In its effort to improve health care while trimming costs, Minnesota may be placing unrealistic hope on an innovative style of medical clinic called "health care homes," a new study suggests.
The study of 21 Twin Cities HealthPartners clinics that adopted the new model showed that patient satisfaction rose 1 to 3 percent a year while care quality rose 2 to 7 percent on four key measures over five years. That was only slightly better than in 19 other clinics studied.
The findings suggest that the current wave of state and federal health reform, like similar efforts in past decades, may find the nation's health system stubbornly hard to change.
"Health care homes are beneficial for patients, especially patients with complex or chronic diseases that are the major source of health care spending," said Dr. Leif Solberg at the HealthPartners Research Foundation, who led the study. "But our research says we shouldn't expect too much too fast. Expectations for large and rapid change are probably unrealistic."
Still, Solberg said in an interview, the modest benefits from those clinics might be a necessary first step in moving toward the next generation of care in "accountable care organization" clinics, which harness even deeper coordination and payment reform.
Under a 2008 Minnesota law to reorganize how care is delivered and financed, medical clinics are encouraged to reorganize as health care homes, which offer highly coordinated primary care with a team that includes health professionals, the patient and sometimes the patient's family. The goal is giving the right amount of care in the right setting, resulting in better and cheaper care and healthier patients.
Some 145 clinics -- 20 percent of the 700 in Minnesota -- have been certified as health care homes by the Minnesota Department of Health. Because they tend to be larger clinics, they provide primary care for about one-third of Minnesotans, or 1.75 million people, officials say.
The study was financed by a federal grant and published on Monday by the Annals of Family Medicine. Quality measures included care for diabetes, coronary artery disease, preventive service and generic medication use.
New study underway
The health care home model represents a significant improvement and is worth expanding despite Solberg's findings, said state Health Commissioner Dr. Edward Ehlinger.
Research now underway by Solberg, who is examining a wider range of health care home clinics under a state contract, "may well show bigger increases in quality and satisfaction," Ehlinger said.
That's because the clinics in the study released on Monday have been working on quality improvements for a decade, Ehlinger said, and other clinics "may have more to gain from becoming health care homes."
Solberg agrees that's possible, although his earlier research found no direct correlation between the quality of a clinic as measured by the National Committee for Quality Assurance and the quality of the care it provides.
But the biggest gains in raising quality and lowering costs, Ehlinger said, may come from getting Minnesotans healthier.
"Treating patients more efficiently is very important, but our greatest advances will come by keeping people healthy, so they need less care in the first place," he said.
That includes efforts such as the state's $47 million investment in the State Health Improvement Project -- local programs in every county over the past two years to reduce smoking and obesity. The state also is rolling out a program to help consumers gauge providers by quality and costs of treatment.
Waiting for proof
The state pays health care homes a monthly care coordination fee averaging $31.39 per patient to manage the care of complex patients on Medicaid and other state-subsidized health programs. That coordinator plays a key role, tracking care of patients wherever they see providers and providing phone checks and education to patients.
One reason to expect that Solberg will find more improvement in clinics under his current study "is that we now have that coordination payment in place," said Dr. Jeff Schiff, health care programs medical director for the Minnesota Department of Health.
"Dr. Solberg's work is helping us, really for the first time, track actual changes in quality as our system evolves," Schiff said. "I'm very optimistic. I think we're going to see good results. ... But sometimes, you have to move ahead before all the proof is in."
Warren Wolfe • 612-673-7253