Capsules

Federal Suit Filed Against BCBSMN

The U.S. Department of Labor (DOL) recently filed suit against Blue Cross Blue Shield of Minnesota (BCBSMN) for alleged improper collection of over $65 million from its self-funded plans. The suit cites prohibited transactions and breaches of fiduciary duties under ERISA. BCBSMN allegedly caused its self-funded plans to compensate its own in-network providers for amounts they owed under a Minnesota provider tax—expenses the providers never billed or passed on to the plans. DOL claimed, “Without authority to do so under the [plan governing documents], and without obtaining approval from independent fiduciaries of the plans, BCBSMN caused the Plans to reimburse BCBSMN the amounts it paid to the providers for the providers’ MNCare tax obligations, and in so doing exercised authority over the assets of the plans and discretionary authority over the management or administration of the plans.” The implication is that by charging the client plans for taxes they did not actually incur, BCBSMN became a fiduciary of the plans by exercising control over plan assets.

As a means to improve fiduciary standards and health plan payment transparency, DOL has pursued similar action in other states. A spokesman for BCBSMN stated, “While we cannot comment on specifics of active litigation, Blue Cross and Blue Shield of Minnesota strongly believes the underlying claims in the Department of Labor lawsuit are without merit and based on unsupported interpretations of the MinnesotaCare Provider Tax law. Our negotiated payment rates incorporate all applicable taxes and fees and reflect our commitment to ensuring every member has access to affordable, high-quality care. We look forward to actively defending our position throughout the legal process.”

Smoking Costs Minnesota $9 Billion and 6500 Lives in 2021

A new report recently released by Blue Cross and Blue Shield of Minnesota (Blue Cross) shows that smoking is responsible for 6,530 deaths and $9.4 billion in health care expenses and lost productivity costs. Over 1 in 4 deaths in Minnesota in 2021 could be attributed to smoking. The report highlights the urgent need for comprehensive measures to address smoking-related health issues and inequities in Minnesota. Not only does smoking result in a high number of deaths each year, but it also places an enormous burden on the state’s health care system, with billions of dollars being spent on treating preventable diseases and conditions related to smoking. To put this into perspective, the $4.7 billion in excess health care costs associated with smoking could also fund:

• Building 471 community centers
• One year of K-12 education for 273,768 students
• 4 U.S Bank stadiums
• 16 years of maintenance for all MN state parks, lakes, and recreational facilities
• 94,160 jobs at $50K a year

The 6,530 deaths that could be attributed to smoking in Minnesota in 2021 adds up to approximately 81,000 years of potential life lost and about $4.7 billion in lost productivity. When considering both health care expenses and lost productivity, the cost of smoking in Minnesota skyrockets to an estimated $9.4 billion. This broader perspective considers not only the direct medical expenses but also factors in the indirect costs associated with decreased productivity due to illness, disability, and premature death caused by smoking. “We know the overall smoking rate in Minnesota continues to decrease, and we have seen considerable progress with the passing and implementation of policies that safeguard the well-being of Minnesotans,” said Bukata Hayes, vice president, racial and health equity, and chief equity officer at Blue Cross. “Yet, marginalized communities continue to be disproportionately targeted by big tobacco and have higher rates of commercial tobacco use and exposure to secondhand smoke. We have a collective obligation to prioritize reducing the burden that smoking and other commercial tobacco-related health inequities impose on our state.”

DHS Expands Childhood Medicaid Coverage

The Minnesota Department of Human Services (DHS) recently announced that children in Minnesota will now be provided more stable access to Medicaid health insurance. A new continuous eligibility policy for children will help provide a healthier and more equitable start for the youngest Minnesotans. All children under age 19 who are eligible for Medical Assistance will have 12 months of continuous coverage at a time. Medical Assistance is Minnesota’s Medicaid program. This important change will prevent paperwork issues due to temporary changes in a parent’s income from disrupting a child’s health insurance. Families with low and moderate incomes may experience fluctuations in income during a year that briefly exceeds the Medicaid limit because of temporary employment, variable work hours or occasional overtime pay. “Continuous eligibility will help prevent unnecessary, harmful and expensive gaps in children’s health care coverage,” said Human Services Commissioner Jodi Harpstead. “This policy will go a long way toward helping Minnesota kids reach their full potential.” Signed into law in 2023 by Governor Tim Walz, continuous eligibility promotes and supports health equity by preventing gaps in needed care. Minnesota has significant racial disparities in health outcomes, with Black and Hispanic children more likely to experience gaps in coverage. To illustrate one element of this disparity, Medical Assistance in Minnesota covers:

• 64% of Black children
• 54% of American Indian/Alaskan Native children
• 52% of Hispanic/Latino children
• 31% of Asian children
• 17% of white children

Better access to preventive care may lead to healthier children and ultimately result in lower spending in public health care programs, since identifying and treating issues early can reduce the need for costlier treatments. Although children in Medical Assistance will maintain coverage for a year at a time, they will still be subject to annual eligibility renewals. Renewals were suspended during the COVID-19 emergency but have since resumed. To avoid gaps in coverage, Medical Assistance enrollees are urged to update their contact information and watch their mail for important renewal paperwork. For more information about Medical Assistance renewals, visit mn.gov/dhs/renewmycoverage

