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Study: Program focused on preventive medicine, team treatment shows promise

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​A health care effort focused on preventive medicine and a team approach to treatment is showing promise improving care and reducing costs, state officials say.  

The Health Care Homes initiative has increased patient access to clinics, particularly for people of color, while improving quality and coordination of care, according to a state study released Thursday.

  Health Care Homes is not home health care. The idea is to change the way clinics provide care from a traditional, illness-based model, to one that strives to improve the health of patients with chronic conditions and disabilities.  

Clinics can receive extra payments for their efforts. At the same time, the program is intended to reduce health care spending enough to cover its own costs.

  In the first three years of the program, Minnesota has certified 322 primary care clinics as health care homes. That's about 43 percent of eligible family practice clinics in the state.  

Besides lowering costs, Health Care Homes clinics outpaced other clinics on quality metrics such as asthma care and colorectal cancer screening, officials said.

  "What you're seeing here is that the care is better for those individuals who are enrolled in a health care home," said Doug Wholey, who led the University of Minnesota team that evaluated Health Care Homes for the Legislature.

  "Health Care Homes had higher overall quality of care for diabetes care, vascular care, asthma care and colorectal cancer screening," Wholey told reporters. Clinics that were certified as Health Care Homes scored better than non-certified clinics on a number of quality measures, he added.

  The rate of appropriate asthma care was approximately 20 percent higher among Health Care Homes clinics than it was for uncertified clinics. Screening for colorectal cancer was 8 percent higher in Health Care Homes. And blood vessel care scored 4 to 8 percent higher. The results were all statistically significant.

The evaluation found that the average cost for Medicaid enrollees in a Health Care Home was 9.2 percent less than for patients in non-certified clinics over three years.

  It's still unknown whether Health Care Homes can be credited with actually reducing health spending, though the 9 percent reduction was financially significant and amounted to more than the state's expenses on the program.

  All the data point in the right direction, said Minnesota Department of Health Commissioner Ed Ehlinger.  

"This is an approach that is really working well in this state, and really has a lot of promise, that is being realized right now, but (has) even more promise in the future," he said.  

While Ehlinger is pleased with the number of providers certified as Health Care Homes, he says it has been a challenge to get insurers to agree to a common reimbursement system for the program. That has made it hard for clinics to get the extra payments for participating.  

Getting all of the state's health care payers on board with the program is the next hurdle, said Marie Maes-Voreis, who directs the Health Care Homes initiative for the Health Department.

  "One of the things that I've heard over the past five years is 'show us that it works and then we'll come to the table around payment,'" she said. "I think that we're right at that cusp today."

  The evaluation of Minnesota's Health Care Homes effort is the first of two reports requested by the Legislature. Lawmakers have requested another evaluation of the program in 2015, five years after its implementation.