A big federal push for coordinated care

A provision in the new federal health care law that seems written with Minnesota in mind could accelerate the transformation of medical practice envisioned in the state's 2008 health reform bill. It offers a big financial carrot -- a 90 percent federal match -- for the care of any Medicaid beneficiary with two or more chronic conditions who obtains coordinated treatment, via a certified "medical home."

Minnesota set in motion the certification of clinics as providers of coordinated care, or "medical homes," in 2008. But until now, it's been slow motion. About 40 clinics are in the process of certification; few have completed the course.

The federal law's disparate elements work together to give the state great incentive to get clinics through the certification process more quickly, several House DFLers said at a Thursday briefing. Doing so will increase the flow of federal funds to the state for the care of the chronically ill poor. That money will offset the increased costs that will be incurred if the state moves very-low income childless adults from the low cost General Assistance Medical Care to the more costly Medicaid program in 2012-13.

Money, both the availability and the lack of it, is bound to drive lawmakers' decisions about the options presented to states by the new federal law. But they ought not lose sight of the larger reason to establish medical homes. A number of pilot projects show that the interdisciplinary coordination of treatment of chronic medical conditions, combined with outreach efforts by nurses to help people with those conditions stick with prescribed regimens, can keep people healthier and more productive. It gives them better lives and makes them better contributors to society. That's true both for the low-income people whose health care is supplied by government, and for everyone else. That's the real savings that should propel the creation of medical homes.