Statement on President Trump’s CSR announcement

“The Administration has been threatening this since it took office. Most insurers and regulators figured it was going to happen and have done what we can to plan for it this year.

Locally, the damage is different than the rest of the country. But it creates problems in the future. Here, it means legislators don’t really know how much money in the future will be available to fund MinnesotaCare. And it means another broken federal promise to people to who buy their own insurance.

Bottom line, in the future people most in need of help are going to be hurt.”

—Jim Schowalter, President, Minnesota Council of Health Plans

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Dear Acting Secretary Wright and Secretary Mnuchin

Minnesotans should not be punished for our innovative work that helps simplify the complex health care system so people get care.

PDF of Council letter regarding MinnesotaCare funding

Dear Acting Secretary Wright and Secretary Mnuchin:

More than 100,000 working, poor Minnesotans rely on MinnesotaCare, our state’s Basic Health Plan, to get the medical care they need. Recent decisions by the federal government put MinnesotaCare’s future funding at risk.

Echoing the statements of others across out state, my organization, along with our member health insurers, join community organizations and elected officials in asking you to reconsider the decision that reduces MinnesotaCare funding with the approval of our state’s 1332 reinsurance program waiver. These programs are both essential components of our state’s strategic work to help ensure Minnesotans get care. MinnesotaCare is a valuable pathway between Medicaid and private insurance, easing transitions and helping ensure consistent care for individuals and families.
Throughout the development and negotiation of the state’s 1332 waiver application, there was an expectation that MinnesotaCare funding would be maintained as is. We have been told the Centers for Medicare & Medicaid Services and the Department of Treasury assured the state the waiver application met all requirements to keep MinnesotaCare funding intact.

Minnesotans should not be punished for our innovative work that helps simplify the complex health care system so people get care. Our new state-based reinsurance program and decades old MinnesotaCare reflect this commitment to innovation. We respectfully request you support this important work by maintaining the MinnesotaCare BHP funding in the 1332 reinsurance waiver approval.

The problem of rising medical bills is too complex to address without strong partnerships. We believe that our waiver can lower the cost of insurance and we are asking you to support it in partnership with the State, its insurers, and the many Minnesotans that buy insurance on their own.

Sincerely,

James Schowalter

President & CEO

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Statement on Graham Cassidy

We should be spending our time making sure people get care, not counting votes.

“We must do better. Simply chopping federal spending will not slow rising medical bills and will mean new hardship for people who need care, who are elderly, or just don’t have the money. I know our leaders in Washington can do better. We should be spending our time making sure people get care, not counting votes.

Health policy is absent in this bill. Minnesotans, like everyone in America, deserve ideas that work and nothing less. We cannot move backward to a system where only some people get the care they need.”

Read the full statement here.

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Minnesotans who have put up with confusing information and skyrocketing premiums are at the mercy of negotiations with the federal government.

Statement by the Minnesota Council of Health Plans on the state’s effort to lower premiums for people who buy their own health insurance policies

“Like many Minnesotans, I am deeply concerned about recent events that created new, unexpected hurdles as the state works to lower premiums for people who buy health insurance on their own. Without federal approval for what’s called a 1332 waiver, these Minnesotans will pay about 20 percent more for their policies than necessary.

Unfortunately, despite concerted effort, we are extremely late in the process and still without the clear federal approval required by state law. The state is in a difficult position. Formal federal approval is still missing and government employees suggest that that approval of the waiver means cuts to MinnesotaCare funding.

We are just more than a week away from when rates are scheduled to be announced and letters get mailed to current policyholders. Until all contingencies are understood and resolved, waiver rates won’t be final. Minnesotans who’ve been at the center of confusing information and skyrocketing premiums are now at the mercy of negotiations with the federal government.

Regarding MinnesotaCare, we supported reinsurance as a practical step to reduce premiums and ensure options for people buying insurance on their own. At no point was it considered as a transfer of federal effort from the state’s MinnesotaCare program. Minnesota’s insurers did not seek the waiver to reduce federal spending, but instead, to slow our community’s rising insurance premiums and stabilize options for Minnesotans. We still hope for approval of the state’s waiver request without any strings attached.”

