website for the Post-Acute Care Mental Health Video Training Series
"Re-envisioning Care for People With Involved Disabilities" is a series of four videos of 11-13 minutes duration on understanding and adopting principles of person-centered care from the Center for Consumer Engagement in Health Innovation.
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