President Barack Obama will be in one of the nation's healthiest states Saturday, where most people have health insurance, medical care tends to be cost-effective and providers like the Mayo Clinic have made a name far beyond the Upper Midwest.
Minnesota has been a national leader in trying to measure the quality of care and reward providers whose patients do better. People here benefit from nonprofit health plans and hospitals and an integrated system of hospitals, clinics and group practices that make it easier for doctors to consult each other.
The state, along with Hawaii, Iowa, Massachusetts, New Hampshire and Vermont, shows where Obama wants the rest of the country to go. The Democratic president plans a rally with supporters of his health care overhaul in Minneapolis on Saturday.
"If he really wants to talk about the future and where you can see it, you'd come to a place like this," said former U.S. Sen. David Durenberger, a Republican who leads the National Institute of Health Policy at the University of St. Thomas in Minneapolis.
Minnesota was the fourth-healthiest state last year in a ranking by United Health Foundation, the American Public Health Association and the Partnership for Prevention. The state topped a similar list from CQ Press for the past two years.
Forty-one percent of Minnesota's physicians are primary care doctors, who help patients navigate the medical system. The national average is 39 percent. The nonprofit Minnesota Comprehensive Health Association also offers an insurance for people denied private coverage because of pre-existing conditions.
Things aren't perfect: American Indians and other minorities in Minnesota are more likely than whites to get diabetes, heart disease and some cancers. Providers lose money on Medicare and Medicaid patients. And in the face of budget problems, the state plans to cut off subsidized coverage for more than 30,000 low-income adults next year.
Republican Gov. Tim Pawlenty, who is positioning himself for a presidential run in 2012, said Obama has focused too much on expanding public coverage without enough emphasis on controlling costs. The governor has pushed to reduce Minnesota's public programs during his two terms; he said Thursday that the state can't afford those programs.
"We've been viewed as one of the most aggressive and impactful states when it comes to reform and change and improvement in health care, but our view of that is that it needs to be less government-centric," he said at a Capitol news conference.
Pawlenty's administration is implementing a 2007 state law designed to create "medical homes," designated providers patients can call around the clock to guide them to the appropriate place for care and, ideally, reduce costly emergency room visits and duplicative care.
The state also is taking steps toward paying providers based on how well their patients do, although that's still a way off.
State Rep. Tom Huntley, a Democrat from Duluth and one of the state's health care experts, advocates paying providers for keeping patients in good shape instead of mainly covering operations and hospitalizations.
Park Nicollet Health Services in St. Louis Park, Minn., is attempting this as part of a federal pilot program. The health system monitors 400 congestive heart failure patients, using daily reports that the patients make from home to try to prevent unnecessary hospitalization where cheaper care — or simply a conversation with a nurse — is appropriate.
The project has cut hospitalizations in half, saving Medicare more than $3 million. But Park Nicollet estimates it has missed out on about $6 million in revenue over three years.
"If there was a payment system that supported this, the country could save literally billions of dollars on just this intervention for patients with congestive heart failure," said Dr. David Abelson, Park Nicollet's chief clinical officer and president.
Copyright 2009 AP News
