The Courage to Innovate: Hennepin Health

Addiction is on the rise, and one doctor is determined to stop it. How a small grant from a health insurer gave a physician the time and help she needed to save more lives at Hennepin County Medical Center.

An epidemic of poisoning
In 2016, opioids killed 153 people in Hennepin County. That year deaths from cocaine and amphetamines rose dramatically too, and 84 county residents died after what the sheriff calls “acute alcohol intoxication.”

Those startling figures don’t even account for the many, many more Hennepin County residents killed by addiction in subtler ways: by drug-related violence, in accidents caused by people too impaired to walk or drive, by cirrhosis or hepatitis C, by despair and suicide.

Even Minnesota, nationally renowned for treatment centers and a thriving culture of recovery, addiction is killing more and more of us all the time. Many people see the epidemic of substance addiction as a moral and social crisis. But addiction might also be something much simpler — and maybe much easier to remedy.

Dr. JoAn Laes

JoAn Laes, M.D., is an addiction medicine specialist, and she was frustrated. At Hennepin County Medical Center (HCMC), where she works in the addiction medicine department, she’d see patients come into the hospital after an overdose of alcohol, opiates or some other mood-altering substance. She and her colleagues would treat the acute poisoning, then the patient would leave — usually without getting any help for the underlying addiction.

“People would show up with a drug overdose,” Dr. Laes recalls, “and there wasn’t much we could do. Maybe there was a drug and alcohol counselor available to talk to them, but probably not — there were only two counselors for our 500-bed hospital. So we basically had to give these patients lists of phone numbers for treatment options and tell them, ‘Follow up on your own.’” Needless to say, that approach didn’t work very well. “We’d see many of these patients multiple times, after multiple overdoses,” Dr. Laes says.

For an addictionologist, little could be more distressing than to watch people get poisoned, again and again, by the same deadly chemicals. Worse yet, Dr. Laes knew she could help change the course of many patients’ addiction, by writing a prescription for drugs like naltrexone or acamprosate that work by diminishing the power of addictive craving in the brain.

“These medications aren’t new, but our health system doesn’t yet use them very widely,” Dr. Laes explains. “Our counselors, who knew a lot about behavioral addiction treatment, weren’t trained to talk to patients about these other therapies. Most patients didn’t even know they had medical options.” And so the epidemic of poisoning continued.

In frustration, Dr. Laes came up with an idea: What if she and her colleagues could not only treat patients for overdoses, but also for the underlying chemical dependency? To make that more aggressive outreach work, she thought, HCMC would need more help — maybe another Licensed Drug and Alcohol Counselor (LADC), a physician assistant or nurse practitioner, maybe time to consult with other physicians. They’d definitely need to bring the LADCs they had under the umbrella of addiction medicine, so they could coordinate their work with the addiction medicine specialists and other clinical staff.

“I just want to do inpatient consultations with patients who have addictions,” she told an HCMC colleague one day. “How can I get this started?”

Well, her colleague told her, there was actually a program especially designed to get just such ideas off the ground — grants to support experiments aimed at improving the health of people in Hennepin County. Dr. Laes applied for a grant for her idea, and she got it. The work began in October 2015. Two years later, HCMC hasn’t treated addiction the same way since.

The courage to innovate
The money to fund Dr. Laes’s idea came from Hennepin Health, the county-owned health insurer that provides care for people with Medical Assistance insurance. Ross Owen, health strategy director for Hennepin County, smiles when he remembers Dr. Laes’s application for funding. “She’s a doctor who realized that people admitted to HCMC weren’t being treated for addiction,” he says. That’s a little crazy, he adds, “since the people we care for are deeply affected by addiction.” When her proposal came in, it sounded like exactly the kind of experiment Hennepin Health wanted to encourage.

