A Look Back and Ahead at Innovative Health Care Programs in Minnesota

Throughout 2017, TakeAction Minnesota members organized to defend Medicaid by collecting and sharing stories, mobilizing Minnesotans to vociferously oppose bills that would harm Medicaid, and by training individuals on the threats to the state’s Medicaid innovations like Integrated Health Partnerships (IHPs – our Accountable Care Organizations) and Minnesota Senior Health Options.

TakeAction also continued in its role as a convener of health care advocacy organizations in Minnesota to protect all of our public health care programs and improve the transparency and effectiveness of IHPs – to better protect and reflect the interests and needs of individuals.

These initiatives have presented some unique challenges.

To date, Minnesota’s IHPs have been all but invisible to program enrollees, existing primarily as a data-sharing contractual relationship between the state’s Department of Human Services (DHS) and provider organizations to encourage care coordination and experiment with different population health interventions – regardless of their managed care or fee-for-service payment arrangements.

Minnesota DHS already considers IHPs to be a major success. In just a handful of years serving over 460,000 enrollees, Emergency Department visits are down 7 percent, hospital stays are down 14 percent and program costs have decreased by $213 million. However, without the awareness or engagement of program enrollees, the program is more of a payment reform mechanism than a true delivery transformation.

It has been difficult to find enrollees to engage due to the nature of these innovations. IHPs use retrospective membership attribution rather than prospective enrollment – that is, DHS assigns people to an IHP after the fact, based on past health care provider visits, rather than requiring that enrollees affirmatively choose to enroll in one. Other than receiving a notice in the mail, enrollees cannot easily tell through their experience of care whether they are in an IHP arrangement or not.

Paradoxically, Minnesota’s Senior Health Options program presents a different quandary: a familiarity that makes successes invisible. Since the program – one of the first of its kind anywhere in the country for people dually eligible for Medicare and Medicaid – has existed for 20 years, many program enrollees haven’t known any other health care delivery experience and therefore, are not aware of its unique features. While it is not difficult to find Medicaid enrollees with stories to share, it is harder to determine what is attributable to one of the state’s innovations rather than a different aspect of the program as a whole, such as eligibility guidelines, enrollment processes or the state’s use of information technology.

Our policy discussions with DHS officials have continued; they recently released a Request for Comment on a “Next Generation” pilot of IHPs in the Minneapolis-Saint Paul metropolitan area to build on their accomplishments. Key innovations in this pilot include prospective enrollment by individuals with a primary care provider (or another primary provider relationship, such as a mental health provider or OB-GYN) rather than with a Managed Care Organization (MCO), and the option for provider organizations to establish direct contractual relationships with DHS – without an MCO as intermediary – for the care they provide through these programs.

We are encouraged that DHS is continuing to develop the IHP program and push it forward, rather than considering their early results to be good enough. We are now encouraging DHS to establish a robust enrollee engagement and education process to make true delivery transformation possible at the level of the enrollee-provider relationship and to offer recommendations on ways for system savings to be reinvested into upstream interventions on social determinants of health.

2018 promises to be a pivotal year in Minnesota, shaping what’s possible in health care policy for many years to come. TakeAction Minnesota members will continue our decade-long work to protect and expand our public health care programs, Medicaid and MinnesotaCare. The successes of these programs have been strengthened by every one of our state’s innovations, including the ongoing development of IHPs. Our engagement with enrollees to pursue further health care delivery improvements and investments in social determinants of health will be critical to the ability of these programs to thrive in the future.

Dave Zaffrann, Former Health Care Program Manager at TakeAction Minnesota