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Winter 2010 Quarterly Newsletter


									Winter 2010 Quarterly Newsletter


             Director's Column
             Partner Focus
             Community Focus
             Special Feature                WINTER

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     Email Mary Ann Radigan at
     or call 651-201-3855 with

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                                             DIRECTOR'S COLUMN


                                             “When the fire siren wails, two dozen of my neighbors and I act as one, on
                                             behalf of the community....”

                                             This quote, from Population:485 author and EMT Michael Perry, captures the
                                             values that support the social web and safety net that maintains our well-being
                                             from rural townships to urban neighborhoods. Perry’s engaging book recounts
                                             his move home to small town Wisconsin, where he joins the volunteer fire and
                                             rescue squad and reconnects both socially and spiritually by responding with his
     Mark Schoenbaum                         comrades to the emergencies of neighbors and even family. Perry threads the
                                             humor and absurdity of daily life with his fire and rescue stories to paint the
                                             connections that hold his community together in both danger and celebration.[2/8/2011 2:14:24 PM]
Winter 2010 Quarterly Newsletter

                                             Policymakers, planners and other leaders are getting smarter about building this
                                             wisdom about roots and community connections into our evolving health care
                                             system. There’s an article in this issue of the Quarterly about the latest
                                             development in Minnesota’s growing health care homes program, which
                                             originated in the 2008 state health reform law. Health care homes intentionally
                                             build in ongoing interactions with their patients. In both name and execution,
                                             health care homes include the steady link between people that we find in our
                                             other community institutions. Research is starting to show that health care
                                             homes achieve improved access, better outcomes and lower costs. In other
                                             words, staying more closely connected to patients is effective health care

                                             Community health workers are another growing field that shows the value of
                                             these principles. Employed by dozens of health and human service
                                             organizations, community health workers come from the communities they
                                             serve. They navigate, advocate and bridge the gap between the health care
                                             system and underserved communities.

                                             These themes are coming full circle with the arrival on the scene of a new role
                                             called the community paramedic, an approach that combines the health care
                                             skills of our paramedics with their knowledge and commitment to their
                                             communities. As one of the earliest community-based health care professions,
                                             emergency medical staff have great potential to contribute to filling in some of
                                             the health services gaps in our communities. Community paramedics have
                                             demonstrated their value in other countries and states, and a first class of
                                             community paramedics has been trained in Minnesota.

                                             Michael Perry describes his small town fire squad’s response as “my people
                                             acting on behalf of our people.” With a growing recognition of the importance of
                                             community in redesigning our health system, we have one more reason to be
                                             hopeful we’ll achieve the system transformation we’re seeking.

                                             As always, please let us know how we at the Office of Rural Health and Primary
                                             Care can help you sustain and improve health care in your community.

                                             Mark Schoenbaum is director of the Office of Rural Health and Primary Care and can be
                                             reached at or 651-201-3859.

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                                             PARTNER FOCUS

                                             EXPLORING CAREERS IN SCRUBS CAMPS

                                             by Heather Orfe, HealthForce Minnesota

                                             HealthForce Minnesota is using innovative camps to build interest in health care
                                             as the current workforce retires and the need for health care specialists and
     Scrubs Camp shows us what               skilled workers in rural communities increases.
     we will encounter while working
     in health care.                         Charting a Future Through Scrubs Camp[2/8/2011 2:14:24 PM]
Winter 2010 Quarterly Newsletter

                                             Since 2008, high school students from
                                             throughout the state have come together for                     HealthForce Minnesota

                                             “Scrub Camp” at Winona State University to                      interviewed Bryce Kloeck and

                                             explore college and a future in health care.                    Malia Wittman about Scrubs

                                             Students entering grades nine through 12                        Camp.

