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Minnesota: Community Action Plans and Health Care Homes

Minnesota's 2008 Health Reform bill has four elements intended to work together: population health, health care market transparency and enhanced information about the quality and cost of care, payment reform, and consumer engagement. Minnesota's Department of Health is the lead agency implementing the reform plan, which has two major initiatives that build directly on public health concepts: the Statewide Health Improvement Program and Health Care Homes.

"With chronic disease a major cost driver, there was a strong view among stakeholders and policymakers that in addition to improving chronic care, Minnesota must find ways to prevent people from developing chronic disease in the first place," said Scott Leitz, assistant commissioner, Minnesota Department of Health.

Prevention Through Community Action Plans
The Statewide Health Improvement Program (SHIP) is a community-based effort designed to help state residents live longer, healthier lives by reducing the burden of chronic disease. Based on the Steps to a HealthierMN model, the program initially will focus on reducing tobacco use and exposure as well as obesity—risk factors associated with the greatest preventable causes of illness and death in the United States.1 Selected through a competitive bidding process, 52 community health boards and eight tribal governments across the state will receive grants to create community action plans, establish leadership teams and partnerships, and implement and evaluate interventions to improve health.2

The community health boards and tribal governments will choose from a menu of interventions proven to be effective. Examples include: implementing a policy of not accepting any funding, curricula, sponsorships, or other materials from any tobacco companies or their front groups for technical schools, community colleges, colleges, and universities; or implementing policies and practices that create active worksites by increasing opportunities for non-motorized transportation (walking and biking) and access to worksite recreation facilities. Implementation of the SHIP activities begins this summer, with state funding of $47 million over two years. If measurable progress in implementing the SHIP interventions is made after the initial two years, the legislature will make a longer-term funding commitment.

The community-based approach brings challenges. Different communities are starting in very different places and will progress at varying rates. This will make it difficult to measure and show statewide results, particularly within the initial two-year time frame, according to Leitz. Nevertheless, policymakers deemed it important to give each community the room to design a public health plan in line with its needs and local norms. They believed this approach would help build grassroots support for the activities. Minnesota has a history of using policy change to improve health status. For example, SHIP is supported by a statewide smoking ban in restaurants and bars to reduce exposure to tobacco smoke.

Health Care Homes
Chronic care management is another key element of Minnesota's health reform initiative. The state is certifying "health care homes" (also known as medical homes) that will receive additional payments for care coordination for people with complex and chronic conditions. Stakeholder workgroups are developing standards for the certification of health care homes and a payment methodology for care coordination (the public will have opportunities to provide feedback on these standards and methodology). The payment methodology for Medicaid is expected to serve as a model for commercial payers. The extra payments are required by legislation to begin on July 1, 2010. Additional workgroups will be convened to address enrollment of eligible patients, coding and billing, patient cost-sharing, affordability, and other issues.

Other components of Minnesota's health reform law establish standard quality measures for public reporting and for comparing providers on the quality of care and cost.

For more information

On SHIP, contact: Cara McNulty, M.S., Statewide Health Improvement Initiatives Manager, Minnesota Department of Health, [email protected]
About Health Care Homes, contact: Marie Maes-Voreis, R.N., M.A., Program Manager, Health Care Homes, Minnesota Department of Health, [email protected]

1. For more information about the CDC Healthy Communities Program and Steps Communities, see:
2. Minnesota is divided into 53 community health boards responsible for public health. The state also has 11 tribal governments, 10 of which are eligible to receive state funds.

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