How one county improved outcomes while cutting costs
Hennepin County, Minnesota, is getting better outcomes with lower expenses in a high-cost segment of its Medicaid population by being flexible and more targeted in meeting the needs of these patients.
The reason: Hennepin Health, a government-run project to improve system efficiencies between multiple public sector agencies, improve patient experience and reduce costs.
Hennepin Health and its partners have tested specific changes, such as same-day access to primary and dental care directly from the emergency department and coordinating with social services, so that low-income patients with behavioral and chemical dependence issues and multiple chronic conditions can obtain coordinated care that fits their situations.
The better outcomes seen in the program have enabled the county to stretch its healthcare dollars, said Jennifer DeCubellis, the area director of health services in the Human Services and Public Health Department for Hennepin County who leads Hennepin Health, speaking at the National Health Policy Conference Tuesday.
“We were able to change the cost curve,” DeCubellis said at the conference. “And physicians are excited.”
About 5 percent of this high-needs group was driving 64 percent of the costs. If their care could be more effectively brought into the system, she said, the county could fund preventive services for the entire population that needed coverage. “That helped us focus on where the greatest needs were,” she said. The county moved away from care “at our highest-cost, lowest-outcome venues.”
Hennepin Health gets the same money that the insurers get but manages it differently. “What we’ve done is we have to pay the basic Medicaid benefit set, but we can provide things over and above that if it makes sense to bring down their overall healthcare costs,” DeCubellis said.
The project works similar to an accountable care organization. Partners at the table share in the savings and in identifying and innovating solutions.
“That has changed the mentality of the providers from ‘how do I keep my doors open and bill for services?’ to ‘how do we get better care?’” she said.
Hospitals lose money when people who cannot easily be placed post-discharge are stuck in medical beds after the provider is no longer paying for them, she noted, and providers may not be aware of all the social services available. In Hennepin, hospitals partner with local social services to move those folks out or more quickly prioritize them.
To offset the problem of individuals falling through during the transitions of care settings, Hennepin makes sure that patients leave the hospital or emergency department with a phone number and contact person and access to primary care the same day.
As a result, the Hennepin project achieved a 50 percent hospital reduction in patients who have had three or more hospitalizations in a year.
“They were the high-cost population, and if we could bring their costs down, I freed up dollars to pay for more care coordinators,” she said.
In the first year, DeCubellis said, Hennepin Health has reduced overall admissions by 30 percent; decreased readmissions by 2 to 5 percent; decreased emergency department visits by 35 percent; and increased primary care by 23 percent.
Other system improvements included developing a data warehouse containing information from the health plan and the medical, social services, hospital and community clinics in one venue; patient radar reports; and systems simplification by putting the health plan information about patients in their electronic health record and not just in their case management systems.