Director's message: Planning for the future
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Health Care Homes Learning Days 2019 was a successful event due to active participation from clinic partners and other stakeholders, exhibitors and sponsors, and HCH and other staff at MDH. While heavy snow on day 2 presented challenges, we are pleased at the level of turnout and already contemplating Learning Days 2020 when we will celebrate the tenth anniversary of Health Care Homes. Participant input is vitally important to us, and we will be incorporating feedback from this year’s evaluation into planning efforts.
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Community listening sessions on advancing the HCH standards have been another source of valuable input for the program. From January through April, we convened meetings in Minneapolis, Eagan, Fergus Falls, St. Cloud, Duluth, St. Paul, and Maplewood, and heard from clinics, hospitals, local public health, social services, consumers, and other community organizations. We are grateful to everyone who took time to participate in a meeting including representatives for populations with disabilities and disability population health care consumers who offered input on how primary care delivery could be improved for the disability population. (See the Disability and Health article in this issue.)
~ Bonnie
Disability and Health
Individuals with disabilities represent 18.7% (about 56.7 million people) of the U.S. population, and are often overlooked in public health surveys, data analyses, and health reports, making it difficult to raise awareness about their health status and existing disparities. A diagnosis of impairment or disabling condition does not define individuals. To be healthy, all individuals with or without disabilities must have opportunities to take part in meaningful daily activities that add to their growth, development, fulfillment, and community contribution.
Emerging data indicate that individuals with disabilities, as a group, experience health disparities in routine health arenas such as health behaviors, clinical preventive services, and chronic conditions.1, 2, 3, 4 Compared with individuals without disabilities, individuals with disabilities are:
- Less likely to receive recommended preventive health care services, such as routine teeth cleanings and cancer screenings
- At a high risk for poor health outcomes such as obesity, hypertension, falls-related injuries, and mood disorders such as depression
- More likely to engage in unhealthy behaviors that put their health at risk, such as cigarette smoking and inadequate physical activity
To address these and other health determinants, the following WHO principles of action5 are recommended to achieve health equity among individuals with disabilities.
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Improving the conditions of daily life by: encouraging communities to be accessible so all can live in, move through, and interact with their environment; encouraging community living; and removing barriers in the environment using both physical universal design concepts and operational policy shifts.
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Addressing the inequitable distribution of resources among individuals with disabilities and those without disabilities by increasing: appropriate health care for individuals with disabilities; education and work opportunities; social participation; and access to needed technologies and assistive supports.
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Expanding the knowledge base and raising awareness about determinants of health for individuals with disabilities by increasing the inclusion of individuals with disabilities in: Public health data collection efforts across the lifespan; and health promotion activities
The HCH program has added the following disability related resources to the HCH National Resources webpage:
- National Health Interview Survey “Toward the Creation of a Patient-Reported Disability Index” report
- American Public Health Assoc. “Social Determinants of Health among Individuals with Functional Impairments” webinar PDF
- Colorado Department of Health “Disability Competent Care” video
- The Center for Consumer Engagement in Health Innovation video series
- New Hampshire Disability & Public Health Project “Responsive Practice” training
Patient Brochure for Providers -
English, Spanish, and Somali
The Health Care Homes customizable patient brochure is now available in English, Spanish and Somali languages. The brochure, updated in 2018, helps patients understand the concepts and benefits of a health care home and care team in a format to customize with information about your clinic. To access, download pdf files from the Health Care Homes website in the languages that you want, add your clinic in the customizable fields, and print and fold.
Medically Complex Kids have NEW Health Care Home
The Gillette Children’s Complex Care Clinic, located on Gillette Children’s Specialty Healthcare St. Paul campus, is now a Minnesota Department of Health (MDH) Certified Health Care Home!
The Complex Care Clinic was developed with input from many partners around the state including primary care clinics, providers, schools, patients, families and social services. The clinic uses a multidisciplinary, systems-based approach to look at the whole patient. Gillette providers currently serve approximately 350 children and young adults who have chronic complex medical conditions residing across the state of Minnesota.
