Last year, the Robert Wood Johnson Foundation launched a joint initiative with Community Catalyst called the Value Advocacy Project (VAP). The project is supporting consumer health advocacy organizations in six states in their non-lobbying advocacy efforts to pursue local and state policy and health system changes that increase the value of health care by improving health outcomes and lowering health care costs, especially for populations that have disproportionately poor outcomes. Building on the Center for Consumer Engagement in Health Innovation’s recently released Consumer Policy Platform for Health System Transformation, we will be highighting our state partners working on issues outlined in the policy platform and encouraging them to share how their work can translate to advocates’ efforts across the country.
Minnesota is one among a handful of states leading the nation in public and private exploration of health system transformation and consumer advocates have the opportunity – and the urgent need – to embed consumer engagement and priorities in the “Minnesota Model.” Our Valuing Health project is helping these advocates be more effective participants at the multi-stakeholder tables working to define and implement the next generation of Minnesota’s health system through innovative approaches.
In many ways, Minnesota is a leader in value-based purchasing and health system transformation.
Minnesota has fully expanded Medicaid, created the nation’s first Basic Health Plan (BHP) and has significant state-driven investment in health system transformation. For example, in recent years, the Minnesota Department of Human Services has increased outcome-based payment in contracts for public health care programs, developed pilot Accountable Care Organizations (ACOs) called Integrated Health Partnerships (IHPs) in our public programs and is in year three of a federal State Innovation Model (SIM) grant to expand ACOs across the state.
But consumers have not been significantly engaged in the design of these changes as compared to big payers such as the state, insurance carriers and large employers. This is partially due to a lack of opportunities, but also reflects a lack of internal capacity. The work to defend and expand basic access to health care programs and insurance has often eclipsed the time and resources necessary to engage in the myriad simultaneous experiments and explorations in health system transformation.
The gains in access afforded by the Affordable Care Act have created a little more breathing room to dive into these issues, as well as a lot of urgency. The level of public subsidies going to private insurance companies and HMOs is unprecedented and growing, nationally as well as in Minnesota. We and other advocates are hungry to advance our stewardship of those public resources, as well as our commitment to wresting quality care and healthier outcomes from public and individual dollars. The Value Advocacy Project (VAP) is allowing that work to move forward.
Last year, Minnesota launched a Health Care Financing Task Force that brought together consumer advocates, providers, the insurance industry, and elected and appointed officials to explore and make recommendations on key issues in health policy. Before the Value Advocacy Project began (and with separate funding), TakeAction worked to make sure there were multiple dedicated consumer seats on the Task Force, and that its central charge was a consumer priority to “increase access to and improve the quality of health care for Minnesotans.” Through the VAP project, we launched a learning community of advocacy organizations to provide the research, education and support that is often missing for consumer representatives on these sorts of bodies.
As a direct result of this collaboration, our final Task Force recommendations include many consumer priorities that were just not part of the policy conversation prior to the Task Force and a set of consumer protections related to value-based purchasing (VBP) and expansion of successful VBP strategies that we as an advocacy community had not previously weighed in on in a meaningful way. For example, the Task Force recommended that Minnesota: apply for a 1332 waiver to expand MinnesotaCare (our Basic Health Plan) to people with incomes up to 275 percent of the Federal Poverty Level; include undocumented residents in Medicaid and MinnesotaCare; evaluate all current value-based purchasing, accountable care, and care coordination demonstrations, pilots and programs for effectiveness in areas such as improving health disparities, patient choice and provider attachment, and multi-payer alignment. (See the full recommendations here). We are now in a much stronger position internally and in the policy landscape to include a consumer agenda in the state’s value-based efforts.
A key component of Valuing Health is our partnership with Waite House and others in the immigrant advocacy community to understand the health and value priorities of that portion of the uninsured population who are barred from many avenues to health coverage due to their immigration status. Waite House is a community-based center that offers basic needs, self-sufficiency, youth and civic engagement programming in a diverse neighborhood of South Minneapolis. They have also begun extending their community outreach into several growing Latino communities in Greater Minnesota (beyond the Twin Cities).
Because coverage for non-citizens who are currently excluded would likely be paid for almost entirely with out-of-state dollars, there is interest in leveraging value-based models to get the most cost-effective coverage for this population. Additionally, because racial disparities have persisted in public programs for even those who are covered, we want to prioritize engagement of the affected communities early and often in program design. Waite House is leading that work through community conversations that connect real experiences seeking health care to the larger conversations happening in the state. Through Valuing Health, we will continue our partnerships and learning community to connect consumer advocates and on-the-ground consumer expertise to the further development and evaluation of value-based care in Minnesota. We look forward to sharing from our experience and learning from leaders in other states along the way.
Sarah Greenfield, Former Health Care Program Manager, TakeAction Minnesota