-Jim Schowalter, president of the Minnesota Council of Health Plans

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Be aware of mental health care needs 24/7

As Mental Health Month comes to an end the work to improve our mental health and overall well being continues.

Unfortunately, stigma, shame, misinformation and misunderstanding surrounding mental health still exist. It stops people for getting help. It affects how we see people who have mental illness. And it limits how we talk about mental illness and wellness, further isolating people with the disease.

Here are some programs and ideas to help you better understand mental illness. Take a look and share with your friends.

Hilarious World of Depression. This podcast is about depression. And laughs. From its website: Depression is an incredibly common and isolating disease experienced by millions, yet often stigmatized by society. The Hilarious World of Depression is a series of frank, moving, and, yes, funny conversations with top comedians who have dealt with this disease, hosted by veteran humorist and public radio host John Moe. If you have not met the disease personally, it’s almost certain that someone you know has, whether it’s a friend, family member, colleague, or neighbor. Depression is a vicious cycle of solitude and stigma that leaves people miserable and sometimes dead. Frankly, we’re not going to put up with that anymore.

 

Make It OK. This campaign increases public awareness of helpful mental health care by helping people to talk more openly about mental health.

The 45-minute Make It OK presentation provides helpful, simple tips for talking friends and family members. In addition to taking the pledge, you can learn more about reducing stigma.

 

Mental Health First Aid© (MHFA.) This in-person training for youth and adults teaches how to assist people who are in crisis or are at risk of developing a mental illness. This eight-hour course teaches how to identify signs of addiction and mental illness, and how to evaluate the situation and provide help.

MHFA also gives people who take the course connections to local professionals who can help

 

Psychological First Aid (PFA.) Take the course used by first-responders and others to help children and adults experiencing immediate mental trauma. This trauma can come from violence, public health emergency, disaster or other event.

PFA is sponsored by the Minnesota Department of Health Office of Emergency Preparedness. You can take the course as a six-hour interactive online course or use the online manual.

 

Question, Persuade, Refer (QPR.)  These three simple steps  can help prevent suicide. Just as people trained in CPR and the Heimlich Maneuver help save thousands of lives each year, people trained in QPR learn how to recognize the warning signs of a suicide crisis. QHR also teaches you how to question, persuade and refer someone to help.

Learn QPR in an hour at QPR’s website.

 

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ACOs build toward the future

What happens when you realize doctors and insurers, patients and employers are all on the same side? Great care that’s less expensive.

 

Read how an ACO pioneer is reinventing care for Minnesotans.

 

Taking health care personally
When you ask an insurance company vice president about the benefits of accountable care organizations, or ACOs, you expect to hear talking points and impressive figures. But Christine Finn, vice president of sales communications at Medica, says something unexpected. “I belong to an ACO,” she says. “When I go to the doctor, all my records are in one place — I don’t have to say the same thing over and over.” If you’ve ever filled out the same form in a new doctor’s office for the umpteenth time — and chances are you have — you’ll understand why simply not repeating yourself makes such a huge difference.

Chris Finn, Medica

Ken Horstman, University of Minnesota

Lisa Span, Medica

 

Chris has responsibility for sales communications at Medica, but she talks about her ACO from a patient’s perspective. That’s as it should be, she explains. “The accountability in ‘accountable care’ is something we take personally,” says Chris. “Medica, with our health care provider partners, takes accountability for driving improvements in health care that affect our members. Including me.”

Today, nearly 50,000 receive their health care through one of six ACO networks and eight leading health systems — Altru, Essentia Health, HealthEast, Fairview, Mayo Clinic Health System, North Memorial, Park Nicollet and Ridgeview Community Network.