The clinic care team focuses on collaborating and establishing partnerships to bring together services that provide comprehensive, whole-person care that is convenient for the patient and family. The care team includes physicians, nurse practitioners, nurses, care managers, dieticians, social workers, administrative assistants and schedulers. They assess current problems, anticipate future needs and assist with scheduling services to meet need. The clinic also supports family and caregivers by serving as the centralized point-of-contact for both inpatient and outpatient care providers. Teams coordinate the care for acute, preventative, and chronic conditions. Primary care providers, specialty providers, school services, social support, dental, mental health, nutrition, rehabilitation services and many others all contribute to a coordinated plan of care.
"Medically complex kids need an enhanced medical home. There is a phenomenal need to give our kids who have complex conditions the time they need,” says Madeleine Gagnon, MD, medical director of the clinic. “We want to be of high value to parents and guardians. We find services and community resources to support the family. We work in alliance and support of primary care. All of our patients are required to have a primary care provider, and we’ll refer them to one who agrees to partner with us if needed.”
The care team’s main goals are to transform disability into ability, maximize the quality of life, and make sure patients and families realize their potential.
Please see the Complex Care Clinic on Gillette Children’s website for more information.
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Learning Days 2019 Recap
Close to 300 people turned out for Learning Days 2019, “Redefining Health, Redesigning Care” on April 9-10 at the University of Minnesota Continuing Education and Conference Center in St. Paul, MN. The conference featured a half day of pre-conference workshops on April 9 followed by a full day of programming and networking on April 10. Highlights included Hippocrates Café, songs and stories about health with Dr. Jon Hallberg and a cast of actors and musicians, visual artist Amy Sparks, who captured much of the day in visual illustrations, the Health Care Homes Innovation Awards, a vendor fair, and lots of interactive, peer-to-peer learning and networking.
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Based on evaluations, the conference met its objectives and was a well-executed event.
“Having the opportunity to listen to what other clinics are doing as well as to be able to connect and collaborate with each other is invaluable.”
Learning Days 2019 Participant
Improvements for next year include making the registration process easier to use, increasing awareness and value of Health Care Homes Innovation Awards, and expanding opportunities for networking at and beyond the conference. Thanks to all who participated. Stay tuned for 2020!
“This event always gives me the motivation to come back to my clinic and work to be an even better case manager.” Learning Days 2019 Participant
HCH Clinics - Quality Improvement Stars of 2018!
Through a contract with MDH, Minnesota Community Measurement (MNCM) collects data and assists clinics in meeting requirements of the Minnesota Statewide Quality Reporting and Measurement System (SQRMS). MNCM publishes this data annually in the Minnesota Health Care Quality Report and released the 2018 report6 in February of this year.
There is exciting news in the 2018 report! Several HCH medical groups were among the top performers and recognized for the most consistent improvement, which means HCH clinics are setting high marks for the whole state!
HCH high performers in the Primary Care/Multi-Specialty Care Medical Groups category were: Allina Health, Entira Family Clinics, HealthPartners Clinics, Mankato Clinic, Park Nicollet Health Services, and Stillwater Medical Group. HCH medical groups made up 6 of the 8 high performers, with rates significantly above the statewide average on at least 50% of the measures for which they were eligible.
HCH pediatric medical group, South Lake Pediatrics, was one of four groups with rates significantly above the statewide average on at least 50 percent of the measures for which they were eligible. South Lake Pediatrics set the state benchmark of 85.08% for Childhood Immunization Status; the statewide average was 60.4%.
HCH medical groups with consistent improvement on three or more measures from 2016–2018 were: Entira Family Clinics, Fairview Mesaba Clinics, HealthEast Clinics, Hutchinson Health, Lakewood Health System, Park Nicollet Health Services, Ridgeview Sibley Medical Center, and Sanford Health – Sioux Falls Region. HCH clinics represented 8 of 10 in this category.
Benchmarks are drivers of improvement, raising health care outcomes, and resulting in better health for all Minnesotans. Congratulations to these providers across the state, achieving outcomes as the top performers and consistently improving.
Awesome work HCH clinics!
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New Public Use Files from the
Quality Reporting System
MDH recently released the first set of public use files (PUFs) from the Statewide Quality Reporting and Measurement System (Quality Reporting System) with data on health care quality at the patient ZIP Code level, broken out by gender and health insurance type as a proxy for income. PUFs are available for eight quality measures including seven measures used by Health Care Homes. Anyone can obtain the PUFs by submitting a request form to health.sqrms@state.mn.us.
