1. People.Care.Respect Jennifer DeCubellis
Hennepin Health
People.Care.Respect
Jennifer DeCubellis

2. A social disparities approach to healthcare reform
Imagine being worried about where you were going to sleep tonight and how you were going to get your next meal …..
checking your blood pressure and medication compliance fail in comparison to… a life in crisis.
For our lowest income Medicaid recipients this is often the failure of healthcare
Imagine 6 hospitalizations in the past year for unstable diabetes….being labeled “noncompliant”-
If providers only knew that you did not have a refrigerator to keep your insulin safe, the “system” might be able to help-
for less than $500, we could avert a >$12,000 hospital stay.

3. Economy and Revenue Down
The Crisis
Depressed economy + Increased demand for safety net services +Decreased revenues =System Crisis
Economy and Revenue Down
-$$
Service Demand up +$$

4. Focused Problem Problem: High need population Crisis driven care
System fragmentation
Need:
Address social disparities
Improve patient outcomes
Increase system efficiencies

5. What is Hennepin Health?
Minnesota Department of Human Services (DHS) & Hennepin County
Collaborative for Healthcare Innovation
Hennepin County Partners-
Hennepin County Medical Center (HCMC)
NorthPoint Health & Wellness
Human Services and Public Health Dept (HSPHD)
Metropolitan Health Plan (MHP)

6. Premise
Need to meet individuals basic needs before you can impact health
Social disparities often result in poor health management and costly revolving door care
By coordinating systems and services, we can improve health outcomes and reduce costs

7. Population Served
MA expansion in Hennepin County (previous GAMC population)
21-64 year old Adults, without dependent children in the home
At or below 75% federal poverty level ($677/mo for one person)
Targeting ~10,000 members/mo

8. Population Characteristics
~68% Minority status
~45% Chemical Use
~42% Mental health needs
~30% Chronic Pain Mgmt
~32% Unstable housing
~30% 1+ Chronic diseases

9. Objectives Improve quality of life and patient experience
Improve quality of care
Improve provider/staff experience
Reduce costs (County, State, and Federal)
Reduces health/social disparities
Is sustainable/replicable

10. Core Elements Patient-centered care Health care home model
Integration of providers across systems
One core patient record
Primary care partnered with behavioral health and social services
Value vs. volume driven system
Patient
Health Plan
Clinic
Hospital System
Social Service

11. Implementation Live-January 1, 2012 4800 Enrollees 13 clinics
April 2012
Aug 2012
Live-January 1, 2012
4800 Enrollees
13 clinics
~20% of build completed

12. Goals- Yr 1 & 2 Decrease admissions by >10%
Reduce ED visits by >10%
Increase primary care “touches” by ~5%

13. Finance model Partners share risk/gains Tiering approach
Total
Cost of Care
Acute Care
Social services
100% at risk contract
Partners share risk/gains
Tiering approach
fee for service pmpm
with outcome contracts

14. Phase 2 Initiate once primary build complete and outcomes realized
1st
Business model vs. Care model
2nd
Expand to Indigent Care
3rd
Expand to Dual Eligible's

15. Run Charts

16. Early lessons learned Care Enhancements Engagement/Contacts
Dental in ED
Pharmacy Consults
Pharmacists are on our care teams, adding back valuable physician time while ……
Reducing medications often >50%, reducing side effects, increasing patient satisfaction, and increasing medication adherence.

17. Early lessons learned System Enhancements
Health plan outreach, in care system
In reach –corrections, shelters
Nurse line at the hospital
Continuum of care links

18. Sample- Initiatives Going Forward
Health Care for the Homeless
Prescription delivery
Housing
Set aside units
MH/CD
Community partners on site
With 32% of our population in “unstable housing”- healthcare at area shelters is critical to ensure patient access.
Medication delivery to shelters is being tested to improve adherence and reduce transportation barriers, which may further reduce ambulance runs to the ER
Average hospital lengths of stays are often doubled due to placement challenges for persons with behavioral needs, brain injuries, forensic history to name a few-though typical insurance plans do not cover housing supports, Hennepin Health strives to demonstrate that housing assistance for a subset of high need individuals, is a more cost effective model than repeat hospitalizations. (infection mgmt, diabetes, etc)
Housing supports help place individuals and keep them housed and out of hospitals and ER’s

19. Future Initiatives to consider
Virtual visits
Home or site specific monitoring
Peer driven education and activation
Alternative contacts ( /text command centers)

20. Hennepin Health Bringing systems & people together
Video and more information:
As a safety net provider, Hennepin County is excited to be a part of health care reform- this is a great opportunity for innovations-
to reduce costs, and improve outcomes for our patients and our communities!
Hennepin Health is one step in the right direction, and exciting time, for creative changes with positive patient and system impacts.
Thank you!