By the Minnesota Council of Health Plans and the Minnesota Hospital Association

Measles is highly contagious and can be serious — even fatal. More than 100,000 people die from measles each year worldwide; most are under the age of five.

With school back in session you’ll want to make sure your child is up to date with this important vaccination. The measles vaccine has been around for more than 50 years, and it’s been so effective that the United States declared measles “eliminated” back in 2000.

Unfortunately, measles outbreaks still occur in the U.S. and are on the rise. The year 2019 saw the most U.S. measles cases in the last 25 years. In 2017, Minnesota experienced its worst measles outbreak since 1990, with almost a third of the patients who contracted the infection needing hospitalization.

So, what’s behind these concerning trends? Experts blame myths and misinformation. Here are the facts: Vaccines do not cause autism spectrum disorder, infant immune systems are strong enough to handle current vaccination schedules and there’s no risk of getting measles from the vaccine, either.

Without the vaccine, children could be exposed to this highly contagious virus. Among people exposed to measles, studies show 90% will become infected if they’re not vaccinated. Measles is spread through the air as infected people breathe and cough. Measles can lead to pneumonia, brain damage, deafness and even death.

Symptoms of measles typically appear 10-14 days after exposure. Your child might have a fever, dry cough, runny nose, sore throat, inflamed eyes, diarrhea, ear infections and a blotchy skin rash. Often the inner lining of the cheek may reveal tiny white spots with bluish-white centers on a red background.

A Three-for-one
The measles vaccine is combined with vaccines for mumps and rubella (MMR). Children usually receive their first shot when they are 12-15 months old and again when they’re between four and six.

Mumps often causes puffy cheeks and a swollen jaw. It’s also contagious. The virus is often spread in environments where there is close, extended contact with infected people. Symptoms also include fever, headache, muscle aches and fatigue.

Rubella is contagious and is most often spread from coughing or sneezing. It poses its greatest threat to pregnant women. If infected, women could have a miscarriage, or the child could die shortly after being born. The child could also be born with birth defects.

Talk to your health care provider about the MMR vaccine and whether your kids are up to date on their immunizations. Preventive care—including vaccinations—can help keep families and communities healthy.

Medica is calling on its network of providers to adopt a new clinical guideline to diagnose and assess kidney disease that will lead to more equitable renal care and improved outcomes among Black Americans. The change is expected to reduce delays in referrals for specialist care and kidney transplants.

Medica is asking doctors to stop using the most common method to diagnose and assess the severity of kidney disease, which is estimated glomerular filtration rate (eGFR). Most providers calculate eGFR by assuming Black people generally have higher baseline levels of serum creatinine, and therefore adjust their scores upward. This method can overestimate kidney function in people with African ancestry, and lead to worse outcomes.

“Using race as a factor when estimating kidney health is imprecise and disproportionately puts Black Americans at risk for severe health complications that could otherwise be treated,” said Medica Medical Director Charlotte G. Hovet, M.D., Sr. Medical Director of Quality, Care and Utilization Management.

“Our mission is to earn the trust of those we serve, and with that comes our commitment to being an active ally and advocate for changes that help make the lives of all people healthier and happier,” Hovet said.

Black people are about three times more likely to develop kidney failure than white people, according to the National Kidney Foundation. Black people are also less likely to receive a transplant evaluation, have less access to the waitlist, spend longer time on the waitlist, are less likely to survive on the waitlist, and have lower rates of transplant success.

Medica’s Medical Policy Committee, comprised of credentialed Medica-network physicians in a variety of disciplines, voted to adopt a new guideline that recommends providers use either a direct measure of GFR or another method of estimating GFR using serum cystatin C, which does not involve consideration of the patient’s race.

Hovet said the new guidelines align with leading advocates for the advancement of equity in kidney care.

When Twin Cities entrepreneurs Jazz Hampton, Esq., Andre Creighton and Mychal Frelix developed a solution to make traffic stops safer for drivers and law enforcement, Blue Cross and Blue Shield of Minnesota took note.

The nonprofit health plan is partnering with the entrepreneurs to address key factors affecting the health of its residents, including looking at police interactions as a social driver of health.

“The three of us sat down and decided that with our professional and community backgrounds, we were uniquely placed to create a solution to help keep people’s rights protected, reduce stress, trauma and anxiety  – and get everyone home safely,” said Hampton, co-Founder and CEO of TurnSignl.

After Daunte Wright was fatally shot during a traffic stop by Brooklyn Center police in 2021, Hampton, Creighton and Frelix saw an opportunity to improve interactions between police and drivers. The trio developed TurnSignl, an app connecting users to an attorney in real time if they are stopped by law enforcement or have a car accident. The attorney provides legal advice to the user during the interaction with police.

