December 2021 HCH Newsletter
The Connection
In this newsletter:
- Director's Message
- Integrated Behavioral Health in Primary Care
- MNCARES Update
- Improving Access through Collaboration
- HCH State of the Program: Noon February 8, 2022
- Learning Days coming April 28, 2022!
- Open Enrollment: Health Care Homes and Quality
- Two New HCH Portals Coming in 2022
- Congratulations to Certified Health Care Homes
- Noteworthy
Director's Message
Happy holidays!
At the end of another year filled with many challenges, we are grateful for all our colleagues and partners. Thank you to the HCH Advisory Committee and work group members, and all the state agency and community partners who have contributed in countless ways to the HCH program and to improving health amidst many other priorities and challenges. The entire HCH team is thankful for your partnership!
A few special acknowledgements in this ever-changing environment:
- To all the health care workers, there are not enough words to thank you for all you have done for Minnesotans and the HCH program. Please know you are valued!
- Congratulations and happy 50th anniversary to our health improvement colleagues at Stratis Health. We wish you continued success!
- Best wishes and thank you to ICSI (Institute for Clinical Systems) who will be closing their doors at the end of the year. We will miss our collaboration and partnership!
- Best wishes to Deb Krause and members of the Minnesota Health Leadership Council (in affiliation with the National Alliance of Healthcare Purchaser Coalitions) as their work ends after 15 years. HCH is appreciative of being included in this important valuable work!
Wishing you happiness and health in 2022.
~ Bonnie
Integrated Behavioral Health in Primary Care
Last month, the Institute for Clinical Systems Improvement (ICSI) released a groundbreaking paper, Behavioral Health Integration in Minnesota: Recommended Actions, stating that “Mental health leaders, medical leaders, and employers from across Minnesota resoundingly express that integrated behavioral health care in primary care, specifically the Collaborative Care Model (CoCM), is a solution that must be expanded.”
The paper is noteworthy for several reasons:
- Breadth of Contributors. The recommendations were carefully crafted by a multistakeholder group that united individuals and organizations with unique expertise and diverse perspectives. They worked together deliberately and consistently throughout 2021, and all contributors are listed in the paper.
- Relevance in this Time of Crisis. As the paper notes, “Integrated behavioral health is an addition to the continuum of mental health and substance use disorder (SUD) care. Embedded in primary care, it reaches a broad population: Adults, children and families, urban and rural communities, people of varied ethnicities, socio-economic means and insurance types. Integrated behavioral health care normalizes mental health and addiction, meets people’s needs before they are in crisis and require more intensive and expensive services, and facilitates transitions to specialty level care when needed. Importantly, integrated behavioral health also optimizes the mental health workforce, maximizing a severe shortage of psychiatrists and therapists to better meet a steadily increasing demand for services.”
- Consensus on a Specific Solution, the Collaborative Care Model. Supported by 80+ randomized clinical trials, the Collaborative Care Model has overwhelming evidence of better patient outcomes, along with improved patient and provider satisfaction and potential cost savings. Yet, the paper notes, “Simply put, the Collaborative Care Model is systemically underutilized in Minnesota despite having the greatest amount of literature on value (cost, quality, and satisfaction) nationwide, as well as widespread support from experts nationally and here in Minnesota.” The paper references and links readers to the unequivocal evidence supporting the model.
- Clear Call to Action. The paper identifies specific considerations for CEOs and senior leaders at healthcare organizations as well as collective action for Minnesota communities. The ICSI Recommended Actions conclude, “With the undeniable need and overwhelming evidence, it’s time for Minnesota to further support and advance the Collaborative Care Model. Focused action will ensure the Collaborative Care Model can reach its potential in optimizing the mental health workforce and improving outcomes for our patients, friends, and family.”
The paper is unprecedented in its credibility, clarity, and urgency.
