Why is this goal important?
Rising health care costs are a serious problem. While there is no magic bullet to make the problem go away, the Minnesota Department of Human Services (DHS) is looking at a number of initiatives that will reduce costs in both the short and long term.

In addition to the initiatives outlined below, DHS is taking steps to improve program integrity and efficiency. This means making sure that eligible Minnesotans — and only those eligible — are able to enroll in Minnesota Health Care Programs (MHCP). It also involves automating the current enrollment process to ensure that consistent guidelines are followed when adding or retaining individuals in MHCP.
 
Basic health care costs account for approximately 49 percent of DHS’ state funding. Costs include items such as hospital, physician, health maintenance organizations (HMO) payments, etc., but not long-term care costs such as nursing facilities. At a time of lean budgets, it is critical that DHS look at all possible measures to reduce costs.

How will this goal be accomplished?
DHS is pursuing several initiatives, including:

· Prescription medication. DHS has implemented several cost-saving initiatives, such as efforts to promote the use of generic medications. In fall of 2004, DHS joined seven other states in a National Medicaid Pooling Initiative (NMPI) to strengthen its ability to negotiate supplemental rebates with drug companies. DHS participates in another multi-state program called the Drug Effectiveness Review Project. The comprehensive drug reviews produced by the project are used with NMPI rebate information to establish a preferred drug list (a list of cost-effective drugs that can be prescribed to MHCP recipients without restrictions). Doctors must get approval before payment will be made for drugs not on the preferred drug list.

· Covered services. DHS completed the Health Care Services Study, as requested by the 2003 Legislature to identify strategies to cut costs and improve value in Minnesota Health Care Programs. The study was conducted over 14 months and included input from enrollees, stakeholders, health care providers, and national health care experts. The study also included an independent review of Minnesota’s and other states’ practices for covering health care services. The most viable of the identified strategies helped form the basis for proposals presented to the 2005 Legislature related to coverage policies, pharmacy purchasing. and medical care management for chronically ill enrollees. Other strategies require further study and can be pursued over time. The study is available at http://www.dhs.state.mn.us/healthcare/studies.

· Special transportation. The department has been concerned for a number of years about the lack of coordination of transportation to medical appointments in the Twin Cities for health care program enrollees. These concerns include the escalating costs of “special transportation” and the difficulty in obtaining common carrier transportation such as bus or taxi. To address these cost issues, the 2003 Legislature passed a number of changes that affect non-emergency transportation, including the implementation of a transportation coordinator within the seven-county metro area. DHS contracted with Medical Transportation Management, Inc. in July 2004. This coordinator is responsible for authorizing appropriate levels of transportation and managing common carrier transportation for enrollees who need a ride to their medical appointments.
          
· Disease management. Over the past several years, private sector health plans have been focusing on disease management as a tool to manage their enrollees’ health care and reduce costs. With MHCP, many MA enrollees who are in fee-for-service plans are people with disabilities who have chronic heath conditions. DHS is developing a disease management pilot project where MA enrollees, on a voluntary basis, would be assigned a nurse counselor who would manage the enrollee’s health care needs. By providing individual professional care to enrollees, disease management can ensure that enrollees are getting the necessary care when they need it, thus avoiding emergency treatment, hospitalization or longer-term care costs.
            
How is DHS’ progress?
The cost per person in the fee-for-service portion of the Minnesota Health Care Programs (MHCP) grew by 4.84 percent in 2005. Growth in the annual cost per person in the managed care portion of MHCP was 6.38 percent in 2006. DHS’ goal is to have spending on public programs grow at a rate slower than the statewide private health insurance average, which was 6.8 percent for 2005.

The most recently measured average monthly cost per recipient for prescriptions in MHCP was $268 for the last half of 2005.
           
The most recently measured average monthly cost per recipient for special transportation in MHCP was $259 for the last half of 2005.

DHS’ goal for both of these costs is to reduce the historical growth rate.

DHS is meeting its targets as a result of improved management of services and, in part, due to changes in payment policy.

Why is this goal important?
Fueled by the aging of the baby boom generation, a much larger proportion of the population than ever before will need long-term care over the next 30 years. As the major payer of long-term care services, the state could be overwhelmed by the cost of long-term care for these elderly baby boomers.  

