Primary Care Innova.ons in a Safety Net ACO. Kate Hust, MD, MPH Medical Director, Hennepin Health Access Clinic April 7, 2017

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1 Primary Care Innova.ons in a Safety Net ACO Kate Hust, MD, MPH Medical Director, Hennepin Health Access Clinic April 7, 2017

2 Disclosure I have no financial or non-financial conflicts of interests relevant to this presenta.on.

3 Objec.ves 1. Review the Hennepin Health ACO, its partners & its goals. 2. Describe the transi.onal primary care model of the Hennepin Health Access Clinic. 3. Review the clinical and financial impacts of the Hennepin Health Access Clinic for Hennepin Health members.

4 Welcome to Hennepin County Home to: Minneapolis & 44 other ci.es 1.2 million people Largest Somali popula.on in the US 6 large health systems, including VA 15 colleges & universi.es Longest con.nuous skyway system in the world Honeycrisp apples

5 Who do you know? Mr. O is a 50-year-old African-American man with asthma, allergies, hypertension. He is homeless, works occasional odd job helping fix cars, & drinks too much alcohol. Ms. E is a 61-year-old homeless woman who hasn t been engaged with medical care for several years & is untrus.ng of the medical profession because of past trauma. Mr. I is a 28-year-old African-American man with bipolar disorder recently discharged from inpa.ent psychiatry. He is homeless, unable to move into planned apartment because of criminal history. Mr. U is a 49-year-old homeless, Somali man frequently brought to the emergency department for altered mental status and agita.on related to alcohol intoxica.on.

6 Modifiable factors influencing health outcomes 20% Access to and Quality of Health Care 6 80% Social and Economic Factors (40%) Health Behaviors (30%) Built Environment (10%) Adapted from <h.p://

7 Objec.ves 1. Review the Hennepin Health ACO, its partners & its goals.

8 In the Beginning The HMO Non-profit, state-cer.fied County-operated Est. 1983, licensed 1995 Enrolling pa.ents in current version as ACO partner since January 2012 The ACO Building on Medicaid expansion assumes full risk for popula.on : Adults without dependents 2016 current: Children, families added (0-64)

9 Human Services Public Health

10 Community Providers Financial Model Contracted Services Northpoint $ Reinvestment State of MN $ PMPM $ FFS HCMC $ Net Henn Co Public Health $ Dividend PMPM = Per Member Per Month FFS = Fee for Service Henn Co Human Services

11 Analy.cs Model Analy.cs Opportuni.es Real-.me Rx picture Fill in clinical gaps by combining EHR and claims Model how social service use relates to health care u.liza.on

12 Care Model Highlights Shared electronic health record Support for primary care medical homes Care coordina.on staffing Ambulatory ICU models Targeted behavioral health & social service interven.ons In clinics & community-based

13 Quality of care Enrollment Primary Care Medical Home* Clinic-based Care Team Outcomes Pa.ent, provider experience and engagement U.liza.on, Total cost of care Outreach to Connect Pa.ents with Partner Clinics * Extended Care Team providing services in the community* Quality of life * Represent point of linkage to integrated behavioral health care

14 Care Innova.ons: Shelter-based Community Paramedics Total Medical Costs per 1000 Local shelter with high volume of aoer hours EMS calls $3,500,000 $3,000,000 $2,888,358 Embedded community paramedics overnight into largest $2,500,000 shelter in Minneapolis $2,000,000 $1,500,000 $1,480,448 Gained ability to address basic medical needs & decrease $1,000,000 ambulance runs to HCMC $500,000 $0 Pre-CP Interven.on Post-CP Interven.on

15 Care Innova.ons: Housing Navigator Dedicated staff work to place complex pa.ents into suppor.ve housing Decreased ED u.liza.on 36% post-housing Decreased inpa.ent admissions 16% post-housing

16 Objec.ves 1. Review the Hennepin Health ACO, its partners & its goals. 2. Describe the transi.onal primary care model of the Hennepin Health Access Clinic.

17 Hennepin Health Access Clinic Transi'onal, team-based primary care Part of Hennepin County Medical Center focused on pa.ents with Hennepin Health Established in 2014 with goals of: Decreasing emergency department u.liza.on Decreasing hospital readmission rates Increasing pa.ent engagement in primary care

18 HHA Pa.ents are likely to be. Male Non-white years old Homeless Chemically dependent Mentally ill

19 Clinic Team RN Clinical Coordinator Physician (2) Dental Services PharmD Community Health Worker Nurse Prac..oner Diabetes Educator Social Worker Clinical Psychologist Alcohol/ Drug Counselor

20 Community Team Collabora.on at weekly team mee.ngs Community Paramedics Mobile Case Management Housing Naviga.on Healthcare for the Homeless

21 Pa.ent Flow Warm Handoff Hennepin Health Dashboard HCMC Providers & Care Coordinators Community Partners Referral & invita.on Inpa.ent Engagement with HHA team Gradua.on/ Transi.on Engagement with longterm primary care clinic ED

22 Objec.ves 1. Review the Hennepin Health ACO, its partners & its goals. 2. Describe the transi.onal primary care model of the Hennepin Health Access Clinic. 3. Review the clinical and financial impacts of the Hennepin Health Access Clinic for Hennepin Health members.

23 How are we doing in clinic? HHA Clinic has tracked about 500 pa.ents. Deceased Inac.ve Graduated Pending Ac.ve

24 Changing Behavior HCMC u.liza.on for 222 of the first individuals engaged in clinic (yearly average): Pre-Engagement Post-Engagement Change (%) Medical Inpa.ent (3.5) Psychiatric Inpa.ent (68) Urgent Care (26) Medical ED (16) Psych ED (35) HHA clinic visits (yearly average): Visit Type Visit Number Care Coordina.on 3.45 Chemical Dependency 1.52 Psychology 1.48 Medical 5.87

25 What is the impact for Hennepin Health?

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27 Where are they now? Mr. O is a 50-year-old African-American man with asthma, allergies, hypertension. He is homeless, works occasional odd job helping fix cars, drinks too much alcohol. Housed & looking for work. Completed treatment for alcohol use disorder with ongoing sobriety. Improved control of asthma & allergies. ED visits decreased from 13/year to 1.5/year.

28 Where are they now? Ms. E is a 61-year-old homeless woman who hasn t been engaged with medical care for several years, is untrus.ng of the medical profession because of past trauma. Housed in own apartment. Engaged with clinic for 2 years & preparing for transi.on to long-term clinic. Has faced fears of den.st & had several cleanings, extrac.ons & will be getng dentures. Auending group therapy. Hoping to return to volunteer at homeless shelter.

29 Where are they now? Mr. I is a 28-year-old African-American man with bipolar disorder recently discharged from inpa.ent psychiatry. He is homeless, unable to move into planned apartment because of criminal history. Housed in own apartment. Completed outpa.ent intensive therapy programs (day treatment). No repeat incarcera.on.

30 Where are they now? Mr. U is a 49-year-old homeless, Somali man frequently brought to the emergency department for altered mental status and agita.on related to alcohol intoxica.on. Housed in own apartment. 50% decrease in hospitaliza.ons since engaging at clinic. 60% decrease in ED visits following housing. Engaged at clinic for medical care, addic.on support, & psychotherapy.

31 Acknowledgements For their knowledge, guidance, and slide-sharing! Ross Owen, Health Strategy Director for Hennepin County Kate Diaz Vickery, Danielle Robertshaw, & Mark Linzer with HCMC GIM Amy Harris-Overby, Popula.on Health Program Director for HCMC HHA team

32 Ques.ons?

33 Thank you!