Minnesota is a national leader in healthcare delivery reforms, studying spending flows, providing consumer-facing transparency and promoting overall population health. A portion of this success can be attributed to the high quality healthcare organizations present in the state, such as the Mayo Clinic. There is also a significant penetration of HMOs in the Minnesota healthcare market, which differentiates the state from many others.
In 2008, the state passed a comprehensive slate of healthcare reforms targeting public health, chronic care management, payment reform, transparency, administrative efficiency and healthcare cost containment. The reforms also included improvements in healthcare purchasing and an all-payer claims database (APCD). A recent report by the Minnesota Department of Health recommended that the legislature allow expanded use of this data. An independent, non-profit community organization, MN Community Measurement, provides critical consumer-facing information on provider specific costs and quality.
PhRMA, the drug industry lobbying association, sued the state of Minnesota over a newly enacted law meant to prevent people who cannot afford their insulin from rationing it, reports STAT News. The Alec Smith Emergency Insulin Act allows Minnesotans who would otherwise forgo their insulin to immediately pick up a 30-day supply of the drug from a pharmacy for $35, while drug makers would be forced to provide the insulin for free or face hefty fines. PhRMA is seeking a permanent injunction that would prevent the law from going into effect.
Neary all Minnesota health plans have agreed to continue waiving copayments related to the care of COVID-19 through September 30, reports the West Central Tribune. Minnesota health plans had been required to cover testing without cost sharing but had agreed to waive copays for hospitalizations until June 1. The agreement removes the potential that 570 patients now in the hospital with the illness would have to face thousands of dollars in medical bills on top of lost wages. The Minnesota Department of Health has also announced $97.6 million in healthcare grants across the state, to pay for additional staffing, PPE and other expenses associated with preparation for the pandemic
The Governor of Minnesota signed into law the Alec Smith Insulin Affordability Act to provide relief to residents struggling to afford their insulin, reports the Office of the Governor. The bill contains emergency and long-term components, which take effect on July 1, 2020. The emergency provisions allow eligible individuals in urgent need of insulin to go to their pharmacy once in a 12-month period and receive a one-time, 30-day supply of insulin for a $35 co-pay. The long-term program requires manufacturers to provide insulin to eligible individuals for up to one year, with the option to renew annually. Insulin will be available in 90-day increments for a co-pay of no more than $50.
The Minnesota Hospital Association says healthcare systems and medical centers across the state are facing a financial hit of $2.9 billion over the next 90 days due to COVID-19, reports the Star Tribune. The biggest factor is that hospitals and health systems are seeing a decline of $2.8 billion in revenue due to postponed elective surgeries that help preserve scarce supplies needed for handling COVID-19 patients. Minnesota hospitals and health systems are collectively losing $31 million in revenue per day from reduced patient volumes, the association says.
SHADAC has released an update to Minnesota's Uninsured Profile Tool in partnership with the Blue Cross Blue Shield Foundation of Minnesota. The update enables users to view the rates and characteristics of the uninsured population by state, region, county, and ZIP code and by state legislative district. The profile, which is available for download on the SHADAC site, also includes an updated version of the companion interactive map.
The Minnesota Attorney General unveiled a task force report that makes 14 recommendations for lowering prescription drug prices, ranging from new legislation to stronger enforcement, according to the Crookston Times. The 14 recommendations mentioned in the report fall into three broad categories: to make the markets work better for consumers; to use the government’s purchasing power to make drugs more affordable and accessible; and to require more transparency and accountability in the market.
State health officials in Minnesota are alarmed by the high number of incidents of adverse health events reported in a statewide report in March 2019, reports Modern Healthcare. The state requires hospitals and ambulatory surgery centers to report the 29 adverse events called "never events," but it's difficult for the Minnesota Health Department to get a sense of what the numbers mean, as this set of 29 events only represents a small percentage of situations. The state is considering tracking diagnostic errors and expanding the program to other settings where patients now get care, like outpatient clinics, as well as releasing an aggregate report of events from across the state, rather than reporting them by facility.
With enrollment for Minnesota’s health plans set to begin, many are watching to see the effects of insurers’ recent announcements of insulin out-of-pocket caps, according to the Star Tribune. Those who purchase coverage through MNsure or from Medica and UCare will have their out-of-pocket spending on each insulin prescription capped at $25 per month, regardless of annual deductibles. When asked, insurance companies have explained that an amendment in the state’s recent omnibus healthcare spending law makes it illegal for Minnesota insurers to profit from selling insulin. Consumers who use insulin note that it is an important necessity for them, but that other medical necessities are still expensive, like insulin pumps and glucose monitors.
