Health Care Reform 2008—A Timeline
- January 2008: Governor’s Transformation Task Force (TTF) issues draft report and recommendations, includes Levels I-III payment reform concepts
- Jan. 10th: MMA Payment Reform Work Group convenes – reviews TTF report
- Jan. 14th: MMA submits letter to TTF members:
- “…the recommendation to ‘establish provider accountability for the total cost and quality of care’ requires far more explanation and consideration.”
- “It is unreasonable to assume that total responsibility for costs and quality can, or should, fall to providers alone.”
- “The 3-level model for a reformed payment system sends a clear and powerful signal to the delivery market to consolidate.”
- “…there are internal inconsistencies associated with the 3-level model”
- “…the MMA is disappointed to find little, if any, acknowledgement in the report of the consequences of administrative pricing associated with the current payment system…the consequences associated with cost shifting will only continue to distort an otherwise ‘reformed’ payment system.”
- Jan. 31: Payment Reform WG meets with MDH Asst. Commission Scott Leitz on “level 3” proposal
- Feb. 12/Feb. 20: Payment Reform WG develops, MMA Executive Committee approves, innovative care payments as alternative framework for payment reform:
- Medical home as foundation (or “level 1”)
- Pay for quality
- To encourage greater innovation & less reliance on visit/volume-driven payment system, develop standardized definitions and payments for episodes/baskets of care (both bundled and unbundled)
- Oppose “level 3” as currently defined that places physicians at financial risk for full continuum of care
- Feb. 21: MMA distributes alternative payment reform framework to legislators
- Feb. 25: House & Senate bills introduced
- Senate similar to TTF recommendations
- Level 3 bidding by providers for total cost and quality accountability
- Hospital and health plan assessment for public health
- Eligibility expansion based on “savings recapture assessment” on health plans
- House similar to LCHCA recommendations
- Places PH provisions in separate bill
- Level III - Calls for creation of definition of “total cost of care for a patient group” and recommendations for “additional action needed to successfully achieve health care transformation in Minnesota.”
- No assessments/taxes
- Financing of eligibility expansion undefined
- Feb. 27: Senate hearing on bill
- Bob Meiches, MD testifies
- Expresses serious concerns about the “level 3” proposal that “…is extremely complex, not understood, internally inconsistent, and increases the administrative burden on the system.”
- Feb. 28: House hearing
- Bob Meiches, MD testifies
- Expresses support for House bill
- Urges that medical home be foundation of any payment reform (building upon foundation with pay for quality)
- Expresses strong support for House’s methodical approach to “level 3” that seeks to first understand and define what it is and its implications.
- March 6: MMA Day at the Capitol
- Health care reform talking points: Support House bill and its approach to payment reform
- March 17: House Health Finance Division amends House reform bill to include language on “level 3” payment reform, very similar to that of the Senate.
- March 18: MMA issues Action Alert
- “Stop payment reform that smells like capitation”
- “Tell lawmakers to vote for payment reform that promotes medical homes and care coordination, and make clear they should vote against Level 3, until its implications are understood and its methodologies are clarified.”
- Friday, March 21: Consistent with MMA policy, MMA staff develops amendments to House version of the bill
- Extend implementation timelines
- Clarify some of the medical home/care coordination language
- Move “level 3” away from capitated/”total cost of care” and toward voluntary package pricing for standardized chronic disease episodes.
- Sat., March 22: House Republicans meet with Governor to express their opposition to “level 3” and urge Governor to back off on his support of reform.
- Monday, March 24: MMA staff meets with Rep. Huntley to review MMA amendments; Rep. Huntley expresses interest; Sen. Berglin expresses interest in reviewing MMA amendments.
- Monday, March 24: Governor announces that he is moving away from his support of health care reform.
- Thursday, March 27: Senate adds some of MMA amendments to Senate bill – still retains language on bidding for “total cost and quality”
- MMA refuses request for letter of support for amended Senate language
- March 31: House Finance Committee hearing
- MMA payment reform amendments incorporated
- With amendments included, MMA distributes letter of support for House bill.
- “…As originally proposed, the ‘level 3’ provision …would represent a step backward to models of the past that patients soundly rejected…”
- “…Representative Huntley’s amendment allows for the development of options for new payment models that focus on discrete packages of services, rather than the total cost of care.”
- “…With the incorporation of Representative Huntley’s amendment, the bill provides for a more targeted approach to payment reform with more realistic timelines for expert review, development, and stakeholder input.”
- Some other amendments added, including financing the entire cost of the package from the HCAF
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- March 31: Senate passes SF3099 (39-23)
- April 7: MMA Executive Committee meeting
- Oppose payment reform proposals for physician accountability for the “total cost of care” that requires physicians to take on insurance risk.
- Support proposals for voluntary use of bundled or package pricing, including such pricing for chronic conditions.
- Support further study and investigation of alternative payment reform proposals
- April 10: MMA letter to all Reps. - support for amended version of HF3391
- “…House File 3391 strikes the right balance between immediate action and thoughtful progression on payment reform.”
- “…the House bill replaced the controversial “level 3” proposal with a voluntary option for providers to innovate on bundled or package pricing for services. This concept would support development of new and innovative delivery and payment models by focusing on discrete packages of services.”
- “The ‘level 3’ proposal that was included in the report from the Governor’s Transformation Task Force, the Senate bill, and in earlier versions of House File 3391…fails to recognize the complexity of providers, services, and patient needs.”
- “The MMA strongly opposes a payment system based on total cost of care that turns physicians into insurers and managers of risk. The MMA will vigorously oppose any efforts by the conference committee to move in that direction.”
- April 10: House passes HF3391 (83-50; 1 R)
- April 11, AM: MMA staff meets with Commissioners Ludeman and Magnan, and Asst. Comm. (MDH) Leitz to discuss next steps and MMA positions.
- April 11, PM: MMA staff meets with Commissioner Ludeman, Asst. Comm. Leitz, and representatives from Mayo, HealthEast, Medica, the Minnesota Chamber of Commerce, and the Governor's office.
- Attempt to find compromise payment reform language
- Draft proposal offered that removed provider bidding, but would allow for collection of encounter-level data to support development of a cost and quality indexing system.
- April 11-25: MMA provides a series of changes to the “compromise language” to ensure that any efforts to calculate providers’ cost and quality of care first address key methodological concerns.
- April 21: MMA Executive Committee meeting
- Unanimous agreement to support the compromise language over the current language in both the House and Senate bills, but to revert to MMA support for the House language should the attempt to broker a compromise fail.
- April 21-current: House/Senate conference committee meetings
- April 30: Governor meets with 8 legislative leaders
- Offers compromise language
- Only a subset of which is the payment reform language that MMA supported
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