Senator John Hoffman: Care Coordination legislation will give Minnesota children the best outcomes

Minnesota is moving into a new era of value-based care that includes ensuring patients receive coordinated care from hospitalization to follow-up care to long-term prevention with all steps focused on communication. This important care coordination is essential for achieving positive health outcomes and preventing hospital readmissions.

To make this happen in Minnesota, I recently introduced Care Coordination legislation designed to deliberately organize children’s care activities when they are discharged from the hospital by sharing information among all participants concerned with achieving safer and more effective patient care. My bill focuses on children with high-cost or chronic medical conditions.

If my bill becomes law, a hospital would be required to ensure a child’s primary care provider or managed care organization is notified when a child with ongoing medical problems leaves a hospital. They must have information on the date the child is discharged and have a copy of the patient’s discharge plan and aftercare needs.

The hospital must also make sure there are appropriate arrangements made for either home health care or post-hospital extended care services. This includes a detailed care plan that contains shared goals between the family and providers. It also includes an access plan so families know who to contact if they have questions.

This important coordination has been recognized across the country as an essential service in assuring children with complex medical conditions are taken care of from the point of hospitalization until full recovery. Through Care Coordination, these children will achieve maximum health and wellness.

In 2016, Family Voices of Minnesota conducted a survey of 212 parents of children with medical complexities and asked what they wanted from health providers who care for their children. The number one issue families identified was that they wanted coordination and communication among providers.

Too many families experience fragmented care for their children because of a lack of active coordination services. My legislation will put in place a team-based approach with guidelines to ensure our children will have the best care possible. Care Coordination results in better care for the patient — by all parties communicating and working together. Better, more efficient record keeping along with systems that allow information to flow freely will allow families, physicians, and patients to make more informed health decisions to get well and stay well.

To contact me with your ideas and feedback, you can reach me by phone at 651-296-4154 or by email at You can also mail letters or pay me a visit in the Minnesota Senate Building, Room 2231, right across the street from the Capitol. 

This column was first published in the Home Town Source.

Senator John Hoffman
John Hoffman represents District 36, which includes portions of Anoka and Hennepin County.

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