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Health Care Home

Health care homes represent a significant redesign of health care in Minnesota. A “health care home,” also known as a “medical home,” is an approach to primary care in which providers, families, and patients work in partnership to improve health outcomes and quality of life for individuals, especially those with chronic health conditions and disabilities, and ultimately contain or reduce health care costs. MNAAP helped pioneer this concept Minnesota in 2003 through a series of learning collaboratives to define essential qualities of a health care home, which include increased access, increased communication, improved patient registry, improved care coordination, and improved performance reporting. Since then, MNAAP has helped more than 250 pediatricians become certified as health care home providers in Minnesota. It has also provided training and technical assistance to more than 1,300 physicians and clinic staff in Minnesota.

View Video & Webinars

5/1/13: HCH workgroup call regarding Minnesota’s Transition Collaborative. Listen now!

12/7/11: HCMC’s use of Community Health Workers (CHW) in their certified Health Care Home. Listen now!

Pediatricians Working with Patients in Foster Care

From October 2013 thru April 2014, the Minnesota Chapter of the American Academy of Pediatrics Foster Care Health Learning Collaborative met to discuss the health of children in foster care and ways to improve health services to these children.  The collaborative included clinicians from Hennepin County Medical Center, North Point Health and Wellness, Park Nicollet pediatrics, the Native American Community Clinic, Minnesota Organization on Fetal Alcohol Syndrome, St. Joseph’s Home for Children Community Clinic and Catholic Charities Health Services, and Health Partners pediatrics.

Approved Activities of a Pediatric Care Coordinator for Children in Foster Care

Comments on Minnesota’s Current Policy

11/09/11: Health Care Home Tier E-Tool
Download Here


Pediatricians Working with Children/Teens/Youth with Developmental Disabilities

Pediatricians and their staff who are working with infants, children, and young adults with developmental disabilities and who are covered by Medical Assistance (MA)for their health insurance, may be asked to complete a preadmission screening (PAS) evaluation report prior to admission to a nursing facility (NF) or for other resources.

Minnesota legislation expanded preadmission screening (PAS) activities to all persons that apply for admission to NFs certified by MA. In 2001, the Minnesota Legislature incorporated Minnesota guidelines regarding admission decisions for persons seeking services in an NF and county concurrence into the Long-Term Care Consultation (LTCC) Services.

PAS determines the need for an NF level of care. PAS activities also consist of:

  • Level I Screening to identify all persons who might have a diagnosis of developmental disability
  • Level II Evaluative Report to evaluate and determine if NF services and specialized services (active treatment) are needed if indicated by Level I Screening


Helpful Websites

Minnesota Department of Health – Health Care Homes»
AAP Medical Home Website»



Positioning the Family and Patient at the Center: A Guide to the Family and Patient Partnership in the Medical

Home (June 2013)

This monograph, funded by the American Academy of Pediatrics, demonstrates the partnership of pediatricians and families in true medical homes. Minnesota’s own CentraCare Clinic, located in St. Cloud, is highlighted for having some of the best practices in patient and family-centered care in the country.

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