Blue Cross Blue Shield of Minnesota announced that they will cover insulin costs next year with $0 co-pay, according to Alpha News MN. The insurance company's CEO cited the skyrocketing costs of insulin as a reason for the measure, which have risen by over 300 percent, noting that their first responsibility is to improve the health and financial stability of their members. Previously, Minnesota Medical Insurer Medica and UCare announced that they will cap insulin costs at $25 a month.
A new law requires clinics that are part of a larger hospital or health system to publicly disclose that patients may receive a separate charge for the facility, resulting in higher out-of-pocket costs, according to the Grand Forks Herald. The hope is that these disclosures will lower the number of Minnesotans who experience surprise medical bills. A Healthcare Value Hub survey of adult Minnesotans in 2019 revealed that nearly half experienced healthcare affordability burdens in the past year.
The Minnesota Hospital Association claims Blue Cross Blue Shield (BCBS) of Minnesota, the state’s largest not-for-profit health insurer, may be breaking the law by imposing a slate of new policies designed to deny or delay access to routine colonoscopies and hundreds of other hospital services, according to The Star Tribune. The hospital trade group has asked state officials to investigate these practices and stop the insurer from imposing new policies that do not comply with state law and discriminate against in-network providers by limiting coverage for patients who do not receive prior authorization for services and if there are cheaper in-network service options nearby. BCBS claims that healthcare costs continue to rise to unprecedented levels and hospitals must work with payers and plan sponsors to improve the sustainability of healthcare costs.
Minnesota lawmakers have extended to 2023 a moratorium that blocks the state’s nonprofit HMOs from being sold to for-profit companies, according to The Star Tribune. The measure was first adopted two years ago as a temporary measure to block conversion transactions, as lawmakers were concerned that nonprofit assets could wrongly be shifted to investor-owned carriers in a merger or acquisition.
Early results of Minnesota’s certified community paramedic programs indicate that these house calls improve patient satisfaction and reduce spending on medical care. According to Minnesota Public Radio, these paramedics visit patients at home to help them transition out of the hospital and manage chronic conditions. A local hospital, Region Hospital, implemented a three-year pilot project that made nearly 1,000 home visits to help people manage diabetes and high blood pressure and resulted in large improvements in patient health and cost savings.
Health care spending for Minnesota businesses and their workers jumped 9.6% last year - nearly triple the national growth rate. According to the Star Tribune, Minnesota was an early user of strategies such as moving workers to high-deductible health plans and enticing them to pick cheaper generic prescription drugs. The Minnesota Health Action Group reported the results of it's annual survey of employers regarding workplace benefits. The survey showed that for the first time, the number of businesses offering high-deductible plans exceeded those offering classic preferred provider plans and that cost-sharing by workers increased by 3 percentage points from last year.
The overall cost of healthcare in Minnesota grew at a relatively low rate during 2016, but the broader trend points toward a doubling of expenses over the next decade, reports the Star Tribune. A report by the Minnesota Department of Health projected that annual health costs – totaling $47.1 billion in 2016 – will reach $94.2 billion by 2026. This means that Minnesota would spend $1 out of every $6 generated by the state's economy on healthcare. Spending growth will likely result from higher prices, greater use of services and advanced technology costs. Additionally, demographic shifts will boost Medicare enrollment and spending for people with multiple chronic ailments.
Starting January 2019 four employers in the Twin Cities are offering a new "SmartCare" program, a new employee health plan with a limited network of doctors and hospitals, according to the Star Tribune. This limited clinic choice is another example of how health insurers are offering lower premiums, with consumers agreeing to have their care coordinated by a small subset of doctors and hospitals, and pay more out of pocket to visit other healthcare providers. Narrow network health plans have been around for decades, but they are making new appearances in the Minnesota insurance market recently, particularly in the market where individuals under 65 buy their own coverage. The first SmartCare clinic has seen a 10 to 20 percent reduction in total cost.
