Safety net clinics try a high-tech new model

The waiting room at Cedar Riverside Clinic was packed with patients and translators one recent morning and buzzing with multiple languages. To Julie Tate, waiting to see her doctor, it was a familiar sight.

"I used to go to the emergency room" for medical care, Tate said. But now, after 14 years as a patient at the Minneapolis clinic, she knows her doctor personally — and much of the staff as well.

"The people at the front desk know you," said Tate, now a member of the clinic's board of directors. "You know you can get care if you need it."

That's exactly the sort of bond that state health officials hope to build on as they embark on an experiment between community clinics like Tate's and the state of Minnesota to reform medical care for thousands of underprivileged patients.

An alliance of 10 community clinics has contracted with the state in an unusual experiment that aims to improve health care and reduce costs for nearly 22,000 people on Medical Assistance, the state's Medicaid program. The 10 clinics have banded together to form an "accountable care organization," or ACO, a medical care delivery system that rewards doctors and hospitals for controlling costs and boosting quality.

ACOs were adopted by the 2010 Affordable Care Act as a model in which hospitals and clinics link together to give patients coordinated medical care and share whatever money they manage to save. Now, more than 40 percent of Americans live in areas served by at least one ACO, according to a recent analysis by the consulting firm Oliver Wyman.

"Successful ACOs won't just siphon patients away from traditional providers," the report said. "They will change the rules of the game."

The Minnesota clinics, members of the Federally Qualified Health Center Urban Health Network, or FUHN, represent one of the first times that safety-net clinics have tried to form an ACO. Under a three-year contract with Minnesota, the clinics will keep half the money they save Medical Assistance, with half returned to the state.

While ACOs have spread steadily among conventional clinic and hospital groups, the Minnesota experiment is one of the first to apply the model to an unusually disadvantaged patient population.

A large share of patients at community clinics are poor, many are immigrants or non-English speakers, and some are homeless. They have higher rates of chronic illnesses such as asthma and diabetes than the general population, and often wind up seeking treatment at overextended, high-cost hospital emergency rooms because they lack regular preventive care.

Under the Minnesota experiment, "those at a higher risk now have a care team who works with each patient, to keep them out of the emergency room," said Peggy Metzer, CEO of People's Center Health Services.

"These clinics have very close relationships with their patients," said Jonathan Lips, an attorney at Halleland Habicht who advised the clinics during negotiations with the state. "They have an excellent ability to engage their patients, and this will put to the test the effectiveness of data-driven primary care."

Coordinated care

Cedar Riverside Clinic had 35,000 patient visits last year. More than 58 percent of its patients were non-English speakers, 94 percent live in households below the federal poverty line, and about 68 percent were Medicaid eligible, Metzer said. Like the coalition's other health centers, Metzer's clinic is federally mandated to give people care when needed and must be accessible to everyone.

"It's really a holistic approach to care," said Dr. Jaeson Fournier, chairman of FUHN and CEO of West Side Community Health Services in St. Paul.

Fournier said the project will also give the 10 clinics access to greater shared medical information to better understand how patients are being treated, the resources they use and the challenges they face.

To help chart those patterns, the clinics have partnered with Optum, an Eden Prairie-based health care services and technology company, which is providing the ACO with tools to analyze patient history and risk factors and compile performance reports for each clinic.

"This has a lot of potential to benefit patients going to the safety-net clinics," said Julie Sonier, senior research fellow at the University of Minnesota. The project should "reduce the fragmentation" of health care in Minnesota, she said.

Or as Tate put it simply: "We all do better when we're all doing better."

Jeff Hargarten is a University of Minnesota student journalist on assignment for the Star Tribune.