In these challenging times, Health Care Homes are on the frontlines of patient care in Minnesota and will play an important role in advancing the Recommended Actions. For further information, please review Behavioral Health Integration in Minnesota: Recommended Actions, published by ICSI.
The HCH program thanks Deb Krause, Minnesota Health Leadership Council, for her work on this article.
MNCARES Update
The purpose of MNCARES (Minnesota Care Coordination Effectiveness Study) is to compare two approaches to care coordination for patients with high health care costs and multiple morbidities. The goal is to learn what approaches to care coordination in primary care settings produce the best care quality, utilization, and patient-centered outcomes.
Forty-three HCH organizations are participating in the study, twenty-two using a medical model of care coordination, nineteen using a medical/social model of care coordination and two organizations using both a medical and medica/social model within their organization. To view an updated definition of the care coordination models, the type of services provided by both models and early findings of the similarities and differences please go to: Health Care Homes - Minnesota Care Coordination Effectiveness Study in the “MNCARES Update” section to view a recent presentation provided to the HCH Advisory Committee.
On behalf of the MNCARES partners, we greatly value and appreciate your participation in this study and look forward to continuing our work with you.
Please email HCH with questions at Health.HealthCareHomes@state.mn.us .
Improving Access through Collaboration
Owatonna has significant populations of Latino immigrants (2x state average) and Somali refugees, as well as large migrant labor camps in the summers. When uninsured patients in Owatonna needed care, 70% went to the emergency room, 60% went without care, and 25% went to a community clinic outside of Steele County. Driven by their shared missions to expand access to medical care to their communities, the Free Clinic of Steele County, based in Owatonna and HealthFinders Collaborative, based in Rice County merged to serve approximately 20,000 underserved individuals in the new combined service area.
“The model of care is based on local community engagement,” said Daisey Sanchez, Director of HealthFinders’ Operations, “and this will continue to be central to our work in the Owatonna and Faribault communities. We are committed to hiring local staff and engaging the local community.” Both HealthFinders Collaborative and the Free Clinic of Steele County leverage volunteer providers, such as nurse practitioners, dentists, and physicians, to offer services to patients who otherwise would not have access. Regardless of insurance coverage or language spoken, the community-based clinics provide essential education, advocacy, and access to high-quality care. Together, patients and partners across the region will have access to HealthFinders coordinated model of clinical care, wellness programs, and community engagement.
The merged organization under HealthFinders leadership has already had impacts on the Owatonna and Steele County communities. Two patient examples of the benefits of the collaborative relationship follow:
- An urgent cardiology referral from a volunteer internal medicine doctor at the Owatonna HealthFinders location was made by the care coordinator. The patient’s referral was reviewed thoroughly and found the patient was uninsured. A patient advocate was brought in to help educate the patient on his options and help the family apply for financial assistance. After an appointment with the advocate, a few days were given to the family to make an informed decision on their next steps in respect of patient autonomy and self-determination. A follow-up call was made a few days later to see how the patient wanted to proceed with referral after having time to consult with his family; it was decided the patient would move forward with the financial assistance application. The care coordinator then helped with the rapid scheduling of a specialist consult to help connect the patient with the help he needed. The patient was grateful for all the help he received in his own language by the care coordinator, patient advocate, and the interpreter who worked with the provider directly.
- A previous Free-Clinic patient was connected to a patient advocate to help her with outstanding bills at a local health system. This patient was under a lot of stress from her financial issues and asked for help while at a medical condition visit. Free Clinic staff connected the patient to the HealthFinders care coordinator who assisted the patient with an advocacy appointment to help her apply to financial assistance programs for multiple bills allowing for chronic disease and social determinants of health management.
The HCH program thanks Charlie Mandile and Daisey Sanchez, HealthFinders Collaborative, for their work on this article.
HCH State of the Program: Noon February 8, 2022
Feeling out of touch or new to the program? Plan to attend HCH’s State of the Program, where we'll cover how the HCH program and clinics are adapting to certification and recertification during COVID-19, and review some of the resources and services that can help you through these challenging times. Mark your calendars now and watch for your invitation in December.
