Group Health (today HealthPartners) pioneered prepaid, consumer-governed health care in Minnesota and has developed innovations in quality that have changed and continue to change the health care landscape in this state and across the country. That is why we believe the organization is worthy of consideration for the Minnesota Historical Society's Minnesota 150.
Pioneers in Prepaid Health Care "It was one of America's most pressing social problems. People developed minor illnesses and delayed medical care because it was too expensive. The illness eventually became serious, forcing them to be hospitalized, leading to higher medical bills. Often, families went into debt. Sometimes they never recovered. In 1937, four men - a credit union manager whose health was failing, a cowboy turned postal worker, an idealistic cooperative manager, and a lawyer committed to social causes - met to organize a prepaid health plan. But there was just one hitch - prepaid medicine was illegal in Minnesota. The group worked for almost 20 years to change the laws, finally organizing Group Health Plan (today HealthPartners) in 1957 after Attorney General Miles Lord issued an opinion supporting prepaid health plans." (Excerpt from: An Enduring Mission, The Story of Group Health, 1991, Group Health, Inc, St. Paul, MN.)
The goal of prepaid health care was to help make quality health care affordable for groups of people, including farmers, blue collar workers and their families. Unlike traditional health insurance that typically only provided coverage for hospitalization, members enrolled in prepaid plans paid a predetermined fee to receive coverage for preventive and acute care from a physician and for hospitalization.
As the only prepaid health plan in the state, Group Health Plan took a lead role in the drafting and passage of the Minnesota HMO Act of 1973. This HMO-enabling legislation created the foundation for one of the most competitive and innovative HMO/Managed Health Care markets in the country.
Pioneers in Health Care Quality Group Health was the first health care organization in Minnesota to offer an integrated health care financing and care delivery model built around a salaried medical staff with a commitment to comprehensive and coordinated health care. The plan was designed to allow families to budget in advance for medical care and encourage them to seek a physician's help when they needed it rather than as a last resort.
While the premiums Group Health charged members were equal or more expensive than traditional insurance, its coverage and benefits were typically more comprehensive, focusing on preventive care, outpatient care, immunizations and other services not covered by traditional insurance at the time. Group Health was member-owned and members elected a board of directors to oversee operations. The organization elected its first consumer board of directors from its membership in 1955. This tradition continues today and actually preceded state HMO regulations requiring health care boards of directors to have consumers as a majority of board members.
As a result of its consumer orientation, Group Health/HealthPartners has developed innovations that improve health care quality and reduce cost. Many of these innovations are now commonplace in Minnesota and some are models for the nation. Here are a few examples:
Best Practice Guidelines Best practice guidelines are tools that physicians use to aid in decision making. Best practice guidelines are based on authoritative examination of evidence-based medicine and allow groups of physicians to standardize care which improves health care outcomes and quality and lowers cost. Group Health pioneered best practice guidelines in the 1980s. In 1993, Group Health founded the Institute for Clinical Systems Improvement (ICSI), with Mayo Clinic and Park Nicollet Clinic, to serve as an independent, non-profit organization, providing evidence-based best practice guidelines to its physicians. Today, ICSI serves medical organizations representing more than 7,600 physicians across Minnesota.
Outcomes Recognition and Pay for Performance HealthPartners introduced its Outcomes Recognition and Pay for Performance programs in 1997. The Outcomes Recognition program rewards primary care clinics that achieve superior results in effectively promoting health and preventing disease. The Pay for Performance program links provider reimbursement and measurement of quality and efficiency to improved care and outcomes for HealthPartners' members. Today Medicare and other payors across the nation are using these programs to improve health care quality.
Composite Quality Measures HealthPartners began collecting and publicly reporting composite quality measures for diabetes, coronary artery disease and preventive care for its owned and contracted medical groups in 1995. Composite measures enable doctors to focus on all the components or excellent patient care, rather than individual components. For example, there are five key measures for optimal diabetes care that, when managed well, contribute to better health. Focusing physician efforts on the reliable delivery of all important components of care for many diseases leads to dramatic improvements in patient outcomes.
HealthPartners composite measures played a key role in the creation of the Mnnesota Community Measurement Project. In 2001, HealthPartners, the Minnesota Council of Health Plans and five other Minnesota health plans launched the Minnesota Community Measurement Project to create a single online source of quality information for consumers seeking information on the quality of care in Minnesota medical groups.
According to Helen Darling, president of the Washington-based National Business Group on Health, "HealthPartners groundbreaking work in composite measurement and quality innovation is rapidly being adopted across the country. Their quality innovation programs are transforming health care for providers, employers and members." (Excerpt from National Business Group on Health Honors HealthPartners with 2006 Award for Excellence and Innovation in Value Purchasing, March 16, 2006 News Release, Washington, D.C.)
While the idealism of Group Health's founders is now part of history, their ideas are as significant today as they were 50 years ago. As previous Chairs of the Group Health/HealthPartners Board of Directors we are proud to submit this nomination to the Minnesota Historical Society. Sincerely, Michael Ahern, Ray Ahrens, Alan Fletcher, Jean Jantzen, Steve Mosow, Samuel Popper, Merlyn Scroggins, Russ Tall
~Michael Ahern, Bloomington,MN