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The PUFs show that health care quality varies across Minnesota. Rural Minnesotans often have lower health care quality than people living in urban areas. Quality also varied by patient gender and health insurance type. Users can examine care quality in their ZIP Code, or examine data from multiple ZIP codes for their town, city, or region. The PUFs can be used to complement other sources of health data or information, like prevalence statistics, community needs assessments, and community health improvement plans. The PUFs do not include information on clinic-level quality, and patients did not necessarily seek care at clinics in or near their home ZIP Codes. Clinic-level reporting is available at MN Community Measurement’s MNHealthScores website. The PUFs complement clinic-level quality measurement by providing a snapshot of quality in a clinic’s city or region and a portrait of variation in quality across the state.
MDH developed these PUFs in response to a directive from the Minnesota Legislature to stratify Quality Reporting System measures by socio-demographic factors, and a recommendation from communities most impacted by health disparities to provide raw stratified data and companion materials to the public.
To prepare for future PUFs releases, MDH will engage with communities and PUF requesters to gain insights into what users are learning from the data, and obtain guidance about how to evolve the PUFs, including how to incorporate meaningful information on patient race, Hispanic ethnicity, preferred language, and country of origin at different geographic levels.
For more information, please visit the Public Use Files website.
Congratulations:
Certification and Recertification
HCH clinics certifying and recertifying so far in 2019 are listed below in calendar order of certification/recertification. Congratulations to these and other certified clinic staff working every day to provide better health and better care at lower costs.
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Certification
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Ridgeview Medical Center & Clinics: Arlington, Belle Plaine, Chanhassen, Chaska, Delano, Excelsior, Gaylord, Henderson, Howard Lake, Le Sueur, Spring Park, Winsted, Winthrop
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Gillette Children’s Complex Care Clinic: St. Paul
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St. Luke’s Medical Arts Clinic: Duluth
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Scenic Rivers Health Services: Cook, Tower
Recertification
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NorthPoint Health & Wellness: Minneapolis
- Indian Health Board of Minneapolis
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Avera Medical Group: Marshall, Windom, Worthington
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United Family Medicine: St. Paul
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Richfield Medical Group: Richfield
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CHI St. Gabriel’s Health: Little Falls, Randall
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North Memorial: Blaine, Brooklyn Center, Brooklyn Park, Minneapolis, Elk River, Golden Valley, Maple Grove, Minnetonka, New Hope, Plymouth, St. Anthony
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Olmsted Medical Center: Byron, Cannon Falls, Chatfield, Lake City, Pine Island, Plainview, Preston, Rochester, spring Valley, St. Charles, Stewartville, Wanamingo
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Alomere Health: Alexandria, Osakis
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Children’s Hospital & Clinics of MN: Minneapolis, St. Paul
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Lake Superior Community Health Center: Duluth, Superior
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Sawtooth Mountain Clinic: Grand Marais
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St. Luke’s Hospital and Clinics: Duluth, Hermantown, Two Harbors, Ashland, Superior
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Open Door Health Center: Mankato
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HealthEast Care System: Cottage Grove, Hugo, Maplewood, Oakdale, Roseville Stillwater, St. Paul, Vadnais Heights, Woodbury
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Fairview Health Services: Andover, Apple Valley, Blaine, Bloomington, Brooklyn Park, Burnsville, Chisago City, Columbia Heights, Eagan, Eden Prairie, Edina, Elk River, Farmington, Fridley, Hibbing, Hugo, Lakeville, Lino Lakes, Maple Grove, Milaca, Minneapolis, Mountain Iron, Nashwauk, New Brighton, North Branch, Pine City, Princeton, Prior Lake, Rogers, Rosemount, Savage, St. Paul, Wyoming, Zimmerman
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Lakewood Health System: Browerville, Eagle Bend, Motley, Pillager, Staples
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Lake Region Healthcare Clinic Services: Ashby, Barnesville, Battle Lake, Fergus Falls
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Sanford Clinic Fargo Region: Bemidji, Fargo, Detroit Lakes, East Grand Forks, Jamestown, Mahnomen, Moorhead, Pelican Rapids, Perham, Thief River Falls, Wahpeton, West Fargo, Wheaton
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Life Medical, PA: St. Louis Park
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Mayo Clinic – Employee and Community Health: Kasson, Rochester
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AALFA Family Clinic: White Bear Lake
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St. Paul Family Medical Center: St. Paul
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South Lake Pediatrics: Chaska, Eden Prairie, Maple Grove, Minnetonka, Plymouth
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Open Cities Health Center: St. Paul
Noteworthy section
Gillette Children’s is sponsoring Transforming Care and Experience for Children with Health Complexity Thursday, June 20, 2019 | 9 a.m. - 5:30 p.m. at 317 on Rice Park Event Center. The conference is for care coordinators, specialists, parents, pediatricians, primary care physicians, advanced practice providers, nurses, and other interested health care professionals. The overall conference goal is to advance the system of comprehensive, family-centered care coordination that supports families of children who have complex conditions.
