The frequently lauded “Mind the Gap” report identifies three basic policy strategies to eliminate disparities of “place, race, and class” that plague the Twin Cities:
• “Update ‘the basics’ by making sure education, health care, and public safety meet the needs of the region’s twenty-first century population;
• “Increase income and wealth by helping minority groups close the gap on economic measures; and
• “Operationalize regionalism by making sure that any of the programs implemented are done so on a regional scale.”
Now, some community members are taking issue with the leader of the group that commissioned the “Mind the Gap” report — Itsaca Project Chair and HealthPartners CEO Mary Brainerd. They say that HealthPartners’ recent decision to eliminate psychotherapy services in one of its inner-city clinics will force least-able clients to find new service in suburban locations and undercut the Itasca Project’s stated commitment to “updating the basics.”
“HealthPartners has made a decision to eliminate behavioral health and psychotherapy services at the University Avenue Clinic in Minneapolis,” said Kevin Kuehn, business representative for the Service Employees International Union (SEIU) Local 113, the union that represents the workers who will be laid off. “This is affecting approximately 20 to 30 percent of the workforce around there.
“HealthPartners’ main reason — and this is what they have told us — is due to cost considerations,” Kuehn continued. “They have told us that the psychotherapy services that are provided by Local 113 therapists are too expensive. They have said that the University Avenue Clinic has an exorbitant amount of overhead and is not making sufficient money and profits. HealthPartners is a nonprofit, but whatever profit they make goes back into the company. So it’s essentially a business decision.
“The patients who are being served there have been told that they can continue to go through the behavioral health clinic in St. Louis Park and Inver Grove Heights, or you can go to one of many other HealthPartners clinics that are not represented by Local 113,” said Kuehn. “And they’ve given these patients all these other options, and many of them are out in the suburbs — Woodbury, for example. They have options to go ahead and seek out their own private behavioral health provider.
“The members of Local 113, the workers, have some great concerns with this decision, as does Local 113. The concerns are that we believe that HealthPartners is doing a form of subcontracting of these psychotherapists and nurses and chemical health providers. We believe that HealthPartners is subcontracting out their work to lower paid workers with less benefits, to behavioral health services out in the outer suburbs.
“We do not agree with that.” Kuehn said. “We are fighting this through the proper channels in our collective bargaining agreement. We believe HealthPartners has violated sections of the collective bargaining agreement, including the subcontracting language.
“The members of Local 113 in the behavioral health department are concerned, because we see this as just the beginning. Certainly, HealthPartners has indicated that the employees in behavioral health are too expensive. That’s one of the major reasons for closing the University Avenue Clinic, and outsourcing their patients to other clinics. We are doing what we can to try to prevent this,” said Kuehn.
Kuehn added that the reason why this layoff is different from others that have occurred at HealthPartners in the past is that the company views the problem as one of cash flow rather than patient volume. “The University Avenue Clinic had no problem with patient volume. It was actually in excess there. Other times when HealthPartners does layoffs, it’s because patient volume doesn’t allow them to continue operations,” said Kuehn.
“And we also believe that this decision is affecting many inner-city patients who depend on that location, that accessibility through bus lines or walking distance. It is a short ride to the University Clinic where these people have been seen for years and are comfortable with this location in the inner city. Now, they’re being told that this is no longer an option. We don’t think that this is a good, sound, patient-based decision.”
But Joe Dangor, communications manager at HealthPartners, does not believe that eliminating the psychotherapy services at the clinic will have an adverse effect on inner-city residents and residents of color. “In fact,” he said, “about 11 percent of University Avenue Clinic patients are covered by Medicaid…and only 13.18 percent of the active patients at the University Avenue Clinic (seen in the last 18 months) identify themselves as persons of color.”
Rick Varco, director of communications and research at the SEIU Local 113, counters that those percentages don’t reflect the real issue.
“The lower-class population is not the same as being on Medicaid. There are lots of lower-income people who are not on Medicaid. And that’s not even the question, anyway. The question is whether the people serviced there are more likely to be on Medicaid than patients at other HealthPartners clinics. The question is also: Are the people serviced at those clinics more likely to be people of color than persons serviced at other HealthPartners clinics?
“Minnesota is a mostly White, mostly middle class, fairly well-off state, so any clinic is going to have a majority of clients in those categories. The question is: Is this clinic providing extra service for communities that really need it?” Varco said.
But Brainerd is emphatic that HealthPartners’ commitment to the central cities and to providing care to underserved populations “is strong and is, in fact, growing.” In an email message, Brainerd reported that:
“HealthPartners is the largest private employer in the City of St. Paul with more than 5,700 workers.
“Just last fall, we opened a 120,000 sq. ft. health specialty clinic in St. Paul’s Phalen corridor (east side) which created more than 100 new jobs. This is a neighborhood in the core city and a focus for neighborhood development.
“We recently broke ground on a second 124,000 sq. ft. medical facility in the Phalen corridor that will employ 340 people.
“We are specifically meeting the needs of underserved and new American populations, particularly as it relates to access and language barriers. For example:
“In 2005, we opened a new dental clinic in the Midway area of St. Paul designed to provide same-day access to underserved populations. The clinic uses a model of care developed by HealthPartners that has been adopted by the Minnesota Legislature’s Dental Advisory Committee as a best practice for caring for the underserved.
“We invested more than $5 million in language assistance services for our patients and members in 2004, with amounts increasing in 2005. We provide on-site, in-person interpretive services in all key languages spoken by patients (Cambodian, Lao, Thai, Oromo, Amharic, Spanish, French, Somali, Hmong, Vietnamese, Russian and American Sign Language). Providers also have telephone access to interpreter services for more than 150 languages.
“We provide support for underserved populations in our community and are doing our part to tackle these issues. As one example, Regions Hospital is the second largest provider of charity care in Minnesota, offering care that totals $25 million to patients without the ability to pay.”
In conclusion, Brainerd states, “I view our actions in support of core cities as very consistent with the recommendations in the Brookings [“Mind the Gap”] report.”
She and Brian Rank, medical director of the HealthPartners Medical Group, noted that seven out of 31 total psychotherapy positions at the University Avenue Clinic will be eliminated. “That’s in a total workforce of about 600 [in the entire HealthPartners system],” said Rank.
Rank added, “I think we’ve had an evolving business model. We’ve been trying to break even on the direct costs of services — that’s not even indirect costs. People have tried to step up to the plate, but we had to do something about the basic cost structure. We have very good therapists. We do need a business model that allows us to be sustainable, and we’re working toward that. If there was any way we could have done this without layoffs, we would have done it.”