                                             engage in hands-on sessions, tour medical
                                                                                                             Bryce Kloeck is a student at Sibley
                                             facilities, and network with health care
                                                                                                             East Senior High School in
                                             professionals and fellow students. They
                                                                                                             Arlington, Minnesota. He has
                                             examine careers in dentistry, nursing, public
                                                                                                             attended Scrubs Camp for the past
                                             health, emergency medical services, wilderness
                                                                                                             two summers.
                                             medicine, laboratory science, athletic training
                                             and many others.                                                Q: What were some Scrubs Camp
                                                                                                             A: The surgical team from Winona
                                                                                                             Health came to camp and taught us
                                                                                                             about all the different jobs needed
                                                                                                             to run an operating room. The best
                                                                                                             part though was when they put us in
                                                                                                             full surgical scrubs: masks, gowns,
                                                                                                             gloves, hats and booties. Another
                                                                                                             memorable experience was our trip
                                                                                                             to Whitewater State Park to learn
                                                                                                             from Native American herbalist Paul
                                                                                                             Red Elk.
                                              l to r: Amanda Driesch, Stephanie Josselyn, Mathew Cochrane,
                                                                                                             Q: Why did you choose to attend
                                              Robby Williams, Bryce Kloeckl
                                                                                                             Scrubs Camp?

                                             Programming for Scrubs Camp changes every                       A: My experiences at Scrubs Camp

                                             year. At Scrubs Camp 2010, public health was                    were great. I want to go into the

                                             the focus. Nathan Kendrick, a state laboratory                  medical field, but before attending

                                             training coordinator for the Public Health                      was unsure of what exactly I’d like

                                             Laboratory Division of the Minnesota                            to pursue as a career. Now it’s a

                                             Department of Health, offered his energetic                     toss up between neurosurgery and

                                             personality and content expertise to Scrubs                     otolaryngology, neither of which I

                                             Camp students. Students learned what public                     was considering before attending

                                             health laboratorians do when concerns like                      camp.

                                             influenza and biological and chemical terrorism                 Q: Do you recommend Scrubs
                                             threats arise. While learning about                             Camp?
                                             epidemiology, students conducted a simulated                    A: I highly recommend it to any
                                             foodborne disease outbreak investigation                        student thinking about pursuing a
                                             focusing on the importance of critical thinking.                career in health care; not only
                                             Students also performed dipstick urine analysis;                because it’s a great experience, but
                                             observed how blood glucose levels are tested;                   also because we learned a lot while
                                             and conducted simulated blood gas, chemistry,                   having fun and meeting new people
                                             hematology and coagulation testing.                             who have similar interests. Scrubs
                                                                                                             Camp does a good job of showing
                                                                                                             us what we will encounter while
                                                                                                             working in health care.

                                                                                                             Q: What was your experience like at
                                                                                                             Scrubs Camp?
                                                                                                             A: I had a great time. There were
                                                                                                             always activities planned for us. I
                                                                                                             enjoyed meeting new people, seeing[2/8/2011 2:14:24 PM]
Winter 2010 Quarterly Newsletter

                                                                                                         cadavers and visiting so many new
                                                                                                         places I would have never gone if it
                                                                                                         were not for camp. I left camp with
                                              Malia Wittman studied wilderness medicine at Scrubs Camp   such an insight into the medical
                                                                                                         field. I also enjoyed getting to
                                             Students immerse themselves in the world of                 experience a college setting and all
                                             medicine at camp, but to add to their practical             of the hands-on activities.
                                             knowledge, they also live on a college campus.
                                                                                                         Malia Wittman, now a first-year
                                             Experiencing college life is especially important
                                                                                                         student at St. Cloud State University
                                             for first-generation college bound students and
                                                                                                         from Andover, attended Scrubs
                                             for those unsure about attending college.
                                                                                                         Camp 2010 after being awarded a
                                             Broadening Interests for all Ages                           scholarship from HealthForce
                                                                                                         Minnesota at the spring leadership
                                             Scrubs Camp has sparked interest beyond high                conference of the Health
                                             school students. To accommodate the                         Occupations Students of America
                                             enthusiasm of middle school students,                       (HOSA)—the health science student
                                             HealthForce Minnesota offers Health Career                  organization.
                                             Day Camps in Mankato and Rochester. The
                                                                                                         Q: Do you think other students
                                             Career Day Camps reinforce the importance of
                                                                                                         would enjoy Scrubs Camp?
                                             math and science and jump-start thoughts
                                                                                                         A: Anyone thinking about a career in
                                             about career possibilities.
                                                                                                         the medical field would really have a
                                             Adult Scrubs Camp introduces unemployed,                    great time and learn a lot, too.
                                             underemployed and dislocated workers to                     Attending camp let me see that
                                             careers in demand. In 2010, Adult Scrubs                    there are so many opportunities out
                                             Camps were held in Pipestone, Rochester and                 there, you just have to have an
                                             St. Cloud.                                                  open mind and be willing to explore
                                                                                                         them. Scrubs Camp helped me
                                             Reaching out Around the State                               figure out what I wanted to do with
                                                                                                         my life. I think it can do the same for
                                             The 2011 WSU Scrubs Camp is June 26-July 1.                 anyone who attends.
                                             Space is limited so early registration is advised.
                                             Scholarships are available, but limited; those              Q: How did attending Scrubs Camp
                                             interested in sponsoring a student can contact              help you to determine your future?
                                             the Rochester office at 507-280-5034 or Sonya               A: Coming into camp, I intended to
                                             McNamara, sciences career and technical                     pursue a nursing major. Now I have
                                             education coordinator, at                                   changed my major and plan on
                                                                          transferring to the University of
                                                                                                         Minnesota for the dental hygiene
                                             Scrubs Camp is designed to be replicated in         program.
                                             other communities across the state. To host a
                                             camp in your community, contact Jane Foote,
                                             HealthForce Minnesota executive director, at And if you are
                                             a health care professional interested in sharing your passion for your career at a
                                             Scrubs Camp, contact the Rochester office at 507-280-5034.[2/8/2011 2:14:24 PM]
Winter 2010 Quarterly Newsletter

