Pediatricians in the 21 clinics that participated in the Minnesota Medical Home Learning Collaborative, myself among them, have watched as medical home has been transformed from a model of how to provide care to children and youth with special health care needs to a process regulated by the state with terms to be negotiated with the insurance companies.
We may long just a little bit for the good old days when we had medical home all to ourselves as a project for our pediatric patients. Those days are gone, at least in Minnesota.
So, what’s a snapshot of health care home today, and what may lie ahead?
To those certified health care homes, the state of Minnesota will pay patient coordination fees on a monthly basis. Providers will identify health care home patients using the tiering tool developed for Minnesota by the Department of Human Services and the Department of Health.
The tool ranks medical complexity from 1 to 4, with an additional payment per month increased by 15 percent for language barriers and/or serious mental health conditions in the patients or caregivers. These increases are a first attempt, though imperfect, to take into account the added difficulty of coordinating care in the face of cultural and social barriers. We can expect that the tiering tool will change over time, hopefully to ever more accurately reflect the time and work that go into providing care coordination to our patients.
This summer the leadership of MN-AAP, Minnesota Academy of Family Physicians (MAFP), Minnesota Internists (MN-ACP) and Minnesota Medical Association (MMA) met with representatives from Minnesota health plans to gather information about how each plan will implement health care home payments to clinics “in a manner that is consistent with” the system developed by the state, as required by state law.
We posed a set of written questions to each plan, and the answers are posted on the health care home section of our website along with contact information if that was provided by the health plan.
You and your business manager/contract negotiator can call the insurance plan contact number listed to get started on the process of negotiating your clinic’s health care home contract. Health plans have said they will not be contacting individual clinics/physicians regarding this.
The Minnesota Departments of Human Services and Health have applied for a Medicare demonstration project through Centers for Medicare/Medicaid. We should hear next month if Minnesota will be part of this large project to fund medical homes/health care homes for Medicare recipients. This will be good news for our adult medicine colleagues and should give even more momentum to health care home activity in our state as it becomes more financially feasible for primary care clinics to fund care coordinators.
I am always interested in hearing stories from you and your patients about your experiences in the health care home arena, positive or negative. It is by acting together that we can best advocate for our young patients and keep the medical home functioning in a way that works for all of us.
You can send me an email at peitsom@centracare.com with your comments.
Marilyn Peitso, M.D., FAAP
MN-AAP President |
