Human Services

Health Care

http://www.dhs.state.mn.us/id_006301

Statewide Outcome(s):

Health Care supports the following statewide outcome(s).

Minnesotans are healthy.

Context:

The Minnesota Department of Human Services (DHS) Health Care Administration is responsible for overseeing the development, operational components and federal and state compliance of Minnesota’s public health care programs, including:

· Medical Assistance (MA, or Minnesota's Medicaid program), which provides coverage for an average of more than 660,000 low-income people each month, including children and families, people 65 or older, people who have disabilities and adults without children.

· MinnesotaCare, which is designed for Minnesotans who do not have access to affordable health care coverage. MinnesotaCare serves an average of 148,000 people each month, and can be critical to helping people leave welfare and go to work without losing health care coverage.

· Healthy Minnesota Contribution Program, which began July 1, 2012 and provides a subsidy for adults without children at the upper end of the MinnesotaCare income range to purchase private health care coverage in the individual insurance market.

Through these programs, the state pays all or part of enrollees' medical bills. In FY 2011, about 74 percent of DHS' all-funds (state and federal funds) budget was devoted to these programs. These programs provide a safety net for low-income families, the elderly, disabled and very low-income adults without children. When faced with no coverage, individuals often seek preventative care services in an emergency room setting or choose not to seek preventative care. Uninsured Minnesotans also receive care in an uncoordinated and uncompensated manner in disparate provider settings (as opposed to a primary care setting), and/or delay seeking health care for emerging conditions. All of these choices result in reduced health outcomes for Minnesotans and/or increased cost for taxpayers.

The goals of the DHS Health Care Administration (HCA) are to:

1. Reduce the number of uninsured Minnesotans, by helping eligible people get health care coverage and measuring the quality of this coverage to improve it;

2. Reform the payment and service delivery models for Minnesota’s public health care programs, by designing our rates and systems to be transparent and of maximized value for the taxpayer dollar;

3. Utilize research, data and analysis to develop HCA initiatives, support DHS health care programs and evaluate results;

4. Employ technology solutions to reduce costs and improve services for applicants, members and providers; and

5. Encourage stakeholder communication across HCA, to promote understanding and support of Minnesota's public health care programs.

HCA is actively engaged in implementing federal and state health care reform initiatives, to maximize available opportunities and promote health reform.

Strategies:

HCA’s operational components include eligibility policy, provider and member enrollment/relations, federal relations (with the Centers for Medicare & Medicaid Services, or CMS, which administers Medicaid federally), managed care enrollment and contracting, project management, purchasing and service delivery, claims processing, benefit recovery, system development and maintenance, performance measurement, and numerous other functions of a public health plan. (HCA shares some MA and MinnesotaCare coverage policy and rates development functions with the DHS Continuing Care and Chemical and Mental Health Services administrations for those services.) HCA also develops improvements to the way we administer and deliver these programs.

DHS and HCA work with many stakeholders to help us determine how we can improve our health care programs:

Improve health outcomes of public health care recipients while lowering costs for taxpayers

· MA and MinnesotaCare provide coverage of care coordination services for people with chronic illnesses through physician clinics that are certified Health Care Homes.

· DHS, per legislative direction in 2011, is seeking federal approval to reform MA to achieve better outcomes for people with disabilities, seniors and other enrollees through the Reform 2020 initiative. More information is available online at http://www.dhs.state.mn.us/main/dhs16_166654

· DHS is submitting a grant application for a CMS Innovation Challenge for the “Strong Start for Mothers and Babies” initiative, to decrease disparities in birth outcomes for infants from communities of color.

· DHS is working with many partners to launch the Money Follows the Person Rebalancing Demonstration Program, aimed at increasing the number of Minnesotans with disabilities served in their homes and communities rather than in institutions. (See http://www.dhs.state.mn.us/dhs16_162194

· DHS is partnering with the Minnesota Department of Health to help MA and MinnesotaCare enrollees prevent diabetes and other chronic disease by participating in the YMCA’s Diabetes Prevention Program and receiving other incentives for healthy behavior. Funded through a five-year grant, this program will help clients improve their health while lowering state health care spending for chronic conditions.

Integrate primary care, behavioral health and long-term care

Minnesota will see large growth in cost and utilization of long-term care services as Minnesota’s population ages. We can save money, reduce duplication of services and improve the health of our recipients if we better integrate our health care services. Some examples include:

· As part of Reform 2020, DHS is building on current state initiatives to improve performance of primary care and care coordination models for dual Medicare-Medicaid eligibles. Part of this focus is on primary care payment reform, and the consistent measurement and improvement in clinical outcomes. More information about this component of the overall reform is available at

http://www.dhs.state.mn.us/main/dhs16_163573

· DHS is developing a grant project to integrate primary care and behavioral health care.

· DHS is partnering with Hennepin County on an innovative pilot project to test new strategies to better deliver human services to high-needs populations. This new demonstration, Hennepin Health, will provide a system that integrates medical, behavioral health and county human services for up to 10,000 low-income Minnesotans in a patient-centered model of care, improving patient outcomes while reducing overall costs.

Institute payment reform in health care purchasing

HCA is negotiating with potential Health Care Delivery System (HCDS) sites to begin full operation by January 2013. HCDS demonstration projects will contract directly with providers in a new way that allows them to share in savings for improving quality of care and patient experience and reducing the total cost of care for Medicaid enrollees. In this new model, MA enrollees will receive more coordinated care to improve their overall health, and health care providers will be paid based on the quality of care they provide to their patients and their ability to reduce the cost of care.

HCA’s work also supports the following strategies in the DHS Framework for the Future: 2012 (https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6464-ENG):

· Increase access to affordable health care

· Integrate primary care, behavioral health and long-term care

· Institute payment reform in health care purchasing

· Use technology to increase our outreach through online applications, a new website and e-licensing initiatives

· Narrow the health care quality gap between clients in publicly-funded health care and private enrollees

· Increase enrollment outreach to communities of color.

Results:

Minnesota is consistently a national leader in promoting and implementing policy and payment initiatives that improve access, quality, and cost-effectiveness of services provided through publicly funded health care programs. We monitor performance measures that help us get at key actions and strategies. If DHS can quickly reimburse providers who serve our recipients, these providers may be more apt to serve recipients of Minnesota's public health care programs. Timely disposition of applications greatly improves access to health care coverage for eligible customers. Treating people in emergency rooms is more expensive than keeping them healthy to begin with, so it makes sense to get people the primary care they need. This last performance measure needs improvement, since providing people with insurance offers access to the kind of preventive care that keeps costs down and helps people live better lives.

Performance Measures	Previous	Current	Trend
Percent of electronically submitted claims paid within two days¹	98.4%	98.5%	Stable
Average number of days to process MinnesotaCare applications²	32 days	25 days	Improving
Percent of Minnesotans lacking health care insurance³	9%	9.1%	Stable

Performance Measures Notes:

1. Source: DHS Data Warehouse, measured quarterly. Compares Fiscal year 2012, 2^nd Quarter (Previous) to Fiscal year 2012 3^rd Quarter (Current). The goal is to continue to pay 98 percent of electronically submitted claims within two days.

2. Source: DHS HCEA Operations, measured quarterly. Compares Fiscal year 2012, 1st Quarter (Previous) to Fiscal year 2012 2^nd Quarter (Current). The goal is to process applications for MinnesotaCare within thirty days.

3. Source: Minnesota Department of Health Access Survey (conducted semiannually). Compares 2009 (Previous) to 2011 (Current). Nearly three-fourths of the uninsured have some potential access to coverage but do not take advantage of it.