                                             Complete information is online at

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                                               COMMUNITY FOCUS

                                               MINNESOTA TO TRAIN OVER 500 HEALTH CARE IT

                                               Estimates indicate a national shortfall over the next five years of approximately
                                               51,000 health information technology workers qualified to meet the needs of
                                               hospitals and physicians moving to electronic health care systems. Four
                                               schools in Minnesota are part of a nationwide effort to ensure health care
                                               facilities and medical practices meet the requirements of the Health
                                               Information Technology for Economic and Clinical Health (HITECH) Act.
                                               Normandale Community College is part of the Midwestern Consortium Health
                                               IT Short-Term Training Program. The University of Minnesota - Twin Cities,
                                               the College of St. Scholastica, and the University of Minnesota - Crookston
                                               make up the University Partnership for Health Informatics.

                                               Midwestern Consortium Health IT Short-Term Training Program

                                               Normandale Community College is one of 17 colleges in the Midwest
                                               Consortium using a common HIT curriculum. “Our goal is to create a skilled
                                               workforce to support the adoption of EHRs, exchange of health information
                                               and the redesign of workflows within health care settings to gain quality and
                                               efficiency while protecting privacy and security,” said Sunny Ainley, director of
                                               Normandale’s Center for Applied Learning.

                                               Normandale’s program—Minnesota Health Information Technology (MnHIT)—
                                               focuses on job-specific training. MnHIT will train 300 students in one of four
                                               roles in health information technology over the next 18 months:

                                                       Clinician/practitioner consultant

                                                       EHR/application trainer

                                                       Implementation support specialist

                                                       Practice workflow and information management redesign specialist.

                                               The six-month program would normally cost students $1,650; however, federal
                                               financial assistance is covering all but $500. All courses are available online to
                                               support students who live in rural areas or who would otherwise be prevented
                                               from attending in person. The first cohort began in September and the second
                                               in January. “This program is a professional level, industry training program to
                                               prepare individuals to work successfully in the HIT environment,” said Ainley.
                                               To be eligible for this short-term program, students must have experience in
                                               information technology or information system, medical records, health
                                               information management, medical billing, a hospital business office or as a
                                               clinical practitioner. Applications will be accepted for the fall 2011 cohort
                                               through August 2011.[2/8/2011 2:14:24 PM]
Winter 2010 Quarterly Newsletter

                                               “We are continuing to support the career and employment success of our
                                               graduates with the CareerHITrac program, which includes trainings, guidance,
                                               informational interviews, referrals and on-site experiences,” said Ainley. She
                                               also noted that nearly half of current enrollees are unemployed professionals
                                               seeking new opportunities in the field of health information technology.

                                               University Partnership for Health Informatics

                                               University Partnership for Health Informatics (UP-HI), a university-based
                                               training program, was also created to educate new health professionals who
                                               can assist in the transition from paper to digital records—patients’ electronic
                                               health records, prescriptions, best treatments/therapies and more.

