Health Care Homes
Sustainability Roadmap
The Health Care Homes’ (HCH) Sustainability Roadmap is a framework for action that provides strategies and ideas to support sustainability of certified HCH organizations and clinics that deliver patient-centered, whole-person, team-based care. The HCH model assists providers in meeting the Minnesota Department of Health’s long-term mission of protecting, maintaining, and improving the health of all Minnesotans through high-quality primary care.
Who Should Use This Roadmap
This tool is designed for certified Health Care Home:
- Executive Leaders
- Clinic Administration and Management
- Care Coordination and Care Management teams
- Quality Improvement advocates
- Finance team members
- Community and organizational partners working with HCH-certified clinics
How to Get Started
Follow these simple steps to begin using the Sustainability Roadmap:
- Scan the Five Essential Elements
Start by reviewing the five elements below. Identify which areas represent strengths for your organization and which may need deeper focus.
- Explore the Pages Most Relevant to Your Needs
Each Essential Element includes suggested strategies, links to tools and resources, and practical examples. Select the areas that align with your current goals and priorities.
Use the Resources to Drive Action
Apply the strategies, tools, and examples to your own HCH work to:- Update workflows
- Strengthen team roles
- Support value-based care efforts
- Inform financial planning and contracting
- Build community relationships
- Revisit the Roadmap Regularly
Sustainability is dynamic. Organizations may revisit different elements as their needs and capacity change. New resources and examples may be added over time, so check back regularly.
Essential Elements
While financial stability is essential, sustaining the HCH model of care also depends on reliable care coordination, learning systems, effective partnerships, and strong teams.
This Roadmap brings those elements together to support clinics in planning, improving, and maintaining their HCH program over time.
High-quality care coordination is at the heart of the HCH model. This section includes strategies, tools, and examples to strengthen patient-centered, proactive coordination across teams and settings.
Strong internal, community, and organizational partnerships help clinics maintain high-quality care and support patients more effectively. Explore ways to build, sustain, and leverage meaningful relationships that support full-spectrum primary care.
Financial health is a key component of sustainability. This element provides guidance on value-based contracting, alternative payment models, billing resources, and financial planning strategies to support durable primary care services.
Through its focus on redesign of care delivery and meaningful engagement of patients in their care, Health Care Homes is transforming health care for millions of Minnesotans.
A sustainable HCH relies on continuous learning and adaptation. This section offers approaches to quality improvement, data-driven decision-making, and building internal systems that support ongoing learning.
Sustainability requires a stable, supported, and engaged workforce. Discover strategies for role clarity, staff development, team-based care, and approaches that help clinics attract and retain skilled team members.