Four hundred of the poorest adults in our community – those for whom the state picks up the medical bills – were hospitalized 10 times or more at Hennepin County Medical Center last year.
It is for them and for 9,100 other needy, medically vulnerable people who hospital staff expect on their doorstep that HCMC this week kicked off its own version of the new hospital-based care approach being provided under the state’s revised General Assistance Medical Care (GAMC) program.
The state program’s goal: to keep more patients healthier, thus reducing costly emergency room visits and hospitalizations.
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“For this population, there is nothing similar anywhere”‘ on at least two counts, said Lynn Blewett, director of the State Health Access Data Assistance Center, a research facility at the University of Minnesota dealing with health care access and coverage.
Coordinated-care approach considered unique
This coordinated-care delivery system with preventative services being tried in Minnesota is unique in the country, Blewett said, both for its “medical home” approach, and for the reality that hospitals will be trying to provide the service with “insufficient funds.”
So far, only four hospitals have signed on to the new approach in caring for the state’s population of about 35,000 uninsured, very low-income, single adults.
In addition to HCMC in Minneapolis, the others are Regions Hospital in St. Paul, University of Minnesota Medical Center Fairview in Minneapolis and North Memorial Medical Center in Robbinsdale. Those health care providers, too, are devising their own systems of delivering the best possible health care for fewer taxpayer dollars. In addition, other hospitals around the state can provide more fragmented care and be paid through an uncompensated care pool.
Some years from now, this group of individuals will be 100 percent eligible for federal Medicaid coverage under the health reform bill, Blewett said. Gov. Tim Pawlenty has chosen to opt out of available federal funding to bridge coverage until then.
HCMC state’s busiest ‘safety-net’ hospital
At HCMC, Minnesota’s busiest so-called “safety-net” hospital for the destitute and uninsured, the new care approach features personal care teams, intense medical monitoring and even house calls to shelters for the homeless.
The idea, says Dr. Mark Linzer, HCMC’s division director of general internal medicine, is straightforward, though the program is multilayered.
Dr. Mark Linzer
“With this population, we have to stay ahead of the curve. We have to do everything we can to try to keep them well,” said Linzer. “We hope we can invest in this and still have enough money to succeed. But if we do this right, everybody is going to want this,” he said.
Hospital planners have been scrambling over the past couple of months to get their delivery systems in place since state policymakers acted to change the program only last spring.
The challenges are many, including getting patients enrolled. Fifty percent to 70 percent of them will be new to HCMC, arriving without health-care or prescription records, many needing immediate care or prescription refills.
Over the past six or seven weeks, HCMC has taken on 3,000 indigent patients with a capacity to handle 9,500. Many are transient and accustomed to getting their medical care in expensive emergency-room settings rather than clinics or doctors’ offices, Linzer said.
These patients’ problems are broad and serious. Many have chronic pain, psychiatric illnesses, chemical dependency problems or all three, Linzer said. Others have diabetes, asthma, heart problems or kidney disease.
The program is – and isn’t – groundbreaking, said Michael Harristhal, HCMC’s vice president of public policy. The institution has had other, smaller programs hinged on care coordination and the team approach. But what’s different here is the sheer numbers of patients to be managed in this way.
HCMC will receive 30 to 35 percent of the $71 million pot of money the state has set aside for the program, unless other hospitals join the coordinated-care delivery system approach. In that case, the state-allocated money will be divided among all participants, Harristhal said.
With the state’s program, there is “at least minimal, at least some access to health care, either through the four CCDS participating hospitals or through the uncompensated care fund available to the other hospitals in the state,” Harristhal said. (More details on programs here.)
Patient registry, population management
HCMC’s approach focuses on developing a patient registry and on population management, Linzer said.
The registry will group patients with similar medical problems for specialized care from medical teams composed of a nursing care manager, nurse practitioners, physician assistant and/or a physician and so-called patient navigators to guide patients through the system.
Further, patients will be assessed on their care needs in three tiers, with the top group, those with frequent hospitalizations and ER visits, receiving “intensely close care management,” Linzer said.
“If we can decrease that (group) by 30 percent, it will be a huge improvement in their health and huge savings,” he said.
A state budget deficit led to funding cuts and changes in this state health care program last spring.
Blewett says the rush to establish this coordinated care system left little time to consider other options, such as where this population’s medical home should be, at a hospital or in a community-based center or clinic closer to a patient’s home.
“We haven’t really thought what’s the best way to provide care for this population,” she said.
HCMC’s program will require new hires. Grant money is also being sought.
Along the way, the HCMC program is being analyzed for cost effectiveness and patient outcomes.