Where does this money come from? “After we’ve paid for our members’ medical bills and operated our health plan, we take resources that are left over and share them with our partner organizations that work with us to care for county residents — HCMC, NorthPoint Health Center, Hennepin County,” Ross explains. “And some of that money funds what we call reinvestment initiatives. We solicit proposals for improving how we care for people. Every year, we fund a few projects, from six to ten or so. We measure the impact of those projects and bring that information back into the work we do. It’s a way for us to try new ideas, to take risks, to see what new practices might work — and to shore up infrastructure and plan for the long term to create better health for people in Hennepin County.”

“It’s intentional,” says Amy Harris-Overby, director of HCMC’s population health program. “With these grants, Hennepin Health is intentionally taking the value that’s been created in the health plan and creating public benefit by testing new ideas.” The best thing about the reinvestment grants, she says, is simple: “They give us the courage to innovate. Every project we approve has merit, and we give it a chance. Sometimes they work beautifully; other times, we have to admit they don’t, and learn from the failure.”

Amy Harris-Overby and Ross Owen

What does failure look like? Amy and Ross chuckle as they reel off a list of promising reinvestment projects that just didn’t turn out to work. Their favorite example was the time when Hennepin Health got into the business of renting apartments. “Up to half of our members don’t have housing they can count on,” Ross says, “and our teams of social workers hustle all day to help people who are sick find a safe place to stay. The idea was, why not just rent a block of apartments ourselves, so we wouldn’t have to deal with landlords?” It was a radical and brilliant idea — and testing it out showed conclusively that it didn’t work. “Instructive failure,” as Amy calls it, is actually success. By funding small, promising projects, measuring them and learning from them, Hennepin Health behaves more like a startup than like an old-fashioned HMO. They move fast, they learn each experiment, they jettison what fails and double down on demonstrated success.

“We already pay”
For a county-operated insurer like Hennepin Health, success means a measurably better life for county residents — less expensive health care, better experiences for patients, more effective medical care and prevention. But beyond the usual horizon of health care, Hennepin Health and its partners think of their work in the broadest possible terms. “As a part of Hennepin County,” Ross says, “we are the people who bear the cost of inequities and poor health, outside our role as a health plan.”

The connections between medical care and overall community health are sometimes hard to understand, and Ross and Amy take every opportunity to explain them. People in Hennepin County who get health insurance throughMedicaid — many whom are Hennepin Health members — account for more than half of the county’s corrections budget, Ross explains, and more than half of visits to emergency shelters. “If we can’t keep our people well,” he adds, “everyone in Hennepin County is going to pay for the care they need, in one way or another. We already pay — in the criminal-justice system, in public safety, in the foster-care system.”
The only question is whether public resources would be better spent getting people well than in locking them up, policing them or taking away their children. That’s what reinvestment grants are designed to find out.

An antidote for hopelessness
With their grant funding, Dr. Laes and her colleagues hired a new LADC to counsel people who come to HCMC with substance problems. They hired a new advanced practice provider to talk to people while they are in a hospital bed recovering. Even more importantly, she says, “the Hennepin Health grant allowed us to take a team approach. The counselors have better connections to me and my colleagues, and we work together to make sure that each patient has the best long-term care plan possible. We meet all the time, we talk about our patients, and we coordinate between what happens in the hospital and where they go next.”

The long-term plan is just as important as the inpatient consultation. “The LADCs are integral to the work we do,” says Dr. Laes. “They know the entire community network of treatment options, help make appointments for patients and help them access funding for treatment. Physicians and physician assistants like me get people with opiate use disorder hooked up with our addiction medicine program, which uses medication-assisted treatments like methadone or buprenorphine. We have an outpatient clinic, where we follow up with people to continue any medications we start in the hospital.”

The evidence Dr. Laes amassed during the grant period made a compelling case for the work they were doing. In a three-month period, the LADC worked with 333 HCMC patients, and the physician and advanced practice provider consulted with 72. The need for their help was clear: tree out of four of those patients said they were currently using alcohol, 28 percent said they were using stimulants, 22 percent reported using opioids. But the big news, for Dr. Laes and Hennepin Health, was what those consultations accomplished. “We found a 4.4% decrease in 90-day readmissions for patients with substance use diagnoses,” Dr. Laes reports, “and a 2.5% decrease for patients with alcohol.”