What is DHS doing to achieve this goal?
DHS is encouraging more personal savings and use of private financing options, such as long-term care insurance, providing information and assistance that allows consumers to make informed choices that meet their needs and preferences, and targeting public funding to services that support low-income people in community-based settings so they can avoid nursing home placement.

In 2005, DHS began Transform 2010, a project to identify the impacts that the aging of the state’s population will have and to prepare Minnesota for this demographic change. DHS has been working for several years on expanding the financing options that will enable consumers to use their own resources to pay for their future long-term care needs. The newest option soon to be available is the Long-Term Care Partnership program. Minnesotans who purchase certain long-term care insurance policies will be able to protect more of their assets under this new state plan. The plan is intended to give people greater control over how they finance their long-term care. DHS also is helping to redesign long-term care to emphasize home and community-based services and helping Minnesota communities develop the type of home and community services their older residents prefer.

How is DHS’ progress?
In 2006, 48.7 percent of older Minnesotans needing publicly funded long-term care services received those services in nursing homes, and 51.3 percent received services in the community. DHS’ goal is to continue to increase the proportion of older Minnesotans receiving long-term care services in the community. Another goal is to further reduce the proportion of public funding spent on institutions. In 2006, 72.0 percent of public long-term care funds for the elderly were spent on nursing home care, and 28.0 percent of the funds were spent on community services.

DHS’ long-term strategy is to reduce this reliance on public funding and increase the proportion of nursing home days paid by private and other funding. In 2005, Medical Assistance and Medicare paid for 73 percent of nursing home days, and private and other sources paid for 27 percent.
 

Why is this goal important?
Since the late 1980s Minnesota has envisioned serving people with mental illness in community-based settings rather than large public institutions. Research also has shown that people with mental illness are better served in or near their homes as well as near the natural supports of family and friends, using a wide range of mental health treatment practices that have proven to be effective. It is estimated that 20 to 30 percent of people in an institutional (Regional Treatment Center) setting would be better served in community-based settings, including permanent housing.

What is DHS doing to achieve this goal?
DHS, counties and other partners are moving mental health services from state institutions to local communities. An array of community-based services are being developed by regional planning groups to meet the needs of adults with mental illness. Among the array of services will be acute psychiatric inpatient care provided by small state-operated Community-Behavioral Health Hospitals or community hospital psychiatric units.

How is DHS’ progress?
In 2006, 5 percent of people with serious and persistent mental illness received some or all of their services in an institution. The goal is to reduce reliance on institutional settings by improving community-based services.

The average number of annual bed-days for persons treated in an institution for mental illness in 2006 was 65.3 days. DHS’ goal is to reduce that average as a measure of increased access and improvement in community-based services.

In 2006, 11 percent of people discharged from an institution were admitted to either an institutional or a hospital setting within 30 days of being discharged. DHS’ goal is to reduce this percentage over time by improving inpatient treatment and access to community-based services.
 

Why is this goal important?
Every child deserves a safe, loving, permanent home. Children who have their physical, emotional, and mental health needs met are more successful in their families, schools, and communities and more likely to become productive, contributing members of society. Safety and stability are paramount to achieving the well-being of children. Positive enduring relationships provide a foundation for successful childhood development and lifelong self-sufficiency.

The Minnesota Department of Human Services seeks to provide permanent families for children by supporting parents so that they can safely care for their children or by finding an alternative permanent family, preferably with relatives or an adoptive family, to care for children when they cannot safely remain at home. Recognizing that a disproportionate number of families of color and American Indian heritage are part of the child welfare system, the department will strive to ensure there is equity in the access to and delivery of services for all families, particularly families of color and American Indian heritage.

How will this goal be accomplished?
Although the Minnesota Department of Human Services has a good record of establishing safety and permanency for children who need protection, opportunities to improve the way government responds are being pursued. The department is working to provide a continuum of services focused on prevention and early intervention to ensure that children can remain safely at home with their parents.

Several key initiatives implemented thus far include:
· Pursuing Alternative Response (http://www.iarstl.org), a strength-based assessment that offers broader services to families referred to the child protection system
· Working with the courts and counties to improve permanency timelines for children through the Children’s Justice Initiative
· Focusing on permanency for children through the work of the Public/Private Adoption Initiative, the implementation of The Homecoming Project, the implementation of Concurrent Permanency Planning, and ongoing collaboration with stakeholders.