                                               “Our federal government is emphasizing that we need to infuse the workforce
                                               with specialists in health informatics. This is a very broad term describing the
                                               use of technology in health and health care delivery, enabling health care
                                               professionals to do a better job delivering care. HIT also addresses the capture
                                               and archival of data to better treat, diagnose and manage disease and
                                               wellness,” explained Julie Jacko, Ph.D., principal investigator and director of

                                               UP-HI programs are offered at the College of St. Scholastica in the School of
                                               Nursing and School of Health Sciences. The Health Informatics Graduate
                                               Program, the School of Nursing, the Department of Public Health and the
                                               Department of Computer Science are offering UP-HI programs at the
                                               University of Minnesota-Twin Cities. UP-HI at the University of Minnesota-
                                               Crookston includes the health informatics programs in software engineering,
                                               information technology management and applied health.

                                               A total of 237 students will be accepted over the next three years to study in
                                               one of the six areas identified by the Office of the National Coordinator as
                                               areas of workforce need:

                                                       Clinician/public health leader

                                                       Health information management and exchange specialist

                                                       Health information privacy and security specialist

                                                       Research and development scientist

                                                       Programmer and software engineer

                                                       Health information technology subspecialist.

                                               Certificates and degrees within UP-HI are a minimum of six months long and a
                                               maximum of 24 months long, and are offered online, allowing students to be
                                               recruited regionally and nationally. Many students are already working in public
                                               health or health care and are clinicians, engineers or computer scientists.
                                               Type I programs, which include certificates and the Master of Health
                                               Informatics degree, are completed in one year or less. Type II programs offer
                                               Master of Science degrees, and are completed within two years.

                                               Students who apply and are accepted as UP-HI Scholars, are eligible to
                                               receive tuition funding; some are eligible for stipend funding as well.[2/8/2011 2:14:24 PM]
Winter 2010 Quarterly Newsletter

                                               More information is available on the ORHPC website.

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                                               SPECIAL FEATURE

                                               CMS SELECTS MINNESOTA FOR MULTI-PAYER ADVANCED
                                               PRIMARY CARE PRACTICE DEMONSTRATION Including Medicare
                                               as payer for certified health care homes is a critical step for rural

                                               by Leyla Kokmen, Health Reform communications coordinator, Minnesota Department of

                                               Last fall, the Centers for Medicare and Medicaid Services selected Minnesota
                                               as one of eight states to participate in the Multi-payer Advanced Primary Care
                                               Practice (MAPCP) demonstration project. This demonstration will add Medicare
                                               to Minnesota’s existing multi-payer health care home initiative as a payer for
                                               certified health care homes.

                                               The demonstration project, which covers Medicare fee-for-service
                                               beneficiaries, is expected to begin in mid-2011 and last for three years. In
                                               order to participate in the demonstration, providers must be certified as health
                                               care homes by the Minnesota Department of Health (MDH). During the
                                               demonstration period, the state anticipates that certified health care homes will
                                               serve more than 225,000 Medicare beneficiaries. The demonstration funds will
                                               go directly from Medicare to health care homes for care coordination services.

                                               Redesigning Care Benefits Rural Seniors

                                               Minnesota’s health care homes initiative, part of the 2008 health reform law, is
                                               a redesign of primary care that emphasizes a team approach and puts the
                                               patient at the center of care. This model highlights access, communication and
                                               continuous quality improvement. It aims to improve health outcomes, the
                                               patient experience of care and, ultimately, the affordability of health care.

                                               The MAPCP demonstration is particularly important to clinics and clinicians in
                                               rural Minnesota. In some rural counties, more than 30 percent of the
                                               population is 65 or older—more than double the state average. Because
                                               seniors as a group often have higher health care usage, Medicare can often
                                               be the central driver of the health care system in rural areas.

                                               “Selecting Minnesota to participate in the Medicare demonstration is an
                                               important step toward achieving critical mass in the state's goal of transforming
                                               primary care through health care homes,” said Marie Maes-Voreis, health care
                                               homes program manager at MDH. “Having Medicare as a payer can be an
                                               important incentive for rural providers to become certified as health care

                                               As of December 2010, MDH had certified 47 health care homes, representing
                                               a broad range, both geographically and in clinic size and scope. They are in
                                               several regions of the state, include both urban and rural clinics, and range[2/8/2011 2:14:24 PM]
Winter 2010 Quarterly Newsletter

                                               from single-physician clinics to large systems. The 47 certified health care
                                               homes represent 428 clinicians. An additional 105 clinics, representing about
                                               1,270 clinicians, are working toward certification.

