Medical homes were an important part of the policy discussion in Minnesota this year.   In a health care system that can often be fragmented and confusing, especially for people with complex or chronic problems, a medical home offers a health care delivery model where patients can receive more comprehensive and coordinated care from a primary care practice. 

Dr. Mike Ainslie, the Chair of the Minnesota Medical Association, describes a medical home quite aptly (and simply) as the place “where all of a patient’s care comes together.”  Ideally, the medical home takes responsibility for all of the patient’s health care needs, either directly or by arranging and coordinating care with other professionals. 

The hope is that this type of care will create an ongoing and trusted relationships with patients, empower patients to make informed decisions, expand access through longer hours and more channels of communication, avoid duplicative services, reduce medical errors, and increase the use of preventive care.  All together, patients should be healthier and less likely to need more expensive treatments in the future.

To date, few primary care practices take on this added level of responsibility because public and private health plans don’t pay for it. 

Various medical home proposals in Minnesota would create a system to certify and license medical homes and then force public and private health plans in Minnesota to include medical homes in their networks and to reimburse medical homes a monthly management fee.

The proposals differed on how to define the medical home and which health plans should be forced to integrate medical homes into their products.

As these differences and issues took shape over the course of the legislative session, I offered these three recommendations for improving the medical home proposals: (1) The definition for medical homes should be flexible; (2) medical homes should be facilitators, not gatekeepers; and (3) medical homes should not be mandated.  I go into much further detail on these recommendations in the paper, “Medical Home Policy Recommendations.”

Unfortunately, the final legislation ignored most of these recommendations.  While the legislation did allow for a more flexible definition, it gave too much power to the state to control the definition.  Health plans were not given any freedom to define a medical home on their own terms.  Most troubling, Minnesota health plans will now be mandated to include medical homes in their products and they must pay medical homes according to the state’s payment method.  This adds yet another benefit mandate to Minnesota’s nation-leading list numbering 64. 

While Minnesota's government has not taken complete control over how medical homes roll out in the state -- a health plan could conceivably develop their own model and offer it alongside the state model -- it certainly risks discouraging health plans and providers from developing their own competing model.  (How many health plans will want to confuse their customers with two medical home models?)  Without competition, patients will play no role in deciding what a "patient-centered" medical home should be.