Beyond readmission metrics, the payoff of Dr. Laes’s work happens right there at the bedside of a patient who’s suffering. “Most of the time, my patients haven’t heard of the medications we can offer them to treat their addiction,” she says. “They tell me, ‘I’ve been through 28-day treatment 20 times, and then I fall back into my old habits. I’ve learned what treatment programs have to teach me. I just can’t change.’” To people who’ve felt it, that hopelessness is the most toxic poison of all.

“Then I tell them about naltrexone or acamprosate, and we get it started right there while they’re still in the hospital.” She pauses for a second, then smiles: “It’s generally a pretty good visit.” ☤

 

Read More

Be aware of mental health care needs 24/7

As Mental Health Month comes to an end the work to improve our mental health and overall well being continues.

Unfortunately, stigma, shame, misinformation and misunderstanding surrounding mental health still exist. It stops people for getting help. It affects how we see people who have mental illness. And it limits how we talk about mental illness and wellness, further isolating people with the disease.

Here are some programs and ideas to help you better understand mental illness. Take a look and share with your friends.

Hilarious World of Depression. This podcast is about depression. And laughs. From its website: Depression is an incredibly common and isolating disease experienced by millions, yet often stigmatized by society. The Hilarious World of Depression is a series of frank, moving, and, yes, funny conversations with top comedians who have dealt with this disease, hosted by veteran humorist and public radio host John Moe. If you have not met the disease personally, it’s almost certain that someone you know has, whether it’s a friend, family member, colleague, or neighbor. Depression is a vicious cycle of solitude and stigma that leaves people miserable and sometimes dead. Frankly, we’re not going to put up with that anymore.

 

Make It OK. This campaign increases public awareness of helpful mental health care by helping people to talk more openly about mental health.

The 45-minute Make It OK presentation provides helpful, simple tips for talking friends and family members. In addition to taking the pledge, you can learn more about reducing stigma.

 

Mental Health First Aid© (MHFA.) This in-person training for youth and adults teaches how to assist people who are in crisis or are at risk of developing a mental illness. This eight-hour course teaches how to identify signs of addiction and mental illness, and how to evaluate the situation and provide help.

MHFA also gives people who take the course connections to local professionals who can help

 

Psychological First Aid (PFA.) Take the course used by first-responders and others to help children and adults experiencing immediate mental trauma. This trauma can come from violence, public health emergency, disaster or other event.

PFA is sponsored by the Minnesota Department of Health Office of Emergency Preparedness. You can take the course as a six-hour interactive online course or use the online manual.

 

Question, Persuade, Refer (QPR.)  These three simple steps  can help prevent suicide. Just as people trained in CPR and the Heimlich Maneuver help save thousands of lives each year, people trained in QPR learn how to recognize the warning signs of a suicide crisis. QHR also teaches you how to question, persuade and refer someone to help.

Learn QPR in an hour at QPR’s website.

 

Read More

Bringing wellbeing within reach of all Minnesotans

We want to bring wellbeing within reach for everyone in Minnesota. This report shows how our state’s health insurers are working toward that goal today. We’re excited to share with you the important work of our community partners in Bridges to Wellbeing. Here you will read about:bridges-graphic

  • Breathe Free North and Blue Cross Blue Shield of Minnesota. How young people from the North Side of Minneapolis are making their community healthier by making their government change the laws.
  • Saint Paul Promise Neighborhood and HealthPartners. Helping one neighborhood’s little children succeed in school — and changing the definition of “health.”
  • Dakota County and Medica. How social workers and insurance people are integrating physical and mental health care to nurture whole people.
  • Hennepin County community paramedics and Hennepin Health. How a few paramedics are giving some people in the hardest circumstances a chance to feel better — and helping change our state’s health care system at the same time.
  • Center for Victims of Torture and UCare. Helping doctors heal wounded bodies by giving hope to wounded hearts.