 

Starting from common ground
The basic principles of accountable care organizations, like Medica’s, are easy to understand. First, ACOs assume that insurers, employers, medical professionals and patients can and do want to achieve better medical results at lower prices. With that fundamental agreement in mind, ACOs set up payment structures that reward quality and efficient care — then pass any resulting savings on to everybody involved.
“Medica was the first health plan in the region to align with a health system to develop an ACO,” says Chris. Back in 2012, Medica’s partnership with Fairview Health Services was innovative and market-leading. Medica’s partnership with Fairview was so successful that the insurer decided to double down on the collaborative model.
“By now,” Chris says, “we’ve had ACOs in place long enough to prove they’re delivering meaningful improvements.” Members enrolled in ACOs average:

  • a 12 percent increase in the use of preventative services
  • nearly 14 percent fewer ER visits
  • 16 percent fewer hospital admissions
  • increased use of affordable generic medications

“We’re not just giving lip service to efficiency. With our ACO partners, we’re keeping people healthier, for less.” How much less?

 

Employers who choose ACOs are spending up to 15 percent less than they would with broad-network plans and employees enroll year-after-year. That’s how ACOs quickly became one of Medica’s most popular health insurance options.

 

Better care for less
Better care for less sounded like a very good bargain to large employers, for whom health insurance is a massive and growing expense. The University of Minnesota, one of the best research institutions in the nation and the world, is also the state’s sixth-largest employer.

 

“When ACOs came along a few years ago, we saw them as a way to address care and cost all in one package,” says Ken Horstman, the university’s senior director for total compensation.

 

But the ACO model could be a challenge for University employees to accept. Like many other Minnesotans, U of M employees had been accustomed to “open-access” policies, which let them see any doctor or hospital they preferred, and enrolling in an ACO plan would mean choosing from a smaller selection of in-network care providers. “We did not know what the first-year experience would be,” Ken says, “but 95 percent of the employees who chose the ACO plan stayed in it the next year.”
Employees liked it, and the University did too. “After the first year,” Ken recalls, “we looked at the utilization experience, risk reduction and average medical cost for employees and families who’d switched into an ACO and compared it with their experience from the year before, under a broad-network plan. The same employees, on average, had lower costs with the ACO.”

 

With results like those, Ken and his colleagues decided to encourage even more university employees to join ACOs. “We’ve made a commitment that we’re going to support more of the overall premium for our employees who choose ACO plans,” he says, “in the belief that members’ experience with the ACO will continue to be positive and that their overall health will be supported.” This year, about 15 percent of the 38,000 people insured through the University are enrolled in ACO networks, and Ken anticipates that more will make the leap as time goes by.

 

Like Chris Finn, Ken knows the benefits of ACOs from personal experience. “I took my family into the ACO this year,” he says. “I got a call from my clinic and from an ACO representative to encourage us to stay in touch if we had questions. My son got a call from them saying that they’d noticed a gap in care for his asthma, and offered to help him get that taken care of.” Before joining the ACO, Ken observes with delight, “the only time we ever got a call from a clinic ever at our house, it was from our dog’s vet! This was the first time I’d ever received a call from a medical provider without asking for it.”

 

The benefits of partnership
Why are Medica’s ACO partnerships working so well? Better health care happens when you start from the assumption that everybody — employees and their employers, doctors and nurses, hospitals and insurers — is on the side of wellbeing. For insurers and health care providers, traditionally at odds, that shift to agreement has been particularly fruitful.
“I love this work because we’re coming at it with a new mentality,” says Lisa Spann, Medica’s director of market and product efficiencies. “We’re not going into it with our traditional mindset. Instead of looking at health care from an insurer’s perspective, we sit down together with providers. By having these conversations together, the dialogue shifts. We start asking, ‘How would our members experience this? What really matters to them?’ The ACO is more than just a new model for reimbursing providers,” she adds. “It enables real creativity.”

 

Lisa’s work brings her into contact with Medica’s six ACO partners every day, so she understands the difficulties — and the rewards — of crossing old institutional boundaries to put wellbeing first. When she thinks about the future of health care in Minnesota and beyond, she sees challenges. “There’s a long way to go,” Lisa admits. “But we’re tackling the first step. We’re creating infrastructure between payer and provider, and establishing real trust. Once we’ve got that, we can tackle any problem.”

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