While working toward safety and permanency for children, the department has taken extensive measures to address disparities in the child welfare system by:
· Implementing the recommendations of the African American Disparities Advisory Committee
· Working with the University of Minnesota on two studies to examine child neglect in and services provided to black families
· Implementing the recommendations of the American Indian Disparities Advisory Committee.

What is DHS’ progress to date?
Recurrence: The national standard for child maltreatment recurrence is measured after six months of the first maltreatment determination. Nationally, 93.9 percent of children served by child protection are not subject to repeat maltreatment in the six months following an initial report. However, Minnesota believes it’s important to use a longer period (12 months) in judging our success. In Minnesota, about 92.5 percent of the children served by child protection are not subjected to repeat maltreatment in the year following an initial report (CY2006). We hope to improve this outcome over the next year.  Results by race and ethnicity.

Timely Reunification: Minnesota has a very high rate of return of children to their parents within the first year of out-of-home placement; in CY2006, 90.4 percent of children returned home in that timeframe.  Results by race and ethnicity.
 

Timely Adoption: In CY2006, 48.8 percent of the children under state guardianship who were adopted that year had their adoptions finalized within two years of their most recent out-of-home placement.  Results by race and ethnicity.

Reentry: 80.9 percent of children entering out-of-home care in 2006 did not have a prior placement within the previous 12 months.  Results by race and ethnicity.

Why is this goal important?
Minnesota leads the nation in providing access to human services and in key client outcomes. Yet, we lag among certain groups – particularly rural Minnesotans, people of color, and American Indians. These disparities are unacceptable. Examples include:

· As discussed in the prior goal: “More children will live in safe and permanent homes,” children of color and American Indian heritage are overrepresented in the child welfare system. Black and American Indian/Alaska Native children are about seven times more likely to be determined victims of maltreatment than white children.

· DHS analyses show there are disparities in outcomes by racial/ethnic and immigrant status for clients of the Minnesota Family Investment Program, the state’s primary economic assistance program to help low-income families become self-sufficient. When controlling for several individual demographic and county economic characteristics in order to “level the playing field,” some outcomes were lower than expected for several racial/ethnic groups.

· More than 90 percent of Minnesotans have health care coverage, and the state is consistently ranked as one of the “healthiest states” based on a variety of access and outcome measures. Within this record, there are gaps in performance. The disparities include: a comparatively high rate of uninsurance among Hispanics (17.3 percent), American Indians (16.1 percent) and blacks (15.6 percent). In addition, children receiving Minnesota Health Care Program benefits have a lower rate of well-child visits than the commercial managed care population.
     

What is DHS doing to achieve this goal?
The department is working to identify gaps, set goals, and implement targeted, coordinated strategies to reduce disparities and improve outcomes. DHS will build on efforts under way with counties aimed at reducing disparities among Minnesota Family Investment Program participants and among children of color and American Indian heritage receiving health care and child welfare services. DHS is evaluating where inequities exist at key decision points when individuals and families come in contact with its services and will implement strategies so people will experience similar results regardless of their race, ethnicity, or where they live.
  

How is DHS’ progress?
The 2005 data indicates that for children enrolled in the managed care Prepaid Medical Assistance Programs (PMAP), 45 percent of those in the first 15 months of life received the recommended number of well-child visits for their age group. The comparable figure for children enrolled in the MinnesotaCare managed care program is 51 percent. The goal is to increase these rates. In general, publicly funded managed care programs lag behind commercial managed care program performance on this measure. In 2005, the overall figure for managed care plans in Minnesota was 59 percent.

The latest MFIP data indicates that for the July to September 2006 quarter, almost 71.7 percent of all adults are working at least 30 hours per week or off MFIP cash assistance three years after a baseline reporting period, compared with 67.1 percent for the same quarter in 2003. Outcomes for African American and American Indian adults also improved over the same period but are not at the same level. The department has received a multi-year matching grant from the Otto Bremer Foundation to work with counties in order to further understand and reduce these disparities in outcomes. For more information about MFIP and racial/ethnic and immigrant groups see the reports in the "Welfare Reform Outcomes of Racial/Ethnic and Immigrant Groups in Minnesota: Racial/Ethnic and Immigrant Studies (REIS) Series."  (http://www.dhs.state.mn.us/main/groups/economic_support/documents/pub/dhs_id_004113.hcsp)

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