Primary care — your life depends on it


Studies in the United States show that a 20 percent increase in the number of primary care doctors results in a 5 percent decrease in mortality and overall health care costs. Juxtapose the steadily declining number of medical students choosing primary care over specialty practices and physicians across the state are saying we have a crisis on our hands.

Frank Cerra, senior vice president for health sciences at the University of Minnesota, told the House Health Care and Human Services Finance Division Feb. 27 the current medical student population can’t produce enough primary care doctors to solve the access issue. To solve the crisis, the state needs to invest nearly $1 billion over the next decade.

State legislators and officials aren’t oblivious to these statistics, and agree that Minnesota’s health care system needs an overhaul.

Rep. Thomas Huntley (DFL-Duluth) said part of the solution is allowing nurse practitioners, registered nurses and those with medical licenses perform all duties that they are trained to do. The current system doesn’t allow them to use their full skill set, he said.

Greater access, cost control

Huntley sponsors HF3391 that would make efforts toward cost control and creating greater access to health care.

“The timelines in this are extremely aggressive, there’s no doubt about that, but Minnesota can’t wait any longer. If we want to progress as a state, we need to get our health care costs under control, and we need to do it quickly,” he told the House Health and Human Services Committee Feb. 28.

The bill would cover 96 percent of Minnesotans by 2011; set an affordability standard for how much a person would pay for health insurance in proportion to their income; reform payment structures; and promote cost-effective, high-quality care with pay-for-performance standards. It would also allow doctors and nurses to practice the way they want to practice, Huntley said.

Studies show that, over time, patients are happier and healthier when they are in a health care home model — a patient-centered care approach. The bill would establish health care homes, which emphasize primary care and encourage collaboration between providers and patients. The health commissioner would begin certifying providers as health care homes by July 1, 2009.

“The focus of a medical home is to manage people that have chronic diseases that aren’t too bad yet and keep them from getting worse,” Huntley said.

The bill would also create the Minnesota Health Insurance Exchange to provide “individuals with greater access, choice, portability, and affordability of health insurance products.” The exchange would create an Internet-based system to rank individual health market plans and small employer health benefit plans. Among items the rankings would consider are premiums, deductibles, co-payment and co-insurance requirements, and out-of-pocket maximum payments.

The affordability standard for MinnesotaCare would increase to 6 percent for individuals and families at or below 300 percent of the federal poverty guideline ($31,200/individual), and 8 percent for individuals and families at or below 400 percent of the federal poverty guideline ($41,600/individual).

As part of insurance reform, also established in the bill, the Health Care Transformation Commission would be required to create a set of measures to rate health care providers for use in establishing statewide health improvement goals and pay-for-performance systems.

The bill awaits action in the House Commerce and Labor Committee. A companion bill, SF3099, sponsored by Sen. Linda Berglin (DFL-Mpls), awaits action in the Senate Commerce and Consumer Protection Committee.

Complementary plan

Sponsored by Rep. Diane Loeffler (DFL-Mpls), HF3390 would implement public health initiatives to complement the overall health care changes and savings.

It focuses on prevention of childhood diabetes and would develop a public health improvement program “to reduce the percent of Minnesotans who are obese or overweight to less than half by the year 2020.” It would also focus on the reduction of tobacco use by 2 percent annually, starting in 2011.

The bill would make nutrition a required academic standard. “We have a growing number of young people being diagnosed with adult onset diabetes,” and that means they will have decades of serious health challenges and can be more easily dealt with by prevention, said Loeffler. The potential savings in health care through prevention are the goals, she said.

The bill, which has no Senate companion, awaits action by the House E-12 Education Committee.

While many members of the House Health and Human Services Committee commended the bills, some expressed concern on rushing the changes and the costs associated.

“We need to take time to question some of the details,” said Rep. Steve Gottwalt (R-St. Cloud). While focusing more on primary care and less on specialties makes sense, more time is needed “to make certain that we are first doing no harm,” he said.