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

Abstract

Health care 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 health care 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 percent between 2012 and 2013, while outpatient visits increased 3.3 percent. An increasing percentage 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.

Accountable Communities for Health: Moving From Providing Accountable Care to Creating Health

“…Operating under a capitated finance model administered by a countyoperated insurance plan since January 2012, Hennepin Health partners social service and public health leaders with local safety net health care providers through a risk-sharing arrangement that aligns their financial incentives in powerful ways. 13,14 In addition to sharing financial risk, the group integrates social service data with enrollee claims utilization data and electronic health records through a unique data warehouse that is shared across the 4 member organizations and used to produce ad-hoc analyses, as well as a scorecard of operational metrics that is updated monthly. Recognizing that social and behavioral needs are often key drivers of poor health, Hennepin Health also links patients with services not traditionally financed through the health care sector, such as vocational training and housing support.…”

“…Data from the enrolled cohort in Hennepin Health from 2012 to 2013 demonstrated decreased emergency department utilization (9.1%) and inpatient hospital admissions (3.0%), as well as increased rates of optimal care delivery for enrollees with diabetes, vascular disease, and asthma. 13 This program has provided needed care for less than the per-member-per-month rates, and used a portion of the cost efficiencies toward $2.4 million in reinvestment initiatives. Although these early results are encouraging, the observational nature of the data limits interpretation of causal impact, and long-term evaluation of downstream health and social outcomes, as well as utilization and costs, is currently under way.…”

Living in “Cold Spot” Communities Is Associated with Poor Health and Health Quality

“…44 Hennepin Health integrated a public health department, medical center, federally qualified health center, and health plan across payment, delivery, and data systems to better coordinate services and address SDH. 45 Although these 2 organizations transformed care at great cost, practices can make meaningful changes on smaller scales. Using this method, health systems can measure the variation in their own communities, more efficiently distribute staff and resources, and target interventions.…”

Opportunities and Accountable Care Organizations

“…One large safety net Accountable Care Organization applied to Medicaid patients in Minnesota realized financial savings through a model that reduced emergency department utilization, increased preventative visit utilization and redistribute funds. Patient satisfaction scores are high with this Medicaid ACO model, a model that has also increased patient outcomes in optimal care [8]. Replication of this system alongside incorporation of required medical student participation, education in clinical analytics and process improvement would encourage the systems culture change necessary for future model sustainability.…”