Hennepin Health: A Safety-Net Accountable Care Organization For The Expanded Medicaid Population

Sandberg SF, Erikson C, Owen R, Vickery KD, Shimotsu ST, Linzer M, Garrett NA, Johnsrud KA, Soderlund DM, DeCubellis J
Source: Health Affairs
Publication Year: 2014
Patient Need Addressed: Behavioral health, Care Coordination/Management, Chronic Conditions, Homelessness/housing
Population Focus: Complex care, Medicaid beneficiaries
Intervention Type: Partnership, Service redesign, Staff design and care management
Type of Literature: White

healthcare payment and delivery models that challenge providers to be accountable for outcomes have fueled interest in community-level partnerships that address the behavioral, social, and economic determinants of health. We describe how Hennepin Health–a county-based safety-net accountable care organization in Minnesota–has forged such a partnership to redesign the healthcare workforce and improve the coordination of the physical, behavioral, social, and economic dimensions of care for an expanded community of Medicaid beneficiaries. Early outcomes suggest that the program has had an impact in shifting care from hospitals to outpatient settings. For example, emergency department visits decreased 9.1 % between 2012 and 2013, while outpatient visits increased 3.3 %. An increasing %age of patients have received diabetes, vascular, and asthma care at optimal levels. At the same time, Hennepin Health has realized savings and reinvested them in future improvements. Hennepin Health offers lessons for counties, states, and public hospitals grappling with the problem of how to make the best use of public funds in serving expanded Medicaid populations and other communities with high needs.

Insights Results

Overview of model/article

  • Hennepin Health, a Medicaid demonstration project, was created in 2011 through a partnership between the county human services and public health department, county medical center, a trauma center, and a hospital and health system, a FQHC, and a nonprofit health plan (Metropolitan Health Plan). Combined, the organizations integrate delivery of medical, behavioral, and social services for an expanded population of Medicaid beneficiaries. Though all organizations were previously affiliates of the Hennepin County government, prior to the demonstration, they operated in siloes
  • The objective of the demonstration is to reduce use of ED through increased use of preventive care; preliminary findings show the program has shifted care from the hospital to the outpatient setting and is improving the quality of care for patients with chronic conditions
  • Individuals living in Hennepin county that are newly eligible for Medicaid (under the ACA expansion) are eligible for the program
  • Hennepin Health ACO assumes full risk for the Medicaid expansion patients enrolled. The plan receives a per month, per member (PMPM) from the state to cover all Medicaid services; providers are reimbursed FFS and the plan contracts with additional providers to address all service needs. Social services are provided by human service funds from preexisting state and county sources and are supplemented by the PMPM. Social service expenses are tracked. The initial investment to initiate the ACO was $1.6 million to expand staffing and data capabilities. At the end of each year, any outstanding PMPM funds are shared with each partner due to a prearranged gain sharing formula
  • The model is anchored in interdisciplinary care teams that are located in primary care clinics and consist of nurse care coordinators, social workers, CHWs. Based on identified member needs, services such as housing or vocational support are also made available
  • Hennepin Health stratifies patients by risk (low, intermediate, and high) and tailors interventions to those needs. Intermediate-need patients may receive chronic disease management support and enhanced care coordination; high need patients are eligible for a referral to transfer their care to a unique multidisciplinary care team based at the county medical center
  • As of September 2014, there were 6054 people enrolled (25% of all county Medicaid expansion beneficiaries); of the 4884 who sought medical care in the initial 18 month period of the demonstration, 90% had a diagnosis of mental illness and 60% had a major psychiatric diagnosis

    Key takeaways/implications

    • The model is yielding savings; Hennepin County has reinvested funds from previous years to provide additional training, hire staff, and further overall strategy
    • Between 2012 – 2014, 2228 were verbally administered a lifestyle survey to document enrollee needs. 65% reported lack of social support, 43% reported housing needs, 24% reported drug or alcohol use. Other social needs, such as transportation or house, were reported with less frequency
    • Preliminary observational data found a decrease in ED visits of 9.1% and a corresponding increase in outpatient visits of 3.3%. Hospitalizations have remained stable
    • Quality of care is improving . The percentage of patients receiving optimal diabetes care increased from 8.6% to 10%. The percentage of patients receiving optimal vascular care increased from 25% to 36.1%. And the percentage of patients receiving optimal asthma care increased from 10.6% to 13.8%. Hennepin Health has also achieved a high patient satisfaction rating: 87% of members report that they are satisfied with their care