Learning Days coming April 28, 2022!
Plan now to attend Learning Days, a daylong virtual conference on April 28, 2022. Planning is underway for this annual event where health care home clinics and partners come together to network and learn from each other. We’re excited to once again be working with Showcore, our virtual meeting partner for the 2021 event.
Content for Learning Days 2022 will be designed to help participants:
- Revisit population health and health equity
- Redesign care delivery to address social determinants of health and strengthen partnerships with community resources
- Recognize the impact of stress and trauma brought on by COVID pandemic
- Rebuild relationships with community
The curriculum will include a full day of breakout sessions and workshops, as well as inspiration and resources for self-care in these challenging times. Health care home clinics and community partners will be invited to submit proposals to share their knowledge, skills and experience. The request for proposals will go out in early December 2021 and registration will open in March 2022. Stay tuned for more information in the coming months!
Stay up to date on these and other HCH Learning opportunities by subscribing to the LEARN Bulletin.
Open Enrollment: Health Care Homes and Quality
The State Employee Group Insurance Program (SEGIP) now recognizes Health Care Homes (HCH) certification during the open enrollment period for state employees. Primary care clinics that are certified health care homes are identified as such on the SEGIP list of primary care clinics that state employees can choose from during the annual renewal of insurance benefits. SEGIP has determined that HCH certification is an indicator of quality when it comes to the delivery of primary care and have incorporated certification as one of the factors influencing the cost level assigned to primary clinics in their network.
Two New HCH Portals Coming in 2022
The Health Care Homes (HCH) program is excited to announce that two new HCH Portals are coming in 2022!
An enhanced HCH Benchmarking Tool will be unveiled in 2022. Included is the option for clinics to compare their performance with “peer groups” comprised of similar clinics, as well as viewing multi-year trends. Further enhancements include risk adjusted rates in the benchmarking reports, allowing for a more equitable process that considers differences among patient populations. More information will be coming soon!
Additionally, a new certification/recertification online portal will debut in the first half of 2022! The new system includes a streamlined application process for certification and recertification, emphasizing enhanced user friendliness and reduced clinic burden.
Stay tuned for more details in the New Year.
Congratulations to Certified Health Care Homes
Clinics recertifying October - December 2021 are listed below. Congratulations to these and other certified clinics working every day to provide better health and better care at lower cost!
Recertification
- Children's Hospital and Clinics of MN (2 clinics)
- NorthPoint Health & Wellness (1 clinic)
- RiverView Health (3 clinics)
Noteworthy
- Congratulations to Children’s Minnesota! Previously a recipient of an MDH HCH Innovation Award in 2019, The Community Connect program at Children’s Minnesota was recently selected as a Top Finalist for the inaugural Bernard J. Tyson National Award for Excellence in Pursuit of Healthcare Equity by The Joint Commission and Kaiser Permanente. Children’s Minnesota is one of five organizations recognized as a Top Finalist and the only one in Minnesota.
- Minnesota Help Me Connect is a navigator that helps clinicians connect pregnant and parenting families with young children (birth-age 8) across the state of Minnesota with services in their local communities, especially those experiencing racial, economic and geographic disparities. Email HelpMeConnect@state.mn.us for more information/with questions.
- The National Center for Complex Health & Social Needs website highlights a new Building the Value Case for Complex Care Toolkit. The Complex Care Startup Toolkit was designed to be a simple and accessible asset for starting and growing your own complex care program.
- The Surgeon General's Community Toolkit for Addressing Health Misinformation provides specific guidance and resources for health care providers, educators, librarians, faith leaders, and trusted community members to understand, identify, and stop the spread of health misinformation in their communities. View two of their infographics: “Talk to Your Community About Health Misinformation” and “Health Misinformation Checklist”.