Health care reform, point by point
MINNEAPOLIS, May 19, 2008 — The 2008 Legislative Session ended with the passage of historic health care reform supported by the MMA.
Health care reform highlights Medical home
The bill supports the medical home model—coordinating care primarily for patients with complex, chronic conditions. Both clinics and clinicians (physicians, advanced practice nurses, and physician assistants) can serve in this role. The commissioners of health and human services will develop and implement standards for certification of medical homes (described in the legislation as “health care homes”) by July 1, 2009. The model will be evaluated in three to five years by the commissioners of health and the commissioner of health and human services. “This reform will focus on chronic illness, which is where most health care dollars are spent and where there are the most opportunities to improve people’s health and save money,” Dehen says. Essential benefit set
It establishes a work group that will make recommendations on the design of an essential benefit set that includes coverage for a broad range of services and technologies that are determined to be clinically effective and cost efficient. The work group will report to the Legislature by January 2010. Public health
The bill will provide $47 million for statewide grants to be awarded in 2010-2011 for programs aimed at reducing obesity and tobacco use. Move toward universal coverage
The package is expected to expand health insurance coverage to 12,000 more Minnesotans. The bill would increase health coverage in state programs by enrolling 7,000 more people in public programs by making people without children who have incomes up to 250 percent of the federal poverty guideline. The state hopes that additional tax incentives will encourage 5,000 Minnesotans to buy insurance in the private market. Cost and quality transparency
The legislation directs the commissioner of health to develop a uniform and valid methodology for calculating providers’ combined performance on cost and quality and to promote payment reform that rewards quality and efficiency. Bundled services
The bill directs the commissioner of health to establish definitions for at least seven baskets of care, or a set of related services, and suggests that they include in those sets treatment for coronary artery and heart disease, diabetes, asthma, and depression. Providers may then choose to establish a price for each basket. Electronic prescribing
The bill will establish standards by 2011 for physicians who write and send prescriptions to pharmacies electronically. |
“The Minnesota Legislature and the governor are to be commended for passing historic health care reform legislation,” says James J. Dehen Jr., M.D., president of the MMA. Dehen also says the MMA can take a great deal of credit for passing S.F. 3780, which moves Minnesota closer to the vision outlined in the MMA’s Physicians’ Plan for a Healthy Minnesota.
“The MMA really helped get the ball rolling with its reform plan and worked closely with both lawmakers and the governor to broker an agreement this session,” he says.
Lawmakers and the governor began the session saying they wanted to achieve health care reform, and early on were able to find common ground on issues such as cost and quality transparency, the need to increase public health investments, and the promotion of medical homes and chronic disease management.
However, the governor and DFL leaders also found plenty on which to disagree.
The governor came out as an early supporter of a controversial payment scheme known as Level 3, which resembled capitated plans of the past and would have held providers accountable for the total cost of caring for patients.
The MMA strongly opposed this payment mechanism and made it clear to lawmakers that it would not support any reform bill that included it. “It was very important for us to get rid of Level 3, especially for the small clinic and in the rural settings, since it presented some potentially unmanageable financial risks,” Dehen says.
In the end, the governor compromised and was willing to replace Level 3 with a provision that calls for standardized measurement and disclosure of providers’ comparative costs and quality of care. The bill calls for the commissioner of health to collect information about providers and then rank them according to peer groupings, which have yet to be defined.
Another bone of contention was whether the state could afford to expand state health insurance programs. DFL lawmakers wanted to add about 40,000 Minnesotans to state rolls. Pawlenty vetoed the first health reform bill because he said the state couldn’t afford such an expansion.
In the end, both sides compromised, with the final bill making about 7,000 more people eligible for public programs and including tax incentives expected to allow 5,000 people to buy insurance in the private market through their employers.
“We didn’t get everything we wanted,” Dehen says. “But we made good inroads, and clearly made some good moves here with the recognition of the medical home, preventive health, and a step toward universal coverage.”
Although the bill is a good one for physicians, parts of the MMA’s reform plan such as achieving universal coverage and more substantial public health spending were not included.
“The key is prevention, and we’ve made movement. But we need to look harder at that, and we need to achieve universal coverage,” Dehen says. “If this is going to work, everyone needs to be in the game.”