Minnesota Communication and Accountability for Primary Care Systems (CAPS)
In 2007, 27 states received Medicaid Transformation Grants under Section 6081 of the Deficit Reduction Act of 2005. The grants were rewarded to states that proposed innovative methods which in the end of the two years are designed to produce better health outcomes at lower cost.
The Center for Health Transformation is highlighting states that have received these Medicaid Transformation Grants, and will be following their progress for the next two years. In order for key decisionmakers and industry leaders from around the country to learn from others’ successes, it is our intention to provide this resource in order to showcase innovative practices from across the nation. In the future, this site will be interactive, allowing program directors to submit updates and comments regarding their program.
ABSTRACT: The Minnesota Department of Human Services, the state Medicaid Agency, proposes a project that combines two transformational goals:
- The re-establishment of the primary care physician office as a true “medical home” for the coordination of care for the Medicaid client with complex health care needs
- The creation of an interoperable, user-friendly, web-based system, built behind the state’s current MN-ITS system that will enhance and empower this process.
The new system would be adaptable for use with all provider types, and could serve as an all-purpose health care coordination tool. For example, a pharmacist providing Medication Therapy Management or a Home Care Agency providing community based care would find this tool helpful.
The tool, called Communication and Accountability for Primary Care System, or CAPS, is designed to address the current fragmentation of health care delivery, which causes costly, duplicative, and ineffective care.
The tool will facilitate communication between the state, the primary care provider, the enrollee, and other providers involved in the enrollee’s care. Examples of the real-time capacities of this communication tool:
- physician reports outcome measure, which trigger monthly performance payments to state
- state communicates an enrollee’s medical and drug utilization history to physician
- health plan physician reports Encounter Data to state
- physician requests prior authorization for services and reports key medical facts to state; state then communicates an immediate answer to the request for authorization
- state communicates required practice guidelines or outcome measures to physician
- providers and team members communicate care plan and actions taken to one another
- provider communicates care goals and educational information to enrollee
In addition, this tool will provide the state with the information necessary to purchase better ambulatory care for our enrollees, develop risk-adjusted payment rates, target special payment rates to select providers, and focus select services to enrollees with special care needs.
Because of the central role that physicians play in the health care delivery system, as well as the nation-wide need for better coordination of care between the many new sites and layers of the health system, this proposal can model transformational change within both the Medicaid system and the commercial health care market.
The department proposes that the clinical policy development (outcome measures, for example) and the operational system (web-based tool) be built in-house, using a combination of current and temporary policy staff and systems architecture staff. One time technical consultation will be sought from a contracted technical vendor, and one time policy consultation will sought from subject matter experts.