Attorney General Lori Swanson, who is leaving office next year, is reminding lawmakers that legislation blocking nonprofit health plans from becoming for-profit companies will expire next year, and requires follow-on legislation, according to the Star Tribune. For decades, Minnesota required HMOs to be nonprofit, but Republicans pushed for opening the market to investor-owned companies. Swanson highlighted this issue in a letter to Governor-elect Tim Walz, noting the importance to protect Minnesota taxpayers from having billions of dollars in nonprofit health plan assets converted to for-profit use, without providing sufficient compensation to the public.
Healthcare spending at Minnesota clinics slowed sharply last year as physicians discouraged wasteful services and encouraged patients to choose lower-cost sources for prescription drugs, labs and imaging, according to the Minnesota Star Tribune. Per patient costs varied widely based on where patients received their primary care, ranging to a two and a half times difference in price, according to the total cost of care report. For example, specialty clinics, like the Mayo Clinic as well as rural providers tended to have higher prices. The report suggests that doctors managed costs by steering patients to low cost clinics instead of hospitals for outpatient services which declined spending on those outpatient hospital services by 1 percent in 2017 following a 7.3 percent increase in 2016. Business leaders said this comparison information is vital as health care costs increases and the payment burden falls more heavily on patients. Minnesota is currently the only state where detailed price information is published.
The Minnesota Attorney General Lori Swanson targeted drug manufacturers in a lawsuit for inflating the cost of insulin medication, according to the Star Tribune. Swanson is accusing others of being complicit in price-gauging sick patients with diabetes as well as the drug manufacturers. The lawsuit named three drug companies, Sanofi-Aventis, Novo Nordisk and Eli Lilly, that have tripled the list prices of their synthetic insulin medication since 2002. These medications are crucial to people with diabetes to manage their blood sugar and reduce their risk of disability, even death. Swanson is saying part of the price hike is due to the rebate structure implemented by pharmacy benefit managers (PBMs) who have ignored the impact of these rising costs have on patients. PBMs currently play a role in deciding which drugs are listed on insurance companies' preferred list. Because the PBM profits come through rebates, manufacturers have incentives to curry favor with them by raising prices and inflating rebates. Rising prices of insulin have raised concern over the past year with everyone from the President to Senator Amy Klobuchar appealing directly to insulin manufacturers, demanding legislation to compel the companies to lower their prices. Minnesota is the first state to bring a case against the insulin manufacturers.
Lowering overall cost of healthcare is a nonpartisan issue, according to a report from United States of Care. United States of Care profiled the Minnesota healthcare system because the state has a history of being a national leader in expanding coverage and access to healthcare, resulting in one of the highest rates of coverage in the nation. One imminent healthcare issue Minnesota is looking at is funding the Health Care Access Fund (HCAF), which is responsible for funding Medical Assistance Medicaid, MinnesotaCare and other public assistance programs. The provider tax that funds HCAF expires in 2020, so Minnesota legislators need to start thinking about ways to make up this $241 million line item. Other 2019 priorities for Minnesota include modernizing access for patient information, reducing costs of drugs and the future of medical assistance. Some longer term goals include funding for mental health and substance abuse, access to care in rural areas and health equity. Successful solutions to these short- and long-term goals will require continued collaboration and creativity.
In Minnesota, hospital bills for the same surgery can vary dramatically from one patient to another, even the procedure is performed at the same facility, according to a report from The Star Tribune. The findings from the state Health Department, came from a study of thousands of records detailing payments by private health insurers and consumers to hospitals for four common procedures: a simple appendectomy, spinal fusion, major bowel surgery, and removal of uterine fibroids. The report found that the differences patients paid for an appendectomy can range from $6,600 to $35,000 at the same hospital. Researchers did not find any significant difference between the patients to account for the large difference in price. Rather, these variations reflect a market that is not working well. There are many factors to account for the price variation, but the largest reason is through the negotiation of fees between hospitals and insurers.
Two Minnesota healthcare giants—Mayo Clinic and Blue Cross blue Shield of Minnesota—have agreed to a unique five-year contract that will downside risk and eliminate some prior authorizations, according to Modern Healthcare. This change will be implemented in part to lift restrictions on Mayo Clinic’s patients with serious or complex illnesses and make coverage more seamless under Blue Cross policies. Both companies have decided it is better to work together rather than aiming administrative artillery at each other. The agreement will add more conditions and treatments that don’t need prior authorization under the new contract, and will expand the amount of value-based care that will take place between the companies.
