Health Care Homes Sustainability Roadmap
Finance
Despite current high levels of health care spending in the United States, the proportion spent on primary care is insufficient. A shift in resources to support greater access to comprehensive, coordinated primary care is imperative to achieving a stronger, higher-performing health care system.
Financial reimbursement and value-based contracting are important to sustaining the Health Care Homes model. In Minnesota there is opportunity to obtain reimbursement for care coordination and maximize the benefits of participation in programs such as the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP).
Participation and success in value-based payment arrangements is strengthened using a patient centered medical home care delivery such as a HCH certification.
Strategies
- Reimbursement for care coordination services: Some commercial payers reimburse for care coordination services using the Minnesota Health Care Programs (MHCP) process and codes, and others reimburse through alternative payment arrangements or value-based programs. As an example, the Minnesota Department of Human Services reimburses certified HCHs for services provided to the clinic’s Medicaid population.
- Integrated Health Partnerships (IHP): Certification as an HCH serves as a gateway to participation in IHP, the Minnesota Department of Human Services (DHS) Medicaid accountable care organization (ACO). To participate in an IHP, an organization must be HCH certified or meet a set of care delivery standards that match those of HCH. The IHP program requests annual proposals/IHP applications. Integrated Health Partnerships (IHP) - DHS
- Merit Based Incentive Payment System (MIPS): Health Care Homes that participate in the Centers for Medicare & Medicaid Services (CMS) MIPS program are eligible to receive added benefits.
- Advanced Certification Levels: Clinics that progress to Level 2 or 3 certification demonstrate an increased capacity to address social determinants of health and health equity. Payers are increasingly interested in finding ways to meet these challenges, opening potential new avenues for reimbursement.
- Identify and leverage resources that support the Health Care Homes (HCH) model through various approaches, modalities, and partnerships. Research literature demonstrates that implementation of the national “version” of HCH, the patient centered medical home model (PCMH), supports better outcomes for participants in value-based payment arrangements.
- Pursue value-based arrangements with state and national programs, accountable care organizations, and contractual agreements which recognize the value of and provide reimbursement to providers of high-quality, team-based primary care.
Resources
- Physician and Professional Services - Health Care Homes
- Health Care Homes-Incentives & Payments-CMS MIPS
- Health Care Payment Learning and Action Network | CMS Innovation Center
- The Patient-Centered Medical Home: A Purchaser Guide (PDF)
- CMS.gov What are the Value-Based Programs
- Making Care Primary (MCP) Model | CMS
- Advanced Primary Care: A Key Contributor to Successful ACOs (PDF)
- The Roles of Patient-Centered Medical Homes and Accountable Care Organizations in Coordinating Patient Care (PDF)
- Measuring the Cost Implications of the Collaborative Accountable Care Initiative in Texas
- Minnesota Academy of Family Physicians ACO webpage
- Next Generation ACO webpage
- Center for Health Care Strategies, Inc. ACO webpage
Stories
The Health Care Homes (HCH) Sustainability Workgroup and leadership of the State Employee Group Insurance Program (SEGIP) began a collaborative project to educate SEGIP members about the benefits of HCH certification in 2019. The HCH Sustainability Workgroup’s primary objectives are to improve the health of all Minnesotans by ensuring the sustainability of certified HCH clinics and promoting population health and health equity. These goals complement SEGIP’s mission, which is to help members achieve and maintain health in every aspect of their lives by providing high-quality and cost-effective insurance and benefits.
SEGIP administers the MN Advantage Health Plan, the medical insurance program offered to state employees. It encourages members to choose cost-efficient, high-quality clinics. The Advantage Plan covers more than 130,000 members, including employees of state agencies and quasi-state units, their dependents, pre-65 retirees, and other separated employees. Members choose a primary care clinic that manages their care, and each clinic is assigned a cost level between one and four, with one being the most cost-efficient and four the least. Members are encouraged to select lower cost level clinics through reduced cost-sharing.
To help members choose the clinic that best meets their needs, SEGIP maintains a comprehensive online clinic directory that provides information on clinic location, cost level, quality, and HCH certification status. SEGIP incorporated HCH status prominently on the clinic directory starting with Open Enrollment 2022. This shows if a clinic is HCH certified, provides an informational pop-up that explains what HCH certification means for their care, and links to the HCH website for more information.
While analyzing 2022 enrollment results, SEGIP found that HCH certification was widespread in clinic networks, and the majority of members chose to receive care at a HCH certified clinic. In addition, those members enrolled at HCH certified clinics had lower average cost levels.
Nearly 55% of SEGIP primary care clinics in Minnesota had HCH status in 2022.
About 85% of SEGIP members in Minnesota chose an HCH as their primary care clinic for 2022.
Members enrolled at HCH clinics had lower average cost levels for 2022.
“Adding Health Care Homes certification to our clinic directory has been a great way to show our members when a clinic emphasizes effective care coordination,” said Zach Holmquist, a Senior Health Care Analyst at SEGIP.
To further this collaboration, HCH and SEGIP will continue to look at new ways to improve awareness and promote the benefits of the HCH model of care.