The March/April 2019 issue of Minnesota Medicine Magazine features the article, Diabetes management, highlighting the need for a customized approach to supporting individuals ages 18-44 with diabetes. The article includes Health Care Homes as a model that can help address the unique challenges these individuals face. Danette Holznagel and Tina Peters, HCH staffers, co-authored the article with Rozalina G. McCoy, Renee S.M. Kidney, and Vimbai Madzura.
Having a family doctor improves your life is a conversation with Dr. Deb Dittberner, Chief Medical Officer, Alomere Health and Dr. Renee Crichlow, Director of Advocacy and Policy, U of M School of Medicine, and President, MN Academy of Family Physicians. The April 2 MPR Kerri Miller program broadcast is available as a podcast and audio recording.
Stratis Health is updating the Stratis Health MIPS Estimator for program year 2019 and will make it available in June at no cost to support clinicians and health care organizations succeed in the Merit-based Incentive Payment System (MIPS). Please contact QPPHelp@stratishealth.org with questions regarding the Stratis Health MIPS Estimator and visit the Centers for Medicare and Medicaid Services (CMS) website for further information regarding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
CMS has posted the electronic clinical quality measure (eCQM) specifications for the 2020 performance period for Eligible Professionals and Eligible Clinicians. Please visit the eCQI Resource Center for more information.
The CMS Quality Payment Program (QPP) Resource Library provides support in participating in MIPS and/or Alternative Payment Models, including the 2019 Measures and Activities for Primary Care Clinics (PDF).
The Minnesota Oral Health Project (MNOHP) focuses on dental health for children 0-6 years of age in greater (rural) Minnesota. MNOHP provides online training and other resources for medical clinic staff and created a book for children, Bye Bye Germs. Contact Cris Gilb at cris.gilb@crushcavities.com for more information.
References
[1] Brault, M. (2012, Jul). Americans with disabilities. Retrieved from Current Populations Report: http://www.census.gov/library/publications/2012/demo/p70-131.html
[2] Centers for Disease Control and Prevention (CDC). (2015, November 2). Disability and health data system [online database]. Retrieved from CDC: http://dhds.cdc.gov
[3] Centers for Disease Control and Prevention (CDC). (2015, September 30). CDC. Retrieved from National Center for Health Statistics. DATA2010 [Internet database]. : http://wonder.cdc.gov/data2010/focus.htm
[4] Centers for Disease Control and Prevention (CDC), . (2010, November 2). CDC. Retrieved from National Center for Health Statistics. DATA2020 [Internet database]: http://www.healthypeople.gov/2020/data-search/Search-the-Data
[5] World Health Organization (WHO). (2008). Commission on Determinants of Health. Closing the gap in a generation: Health equity through action on the determinants of health. Final report. Geneva, Switzerland: WHO.
[6] Snowden, A., MPH, CPHQ, Brinkhaus, T., & Nelson, G. (2019, February). 2018 Minnesota Health Care Quality Report (Rep.). Retrieved June 4, 2019, from Minnesota Community Measurement (MNCM) website: https://mncm.org/wp-content/uploads/2019/03/mncm-quality-report-2019.pdf
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