 

 

 

Read More

Join our team

We are looking for a skilled professional to provide support and expertise to the Council and our member plans, with a focus medical policy, government programs and community health. Our new colleague will have a demonstrated ability to work with others, strong problem-solving skills and be super comfortable working in changing environment.

We think prior experience working in health care is a good foundation for this work, and a knack for learning a must. Check out the full posting for more details and how to apply.

What does the Council do, you ask? We’ve been here for 30 years and are dedicated to improving health care for all Minnesotans through the work of our state’s health plans. We work closely with people in health plans, government, and other parts of the medical community to better understand opportunities to make sure people get the care they need. We’re also focused on work to make the care we need more affordable.

Read More

For many, healthy food is miles away

A new poll from the Center for Prevention at Blue Cross and Blue Shield of Minnesota identified roadblocks to Minnesotans’ access to healthy food.

infographic-grocery-gap

Fixing the “grocery gap.”

The poll showed:

  • Nearly half of Minnesotans surveyed said that not having a store nearby that sells healthy food impacts what they eat.
  • Most Minnesotans (73 percent) said difficulty finding healthy food on-the-go influences their decisions.
  • A majority of those polled (56 percent) don’t believe that all Minnesotans have access to healthy food, regardless of where they live or their socioeconomic background, while 16 percent are unsure.

See more details here.

The survey also found that the decline in the number of grocery stores serving smaller communities, especially in Greater Minnesota, influences what people buy. Fifty-five percent residents outside the Twin Cities say their food choices are at least somewhat influenced by a lack of stores nearby that sell healthy food. About 46 percent of people in the Twin Cities report similar challenges.

More than one-third of those surveyed said they must travel at least 10 minutes in order to shop at a full-service grocery store. Longer travel times are also more prevalent in Greater Minnesota, where 40 percent report traveling at least 10 minutes to shop at a grocery store, and in rural areas, where trips of more than 30 minutes are reported.

COMMUNITIES SEEN AS PART OF THE SOLUTION
Minnesotans believe their communities should be part of a healthy solution. Nearly all of those surveyed (96 percent) say it is at least somewhat important for communities to increase access to affordable and healthy food.

Some efforts are already underway. The Minnesota Food Charter  identified barriers to healthy food access and recommended policy and systems changes to help resolve them. Initiatives like those underway at Lakeshirts Inc. in Detroit Lakes, and the formation of a new food co-op in Milan, Minn., demonstrate the type of community-driven solutions the Food Charter encourages.

Based in Eagan, The Open Door provides healthy food through its food shelves and Mobile Pantry sites, as well as its Mobile Lunch Box program, which offers healthy lunches and activities for children and families when school is not in session. The organization’s Garden To Table® program promotes improved access to fresh produce by providing garden plots, vegetable and herb seeds, plants, tools and compost to food shelf clients at no cost.

Read More

Health care help is a phone call away; CareLine employees credited for saving life

The calm, quick response of two employees “probably saved my life.” That was the message from a HealthPartners member who called the CareLine while having a heart attack July 4.telehealth

CareLine, a phone line that provides members 24/7 advice from a registered nurse, heard from the member that he was feeling pressure in his chest and he was sweating, both symptoms of a heart attack, but he wasn’t feeling any pain. He knew something was wrong, but he wasn’t sure what to do next.

People often connect having a heart attack to what is seen on television or in the movies; but not everyone clutches their chest from the pain. In fact, symptoms can be subtle and often confusing for people having a heart attack, according to HealthPartners cardiologist Thomas Kottke, M.D.

Many health plans offer free advice from nurse over the phone. The numbers are on the back of your health care card and names such as CallLink, HealthConnection, Nurse Advice Line and Nurse Line.

At HealthPartners alone, CareLine nurses receive about 500 calls every month. About 30 percent of the time, nurses recommend a clinic visit, but about 40 to 50 percent of the time, members are advised to go directly to the emergency room. In the member’s situation above, he was directed to call 911 and take four baby aspirin. The life-saving advice is something that the CareLine team is providing hundreds of times every month.

Read More