U of M evaluates health care homes, finds better access to care, higher quality and lower costs

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Thursday, February 20, 2014

University of Minnesota researchers from the School of Public Health have found that Health Care Homes (HCH) in Minnesota may be upholding their promise to improve access to quality health care while reducing the cost of care.

In an evaluation of the current status of HCHs, researchers also found that HCHs served patients with more severe medical conditions and were associated with better access to care for African American and Native American populations.

The results come from a Minnesota Department of Health (MDH) funded evaluation of HCHs led by co-investigators Douglas Wholey Ph.D., and Michael Finch, Ph.D., from the University of Minnesota School of Public Health Division of Health Policy & Management. 

Within a HCH, primary care providers, families, and patients work in partnership to improve health outcomes and quality of life for individuals with chronic health conditions and disabilities. The goal of HCHs is to transform primary care; patients and families are at the center of their care, and the right care is provided at the right time, in the right place. It is a team approach that gives patients access to healthcare services and the support they need.

The University of Minnesota study is the first of two legislatively mandated reports on HCHs, and the data are released today alongside a MDH and Minnesota Department of Human Services report to the Legislature that found clinics are embracing the HCHs model.

“At the time of our evaluation, Minnesota had over 700 primary care clinics that were eligible to become certified health care homes,” said Finch. “By the end of the review period, there were over 200 certified health care homes in the state. Our goal was to provide an impartial, preliminary evaluation of the health care homes initiative and its impact on government healthcare and patient health in Minnesota.” 

Results 

The report, which evaluates the HCHs initiative from July 2010 through December 2012, includes:

  • A description of demographic trends, including HCH enrollee and provider demographics
  • An evaluation of the quality of care provided by HCHs and eligible non-HCH clinics
  • HCH payment arrangements and interactions with payment policies
  • Racial disparities in the use of care between both HCH and eligible non-HCH clinics and within HCH clinics
  • Costs and use of health care services related to patients served by HCHs 

“When the health care home initiative began in 2010, the enrollees served by health care homes were more expensive than enrolles served by non- health care homes clinics,” said Wholey. “However, over the period 2010 to 2012, Medicaid enrollees in health care homes had 9.2% lower costs than Medicaid enrollees in non- health care home clinics.

According to the report, the quality of care provided by clinics certified as HCHs was higher than non-certified primary care clinics. Quality of care measurements using Statewide Quality Reporting and Measurement System measures showed that compared to non-HCH clinics, HCHs had better colorectal cancer screening, asthma care, diabetes care, vascular care, and follow up care for depression.

Furthermore, populations of color cared for by HCHs used fewer emergency department and ambulatory care services, had fewer evaluation and management visits, and used more professional services and hospital outpatient services than populations of color at non-HCH clinics.

Next Steps

To gain a deeper evaluation of the HCH initiative, researchers will: 

  • Review further quality data as they become available, which will contribute to a greater understanding of the populations and care patterns related to the HCH initiative
  • Estimate the degree to which the HCH Initiative caused clinic transformation
  • Develop further understandings of the underlying effect of HCH care on patient outcomes
  • Examine the transformation of clinics to HCHs and how the specific HCH standards are related to HCH performance 

“This initial report looked at the association between the health care home initiative and health care,” said Wholey. “The next step is to understand why, which will provide feedback that can be used by the health care home initiative to improve care for the people of Minnesota.”

An interim evaluation report will be submitted to MDH in 2014, and an additional evaluation report will be submitted to the State Legislature in 2015 to examine the HCH initiative after 5 years of implementation. 

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The State of Minnesota’s Health Care Home (HCH) initiative is a joint initiative of the Minnesota Department of Health (MDH) and the Minnesota Department of Human Services (DHS), as directed by the Minnesota State Legislature. This initiative contributes to improving health care and population health in the State of Minnesota by implementing a Health Care Home practice model in health care clinics statewide.

As part of the HCH initiative’s enabling legislation, the State Legislature also directed MDH and DHS to provide comprehensive evaluations of the Health Care Home care delivery model to the legislature three and five years after implementation. Following this direction, this report provides a preliminary evaluation of the State of Minnesota’s Health Care Home initiative three years after implementation.