MNCM Report Cites Top Quality Medical Groups

Minnesota Community Measurement (MNCM) recently released a report that identified Minnesota medical groups consistently performing well on measures of health care quality. The report, Minnesota Health Care Quality Report Part 3: Top Performing Medical Groups Across All Quality Measures, combines data from quality measures reported to MNCM and defines top performing medical groups as those with statistically better than average performance on at least half of the quality measures that were applicable to them. The report also recognizes medical groups that are top quality performers while achieving lower total cost of care for privately insured patients than the statewide average. Seven medical groups in Minnesota achieved the designation as top performing groups for their overall quality performance in 2022. The seven top performing groups include:

• Central Pediatrics
• Essentia Health
• HealthPartners Clinics
• Mankato Clinic, Ltd.
• Mayo Clinic
• Park Nicollet Health Services
• South Lake Pediatrics

Of the seven medical groups recognized for high quality, four also achieved lower than average total cost of care for their privately insured patients in 2022: Central Pediatrics, HealthPartners Clinics, Park Nicollet Health Services, and South Lake Pediatrics. “It’s no small feat to achieve consistently high health care quality across a wide range of measures,” said Julie Sonier, MNCM president and CEO. “Recognition of these high performing medical groups is well deserved. In addition, the fact that several of them achieve lower than average costs is important – it demonstrates that high quality and low cost can go hand in hand,” added Andrea Walsh, HealthPartners president and CEO. “Patients need health care quality and affordability to go hand in hand, and this report demonstrates that health systems can achieve both. Our team of 27,000 colleagues is focused on improving quality and access while lowering total cost of care. We remain committed as ever to making much more urgently needed progress.” Measuring and reporting on health care quality and cost helps consumers understand how care varies across providers, allows providers to identify improvement opportunities and how their measures compare to others, and helps health plans and other purchasers better understand and improve value for money that is spent on health care. Learn more at www.mncm.org.

AMA Awards Sanford Health for Reducing Physician Burnout

The American Medical Association (AMA) recently released the results of its 2023 Joy in Medicine initiative, and Sanford Health was one of only 10 health systems nationally to receive gold-level standing. In all, 72 systems met the criteria for some form of recognition. The AMA Joy in Medicine™ Health System Recognition Program is designed to guide organizations interested, committed or already engaged in improving physician satisfaction and reducing burnout. Committed to advancing the science of physician burnout, this program empowers and propels health systems to reduce burnout so that physicians and their patients can thrive. Objectives of the program include: a roadmap for implementing programs and policies that actively support well-being; uniting the health care community in building a culture committed to increasing joy in medicine nationwide; and building awareness of solutions that spur investment within health systems to reduce physician burnout. Recognition is based on organizational achievement and effort in six competency areas. These areas include:

• Assessment: Measuring physician well-being and burnout
• Commitment: A cross-cutting organizational commitment to workforce well-being
• Efficiency of practice environment: Operational efficiency is key to supporting well-being. *Teamwork: Effective teamwork can have a tremendous impact on the overall well-being of physicians and care teams.
• Leadership: Leadership behaviors set the foundation of organizational culture.
• Support: Cultivating connections at work is an important means to driving professional satisfaction.

“At Sanford Health, it is our philosophy to be purposeful with our intent of making sure our clinicians enjoy their practice,” said Heather Spies, MD, physician director of clinician experience and well-being. “We know that when we invest in our clinicians, we’re ensuring all of our patients receive the best care possible. This recognition is a testament to our dedication to the well-being of our caregivers.”

“Focusing on the well-being of our clinicians is the single greatest asset to Sanford Health,” said Daniel Hoody, MD, vice president, medical officer, Sanford Bemidji in Minnesota. “The various programs have played a critical role in ensuring our clinicians are at their best, which in turn has positively impacted patient care.” Applications to the 2024 program will open Jan. 12 and close March 1, 2024.

M Health Fairview Opens Innovative New 16-Bed In-patient Facility

M Health Fairview St. John’s Hospital in Maplewood recently opened a new “short stay observation unit”. In response to rising inpatient and emergency room visits, and an increased need for bed space, this new addition represents an innovative step in health care facilities design. Utilizing an interdisciplinary design team the new facility was designed to streamline the process of care delivery and serve the needs of today’s interdisciplinary care teams. The new facility was primarily built off-site using prefabricated materials then seamlessly transported and installed on the St. John’s Hospital campus — the first of its kind in the state of Minnesota. This process did not create the usual construction-related disruptions in care delivery and almost instantly provided a greatly enhanced patient and provider experience. Construction of the unit began offsite in September 2023. Crews delivered the prefabricated unit to St. John’s in late November with final construction and furnishing now completed. “In the face of escalating patient visits, our ED and inpatient medicine teams have been proactive and innovative in their response,” said Will Nicholson, MD, vice president of medical affairs for M Health Fairview St. John’s and Woodwinds hospitals. “This approach is a game-changer. It allows us to rapidly develop the needed space without impeding current operations.” David Thomack, chief operating officer with Boldt, the company that created the prefabricated materials, said, “We’re facing a very real need for patient bed space in our country right now. Every day that is spent in planning, design or construction is another day that hospitals and patients must do without those beds. Using a modular approach, we’re delivering that space in half the time traditional construction would take, without sacrificing durability, quality or affordability, allowing health care providers to see patients months sooner.” The short-stay observation unit benefits patients from a purposefully designed environment focused on comfort, mobility, and flexible care capabilities that are conducive to recovery and observation. The space provides more flexible patient flow that optimizes hospital resources, reduces wait times and ensures prompt access to necessary medical interventions in a setting aligned to the complexity of the care required. The modular design and construction approach allowed the hospital to cut the schedule in half compared to traditional construction, enabling St. John’s to start treating patients up to eight months sooner.