A new School of Public evaluation of health care homes found that over a five-year evaluation period the model – emphasizing collaboration among care providers, families and patients – saved Medicaid and Medicare approximately $1 billion. At the same time, clinics participating in a health care home model of care outperformed other clinics on quality measures.

The results come from a Minnesota Department of Health (MDH) funded evaluation of health care homes, done in collaboration with the Minnesota Department of Human Services (DHS), led by investigator and professor Douglas Wholey.

A summary of the 2016 U of M evaluation can be found here.

The complete 2016 U of M evaluation can be found here.

Additional findings suggest potentially significant savings if the Medicaid, Medicare, and Dual Eligible patients who were not in a health care home during this period were in a health care home.

“Having had the opportunity to closely observe Minnesota’s health care home initiative during our evaluation of it, I am impressed by the positive results, thorough planning, and effective implementation,” says Wholey.

The health care home program is a cornerstone of Minnesota’s 2008 bipartisan health reform efforts. Within a health care home, primary care providers, families, and patients work in partnership to improve health outcomes and quality of life for patients, including those with chronic conditions or disabilities. The Health Care Homes program is an effort to transform primary care. Certified health care homes strive to place patients and families at the center of their care and provide the right care at the right time and right place. Health care homes use a team approach that gives patients and caregivers access to health care services and support.

Currently, MDH has certified 361 clinics or 54 percent of all primary care clinics in Minnesota. To be certified, clinics meet a rigorous set of requirements related to their ability to provide care that is coordinated, patient-centered, and team-based. About 3.6 million Minnesotans receive care in clinics certified as health care homes.

“These findings show the value of focusing on care coordination and disease management within the broad context of a patient’s life and community,” says Minnesota Commissioner of Health Ed Ehlinger. “Taking this approach can help us achieve the goal of improving quality while also reducing costs.”

The study of health care homes is the second of two legislatively mandated reports. The initial report was released in February 2014.

Results

The report, which evaluates the health care home initiative from 2010 through 2014, analyzed Medicaid and Medicare claims data comparing the use and cost of services between certified health care home clinics and non-health care homes. Results include:

• Medical costs for enrollees who could be attributed to a health care home clinic were 9 percent less than enrollees who did not have a health care home as their primary care clinic.
• Health care homes cost 12 percent less for Medicaid, 3 percent less for Dual Eligible enrollees, but were cost neutral for Medicare enrollees.
• Health care homes were less expensive in four categories of healthcare spending: inpatient hospital admissions, hospital outpatient visits, skilled nursing facilities, and pharmacy.
• Racial disparities were significantly smaller for Medicaid, Medicare, and Dual Eligible beneficiaries served by health care homes versus non- health care homes for most measures, with the exception of African American-White differences in Medicare, which tended to be slightly larger in health care homes.
• On a broad range of clinical quality measures, health care homes clinics outperform non-health care homes clinics.

The University of Minnesota relied on analysis of claims data from the Medicaid and Medicare programs, analysis of data from the Statewide Quality Reporting and Measurement System (SQRMS) collected by Minnesota Community Measurement, interviews with key stakeholders and certified Health Care Homes to assess the effect of the health care homes program on access, cost, quality, and patient experience and the transformation of clinics to being a health care home.

Next Steps

To gain a deeper understanding of health care homes and their context, members of the University of Minnesota team are studying risk adjustment for quality measurement and are continuing to study the correlates of effective inter-professional care teams.