As states across the country tackle certificate-of-need revisions, Minnesotas Legislature last week endorsed some of the latest approaches to reforming healthcare.
Lawmakers there tentatively endorsed medical homes and bundled pay for patients care with a bill that edged toward reform, but stopped short of mandating an overhaul of healthcare financing and delivery.
In the final hours of Minnesotas legislative session, lawmakers on May 18, passed a far-reaching bill that would pay a care-coordination fee to primary-care providers who seek a newly created healthcare home certification. The state would create such a certification by July 2009, which would require, among other criteria, that providers encourage the use of primary care, develop comprehensive care plans, and focus at first on those with or at risk of chronic conditions. Providers may seek certification, but are not required to do so.
Legislators also called for the state to create and set quality standards for at least seven so-called baskets of care by the end of 2009, though providers are not required to price and sell the bundled services. Baskets are a group of services typically used to diagnose or treat an illness.
Overall, the bill is projected to shave 10% to 15% from state spending on employee and public safety net insurance, said its chief author, Democratic-Farmer-Labor Party Sen. Linda Berglin.
Minnesota Gov. Tim Pawlenty vetoed the lawmakers initial version of the bill over objections to coverage expansion that would have added an estimated 25,000 to public insurance rolls. The revised bill, which contained additional compromises, scaled back coverage expansion to an estimated 12,000, Berglin said.
Bruce Rueben, outgoing president of the Minnesota Hospital Association, described the package as more modest than originally planned and added that fewer changes will allow for policymakers and providers to adapt and better understand further reforms. Its a good start down the road of increased transparency and performance reporting.
Rueben said that the legislators compromise will encourage insurers, hospitals and clinics to get really creative with benefit and payment schemes that will improve access, cost and care.
The legislation includes new electronic-prescribing and quality-reporting rules. State pharmacists, physicians and those who prescribe or dispense medication must do so electronically by 2011. E-prescribing is a top federal priority (See story, p. 8). Minnesotas health commissioner must also establish quality measures for public reporting with a July 2010 deadline for releasing performance data and adopting pay-for-performance for state employees. By September 2010, Minnesota would also publish cost and quality comparisons of providers.
The bill, which was sent to Pawlenty May 19, also included $47 million for efforts to tackle obesity and smoking. Its unclear whether the governor will sign the reform bill; at deadline Pawlentys office said it was under review.