                                               Participating in the Demonstration

                                               All certified health care homes may participate in the MAPCP demonstration;
                                               there is not a separate application process to participate. The state’s goal is to
                                               have 150 practices participate in the demonstration in the first year, 250 in the
                                               second year, and 340 in the third year. CMS will use Minnesota's existing
                                               payment methodology for care coordination reimbursements for qualifying
                                               Medicare beneficiaries. Payment is based on the patient’s level of complexity.
                                               The billing mechanism will be the same one that certified health care homes
                                               currently use to bill for services provided to Minnesota Health Care Program

                                               "The addition of funding through Medicare makes it more feasible for primary
                                               care practices to do the work of transforming to health care homes for all of
                                               their patients, regardless of their insurance,” said Ross Owen, manager of care
                                               delivery reform at the Minnesota Department of Human Services (DHS). “It
                                               sends a common message across the market about the kind of health care we
                                               are interested in buying in Minnesota.”

                                               MDH and DHS jointly applied for the demonstration project. To develop the
                                               strongest possible application, MDH and DHS health care homes staff
                                               convened an advisory group of stakeholders with Medicare expertise to provide
                                               guidance on key strategic issues. The group of more than 25 stakeholders
                                               represented professional associations, consumer organizations, health care
                                               providers, health plans, local public health, community service organizations
                                               and higher education. The University of Minnesota School of Public Health
                                               also contracted with the state to develop a detailed analysis, which showed
                                               that the state’s participation in the demonstration project would be budget

                                               Measuring Outcomes

                                               The purpose of the demonstration is to evaluate advanced primary care
                                               practices, also known as medical homes or health care homes, and see if
                                               these multi-payer initiatives can reduce unjustified variation in utilization and
                                               expenditures (including in the Medicare program); improve the safety,
                                               effectiveness, timeliness and efficiency of health care; increase shared
                                               decision making by patients; and increase the availability and delivery of
                                               evidence-based care in historically underserved areas. Minnesota joins Maine,
                                               Michigan, New York, North Carolina, Pennsylvania, Rhode Island and Vermont
                                               in the demonstration.

                                               The demonstration requires that Minnesota participate as a collaborative
                                               partner with CMS in a comprehensive evaluation process that will focus on
                                               primary care results in improved clinical quality, better patient experience and
                                               improved affordability of health care delivery for Minnesotans.

                                               The application also served as the impetus for Minnesota to join Colorado,
                                               Maine, Massachusetts, New Hampshire, Pennsylvania, Rhode Island and
                                               Vermont to initiate a framework for a multi-state learning health system with
                                               common metrics, shared learning and rapid cycle data-guided improvement of
                                               their respective medical home models. These states plan to use common[2/8/2011 2:14:24 PM]
Winter 2010 Quarterly Newsletter

                                               measures and comparative effectiveness to guide their delivery system
                                               reforms, providing the best opportunity to evolve models that are clinically and
                                               financially effective for a successful CMS demonstration.

                                               More information is on the MDH Health Care Homes - Medicare Payment

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                                                                     VIEW ONLINE ALL PREVIOUS ISSUES OF THE OFFICE OF RURAL HEALTH AND PRIMARY CARE


                                                                                                          Minnesota Office of Rural Health and
                                                                                                          Primary Care
                                                                                                          P. O. Box 64882
                                                                                                          St. Paul, Minnesota 55164-0882
                                                                                                          Phone 651-201-3838
                                                                                                          Toll free in Minnesota 800-366-5424
                                                                                                          Fax: 651-201-3830
                                                                                                          TDD: 651-201-5797


                                                                     MISSION: To promote access to quality health care for rural and
                                                                     underserved urban Minnesotans. From our unique position within state
                                                                     government, we work as partners with communities, providers,
                                                                     policymakers and other organizations. Together, we develop innovative
                                                                     approaches and tailor our tools and resources to the diverse
                                                                                                 populations we serve[2/8/2011 2:14:24 PM]

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