Minnesota’s Accountable Communities for Health, is a community-led model of delivering healthcare (both medical and non-medical) that targets patients with substantial health and social needs, according to a brief by SHADAC. The brief describes the development and implementation of the Accountable Communities in Minnesota, as well as the key components of implementing the model across the state.
According to the Twin Cities Pioneer Press, a report released Wednesday by the Minnesota Department of Health examined the wide range of prices Minnesotans pay hospitals for four procedures — hip and knee replacements and normal and C-section births. They found that Minnesotans could pay up to eight times more for certain medical procedures depending on the hospital they choose, but it’s hard to know which facilities offer the most affordable services.
Better efforts to coordinate care have resulted in a 22 percent drop in hospitalizations for diabetes according to researchers at the Minnesota Health Department. The decline between 2006 and 2014 resulted in fewer hospitalizations for diabetes related health problems (other than extremely high or low blood sugar levels). In 2008 the state launched several initiatives to control health care spending related to chronic conditions, focusing on obesity and smoking, improving disease management in primary care, and quality improvement systems that measure care and outcomes as part of state-wide partnership targeting diabetes.
Rural medical clinics coordinate patient care better than Twin Cities clinics, on average, according to a new Minnesota survey that suggests small facilities and do-it-all small-town doctors still offer advantages in an era of modern medicine.
The Minnesota Nurses Association announced that it would pay off approximately 1,800 patients’ debts on the anniversary of its strike against five Allina Health hospitals in the Twin Cities, according to the Star Tribune.
A new report from the Minnesota Department of health showed the state spent $54.9 million on low-value healthcare services in 2014, according to the Star Tribune. The report reviewed claims data for 1.46 million patients and evaluated the use of 28 low-value services as defined by the Choosing Wisely campaign.
The Mayo Clinic is renowned for diagnosing and treating medicine’s most complex patients. However, according to the Wall Street Journal, it must adapt to new payment policies from Medicare, high-deductible health plans and insurers’ restrictions on out-of-network care that are putting pressure on hospital revenue across the U.S to maintain its approach.
Gov. Mark Dayton refused to sign a $542 million reinsurance bill, but allowed it to become law, according to Fox 9. The bill subsidizes health insurance companies in the individual market, helping to defray costly claims. Lawmakers who supported the bill hope that the savings will be passed to consumers in the form of reduced premiums. The Governor’s reservations about the source of funding for the insurance subsidies and failure to include a MinnesotaCare buy-in option on the individual market led to his decision against signing the bill. However, in a letter to the House Speaker, Dayton has pledged to allow the bill to become law by failing to act upon it within three days, as required by law.
A Minnesota nonprofit issued a report identifying the highest-cost health clinics in the state in an effort to help consumers, according to the Star Tribune. Minnesota Community Measurement used claims data from the state’s largest health plans to find clinics with the highest prices and highest utilization rates. The report found that overall the total cost of care increased 5.6 percent overall from 2014 to 2015, while the total cost of pharmacy spending increased 9.3 percent.
The new plan, proposed by Governor Mark Dayton, would reduce health insurance premiums by 25 percent for Minnesotans who don’t qualify for subsidies, according to CBS Minnesota. The plan is being introduced after plans were approved for rate increases of 55 percent for 2017.
Patients who are more involved in the self management of their health are less likely to be hospitalized or to develop chronic conditions compared to less “activated” patients, according to a new study in Health Services Research. Researchers analyzed the behavior of nearly 100,000 patients at Fairview Health Services in Minnesota, an innovation-focused Accountable Care Organization (ACO).
As hospitals move toward value-based payment models, they are increasingly investing in primary care, according to the Star Tribune. Primary care is seen as the linchpin of population-based health strategies that emphasize improved access and care coordination.
Minnesota progressives and elected officials in the state's Democratic Farmer-Labor party are yearning to get back to the future with MinnesotaCare, the state's public insurance program for low-to-moderate income residents who earn too much to qualify for Medicaid, according to the XPostFactoid Blog. Prior to ACA implementation, MinnesotaCare was available to Minnesotans with incomes up to 275% of the Federal Poverty Level. In 2015, the plan was converted under the ACA into a Basic Health Plan, which qualified it for federal funding but cut off eligibility at 200% FPL. Former enrollees above that income level were sent to the ACA marketplace, where both premiums and out-of-pocket costs are considerably higher. A task force appointed by the governor recommended in mid-January that the state seek an ACA innovation waiver to restore MinnesotaCare eligibility to 275% FPL, with funding equivalent to the cost of federal marketplace subsidies for enrollees up to that income threshold.
