Minnesota health care program cuts costs for the poor

Ezekiel Allen's weary voice and his long list of medical challenges — schizophrenia, a back injury, bipolar condition, high blood pressure, brain polyps, dental troubles, migraine headaches — make him sound far older than his 45 years.

Homeless for a number of years, Allen didn't see a doctor regularly for far too long. When the pain of his conditions became overwhelming, the Minneapolis man would get medical care from one of the costliest venues — an emergency room.

But now that he's enrolled in Hennepin Health — a pioneering new Hennepin County and state Department of Human Services demonstration project — Allen relies on less-expensive clinic settings for his care. His conditions are also under better control, he said, because medical staff helped him organize his many medications into separate bubble packs so that he knows what and how many pills to take every day.

"That made it easier for me. I keep up with my meds now,'' said Allen, who also has reading difficulties.

For all of the talk wrought by the federal health reform debate about wringing efficiencies out of the health care system, the hard and unglamorous work of doing this in the real world is just getting underway. But thanks to Hennepin Health — a program whose first-year success helping people like Allen is now garnering national recognition — and other pilot programs, Minnesota is ahead of the curve nationally in figuring out how to deliver better but less costly care for medical assistance patients.

The work here could well become a new blueprint nationally for spending taxpayers' medical assistance dollars more effectively — a critical step forward when federal Medicaid spending stands around $400 billion a year and eligibility for the jointly run federal-state health program for the needy is expanding under the 2010 Affordable Care Act.

Credit is due not just to the Hennepin County officials and the program's hardworking staff, but also state Department of Human Services officials. Under DHS Commissioner Lucinda Jesson, this state agency has shown admirable willingness to experiment with new ways to deliver care for medical assistance patients.

Hennepin Health launched in 2012, and six other demonstration projects are underway. Another, a consortium of southwest Minnesota counties, is expected to begin early next year.

Hennepin Health's first-year results, highlighted in a report released last week by a consortium of Minnesota foundations called Beyond the Bottom Line, inspire confidence. The program serves about 6,200 adults who don't have dependent children and whose income is at or below 75 percent of federal poverty guidelines.

Hennepin Health's staff pragmatically focused on costly emergency-room use and asked a key question: Why do clients go there? Lack of awareness about other options was a common reason.

Hennepin Health staff drew upon the county's extensive social services expertise to address this. They expanded an urgent care center to help link patients with primary care doctors. Same-day access to dental care also was launched. Staff also found better ways to provide prescriptions, such as by delivering refills to homeless shelters and working with patients to better manage their meds and improve "medical literacy" about care options.

Spending for some of the program's top users of medical services dropped by as much as 95 percent. Hospitalizations and emergency-room utilization also declined by more than 20 percent. More than $1 million in savings will be plowed back into care this year to plug service gaps, particularly for patients struggling with chemical dependency or psychiatric problems. The continued reinvestment should lead to even more savings in future years.

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