Health Care Reform: Following Minnesota's Lead
Health Care Reform• Following Our Lead |
As of this writing the fate of U.S. health care reform is still in play and forty-six million Americans remain uninsured. What we know for sure is that a national reform effort will never reach its full potential without making the fundamental connection between health care and public health.
For decades, public health professionals have worked to prevent illness, raise quality of care, reduce costs, and expand health care access--all the issues that figure so prominently in the health care debate.
Minnesota has long put these public health concepts front and center and that emphasis helped shape 2008 landmark legislation that brought sweeping reform to the state.
Investing in Disease Prevention
Over the past year, the Minnesota Department of Health awarded $47 million in grants to its Statewide Health Improvement Program (SHIP) to fight the top three causes of preventable illness in the United States: tobacco use, physical inactivity, and poor nutrition. SHIP has the potential to improve the health of Minnesotans and so curb health care costs in the state. Assuming that SHIP funding continues, projected potential savings could be up to $1.9 billion by 2015.
In addition to the health-improvement grants, the state--with input from SPH experts--is developing rules for "health care homes," clinical settings that coordinate the care for people with chronic or complex conditions. Certified health care homes will be eligible to receive "care coordination payments" from both public and private payers.
"At the root of [both these initiatives] is a goal to achieve better health, not just better health care," says Minnesota Health Commissioner Sanne Magnan. "We're working to prevent the chronic diseases that bring people into the health care system in the first place."
States as Leaders in Health Care Reform
In the 16 years since the Clinton administration failed to rework health care, there has been a lack of national leadership on reform. So states have moved ahead on their own. The progress Minnesota has made helps position it as a leader in national reform, says SPH associate professor Lynn Blewett.
As head of the State Health Access Data Assistance Center (SHADAC), Blewett works with states to increase access to health care, often determining whether Minnesota models can be used elsewhere.
In addition to health care homes and SHIP, Blewett cites quality payment incentives and "baskets of care" as successful Minnesota initiatives.
Using community-based data, experts have developed a set of 29 quality measures for specific services at different health care systems statewide. The measures will be used to compare quality of care and to reward the systems that meet quality benchmarks.
"Baskets of care" involves looking at common services, like asthma care for children and total knee replacement, and bundling together all the costs associated with those services into a "basket." This way, consumers will be able to compare costs across the market. "Each health care system attaches a price tag to each basket," explains Blewett. "So as a consumer, you will be able to compare apples to apples."
Blewett believes that Minnesota will continue to play a leading role in national health care reform even after initial legislation is passed this year. At that point, federal analysts will be looking for models of payment reform that improve efficiency and financial incentives that promote quality. "Minnesota will be at the top of their list," she says.
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