Minnesotans with a chronic disease spent an average of $12,800 a year on healthcare in 2012, roughly eight times the amount spent by those without such a condition. The finding was revealed in a report by the Minnesota Department of Health and was made possible by a 2014 law allowing the agency to use Minnesota's all-payer claims database for analyses pertaining to the cost and quality of care.
New research shows that while the healthcare marketplace in Minnesota is lower cost for those who are a part of the Medicare program, those privately insured pay more for their care reports The StarTribune. This research calls into question the long held belief that the region is an area that should be modeled in many areas of federal health policy. The Minnesota Hospital Association disputes this recent research claiming that the research focused too closely on the list prices and did not take into account the long-term quality and cost metrics.
Associated Press: Consumers who purchase insurance through MNSure—Minnesota’s state-run insurance exchange—could experience rate hikes between 14 and 49 percent. In response, state regulators and lawmakers have begun looking into methods to reign in these price increases in an individual market that is smaller and more expensive than both regulators and insurance companies expected.
Rochester’s NBC affiliate KTTC reports on a Mayo Clinic pilot program to expand telemedicine services in rural southeast Minnesota. The program uses telemedicine kiosks with advanced diagnostic tools that enable providers to evaluate and communicate with patients in rural areas of the state. The state legislature recently required private insurance companies to reimburse providers for telemedicine services and legislators from rural Minnesota have sent a letter to Congress pushing for reimbursement for Medicare patients.
Minnesota Public Radio: More than one million emergency department (ED) visits and more than 70,000 hospital admissions in Minnesota possibly could have been prevented, according to a study by the Minnesota Department of Health. Researchers found $1.9 billion potentially preventable ED visits and hospital admissions in 2012. They said about two-thirds of ED visits likely could have been avoided if patients had better access to preventative care or better-coordinated healthcare.
Minnesota’s obesity rate has held level since 2008 according to Minneapolis NBC affiliate KARE11. This story attributes these results to the Statewide Health Improvement Program (SHIP) that was a part of the state’s 2008 healthcare reform.
This report from the Woodrow Wilson School at Princeton University examines how the state of Minnesota could use Section 1332 of the Affordable Care Act to advance health reform. The Minnesota Department of Human Services and MNsure--the state's health insurance marketplace--have expressed an interest in using a Section 1332 waiver to pursue a triple aim of improving patient experience and population health, while reducing per capita costs. This report explores the possibilities that such a waiver could unlock.
Much of the healthcare in Minnesota is provided by hospitals and insurers that are classified as nonprofit. This Star Tribune commentary finds the excess of revenue over expenses at these nonprofits is “eye-popping.” The authors argues that Minnesota needs a state standard that separates actual charitable activities from those that more closely resemble business promotion.
According to the Star Tribune, Minnesota’s enviable health rankings arise from a number of causes. The state has a relatively strong economy with high levels of employment. Employers have provided comprehensive health coverage, and taxpayers provide generous public programs. Nonetheless, it is unsustainable for an increasingly large percentage of resources to be devoted to health care. Is nonprofit health care benefiting the community?
Lucinda Jesson, the commissioner of the Minnesota Department of Human Services, stated in the Star Tribune that the DHS was able to save over $1 billion and created greater transparency and value in Minnesota healthcare purchasing—which works state wide to develop common strategies for performance measurement, promote greater transparency of healthcare costs, and creating greater accountability for healthcare results. This story explores what actions have been taken to achieve these reductions and what additional steps are being taken.
The Star Tribune reported on an analysis that finds dramatic spending variations depending on the clinics that Minnesotans choose—from $269 to $826 per patient—even after adjusting for sicker or more problematic patients. The analysis, by MN Community Measurement, a non-profit agency formed a decade ago to compare clinics by the cost and quality of care, was billed as a major advance in the consumer healthcare movement.Clinics have previously been ranked on their costs for individual procedures, such as colonoscopies. But that approach doesn’t take into account which clinics are least expensive overall, perhaps because they had fewer medical errors or could deliver quality care with fewer procedures.
The Star Tribune reported that “healthcare homes” – open for enrollment to any Minnesota resident—which were passed as part of the state’s 2008 health reforms, have reduced medical costs while improving the quality of care. This story highlights research done by the University of Minnesota on the impact these “healthcare homes” have on providers and patients.