Clinics that take more responsibility for patients’ health and health habits outperformed other primary care clinics and saved Minnesota more than $1 billion over five years, a University of Minnesota analysis concluded.
The study, released Tuesday, validated Minnesota’s decision in 2008 to offer additional funding to clinics that become certified “health care homes,” meaning they manage patients’ overall care and provide extra support to chronically ill patients.
A patient receiving primary care from a health care home was less likely to need a lengthy hospital stay between 2010 and 2014, and rang up only $7,216 in medical expenses per year — 9 percent less than a patient receiving traditional primary care.
“You save one hospitalization, you save a lot of resources,” said Dr. Ed Ehlinger, commissioner of the Minnesota Department of Health.
Minnesota went “all in” on the concept of health care homes before it became a staple piece of the federal Affordable Care Act, said Douglas Wholey, the health policy professor who led the analysis.
Minnesota now has 361 certified health care homes, or 54 percent of all primary care clinics in the state.
Compared to the traditional office-visit model, health care homes help patients get access to medical specialists and then review the results of tests, prescriptions or recommendations by specialists to make sure they are consistent with a patient’s overall care plan. The clinics also provide or connect patients to exercise, dietary or other wellness programs in their communities.
Asthmatic children receiving care at health care homes were more likely to have asthma action plans, which spell out how to manage the disease and respond in the event of an attack and shortness of breath. As a result, 39 percent of asthmatic children in health care homes were meeting medical goals, compared with 19 percent at traditional clinics, the researchers found.
Patients with diabetes, depression and vascular disease also showed more progress, according to the U analysis, which was required as part of the legislation funding health care homes.
‘It gets their attention’
Lisa Hoffman Wojcik of Mankato is grateful for the health care home that manages the care of her 13-year-old son, Konnor, who has suffered health problems since birth.
Talking immediately with a care coordinator, rather than leaving a message on a nurse voice mail and waiting for a call back, saves time for the busy family, she said. Sometimes the clinic steps in when she is struggling to get help from a specialist.
“I can call, as a parent, 3-4-5 times,” she said. “When you have your provider calling, saying ‘I’m really concerned,’ that really gets the attention of other providers.”
Savings from health care homes weren’t as substantial for patients 65 and older covered by the federal Medicare program, the analysis showed.
Most of the savings came from Medicaid, which provides health care for roughly 1 million low-income Minnesotans and people with disabilities, and serves a disproportionate share of the state’s minorities.
A surprise in the analysis was that emergency room costs were higher among health care home patients; conventional wisdom was that extra oversight would reduce the need for ER care. However, the decline in hospital admissions, outpatient visits and prescriptions far outweighed any rise in ER costs.
Ehlinger said the results should motivate more clinics to achieve certification, especially in rural parts of the state that lack them.
One problem is that private insurers don’t provide care-coordinator payments for health care homes in the same way as public programs such as Medicaid, said Janet Silversmith, a policy director for the Minnesota Medical Association. Private payers have tried to encourage holistic patient care through other value-based payments to clinics, but their lack of direct funding for health care homes makes it harder for small clinics to maintain them, she said.
The $1 billion in savings was largely due to the benefits of health care homes, the analysis found, but patient selection also was a factor. Healthier or more motivated patients simply might be drawn to clinics that are health care homes, boosting their results.
Health care homes did show improved performance and patient health scores the longer they stuck with the approach, Ehlinger noted.
At South Lake Pediatrics, doctors varied their readiness for the new model, which requires record-sharing with specialists at other clinics and more of a team approach in working with in-house care coordinators.
But now, children at its several West Metro clinics receive faster care and families have access to support services through a registry of patients with complex conditions such as ADHD, said Maria McGannon, a South Lake nurse practitioner.
“We could not go back to the way we were before,” McGannon said.