Blue Cross is funding TurnSignl as part of a five-year strategy with the City of Brooklyn Center that aims to improve racial and health equity. The pilot program will provide up to 3,000 residents free access to the TurnSignl app, which launched in Minnesota just weeks after Wright’s killing.

This innovative subscription-based technology is designed to protect driver’s rights, de-escalate roadside police interactions, and help ensure both drivers and police officers return home safely.

Safety is not the only issue TurnSignl can help address. A growing body of research is illuminating how police-involved shootings and other police violence perpetrated on Black people have a deeply negative impact on the mental health and wellbeing of communities, regardless of whether the residents of those communities had a personal connection to those incidents.

“We know that 80 percent of health is determined by environment, neighborhoods, income and other stressors that exist outside of interactions with doctors and the health care system,” said Bukata Hayes, Vice President of Racial and Health Equity at Blue Cross.

“The impact of historical and contemporary trauma and systemic racism felt within BIPOC communities have long added increased mental health burdens to the already large overarching health inequities that exist throughout Minnesota. Our partnership with TurnSignl is an innovative, relevant and a responsive way to address those priorities and create a healthier future for all,” Hayes said.

To reduce health disparities, HealthPartners has mobilized an internal grassroots movement to help close gaps in outcomes and educate colleagues on ways to reduce bias, promote cultural humility and anti-racism. Some 350 employees have stepped up to become Health Equity Champions, serving as a resource for their teams or departments to advance equitable care throughout the enterprise.

“Being welcome, included and valued is a basic human need and essential to health and well-being,” said HealthPartners Chief People Officer DeLinda Washington. “Our Health Equity Champions are a great resource as we work to educate our colleagues on cultural humility, anti-racism and reducing bias.”

In addition to being ambassadors, the Health Equity Champions also help research, write and share the HealthPartners Culture Roots newsletter. Recent issues have focused on addressing disparities in depression screening and treatment, microaggressions and advancing LGBTQ health.

In an issue on maternal and infant health disparities, the newsletter shared how HealthPartners is addressing bias to provide the best care and service to patients and members. HealthPartners team members collect data on births and prenatal and postpartum care and partner with community organizations to ensure patient needs are met.

The United States has some of the highest maternal and infant mortality rates among developed countries, especially among people of color. Black infants, for instance, are nearly four times as likely to die from complications related to low birthweight compared with white infants.

In an effort to eliminate these disparities, HealthPartners has implemented structured, consistent practices for how clinician teams address the complications that can occur during pregnancy and childbirth. This includes things like managing hypertension during pregnancy, addressing abnormal fetal heart beats that happen during labor and preventing and managing hemorrhaging that can happen after pregnancy. These structured approaches are called “safety bundles,” and include steps to:

• Be ready
• Recognize and prevent
• Respond
• Report and learn

Health inequities, especially in the area of maternal and infant health, are profound. Research has shown that college-educated Black mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who didn’t finish high school. Disparities like this are what drive leaders like Washington to galvanize the workforce to bring about equity.

“When we understand and embrace our differences, we work better together and can best serve our patients and members.”

UCare is galvanizing the power of its people to ensure all its members have more equitable access to care.

Among UCare’s 630,000+ members are new Americans, BIPOC and LGBTQIA+ individuals, and people with disabilities. The organization is proactively working to provide more inclusivity to them and anyone else facing greater social and economic burdens due to structural oppression.

Some challenges arise in specific communities. The organization formed a Community Response Team in early 2021, allowing team members to flex as necessary to members’ needs.

The 15-plus member team is focusing on COVID response, but it also screens for medical issues, mental health and substance use disorders or other social needs that may be adversely affected by the COVID-19 pandemic. The team also provides education and support for COVID-19 prevention, testing and vaccination.

“The pandemic accelerated our concerns about health equity for the members we serve,” said Jennifer Garber, Vice President of Mental Health and Substance Use Disorder Services. “We wanted to remove barriers to vaccinations such as transportation and language, and also to de-complicate all the conflicting information about COVID-19 for our members. That is just what our talented and diverse Community Response Team does every day.”

UCare Foundation team members and community relations staff also connect with trusted community leaders and organizations to reduce health inequities. For example, UCare recently operated 80 COVID-19 vaccine clinics in partnership with Hennepin Healthcare, The Stairstep Foundation and the MN Department of Health, providing 8,300 vaccines and 95,000 KN95 masks to individuals in underserved communities across the state.

The Community Response Team includes a manager, a team lead, case managers, community health workers and engagement specialists. Team members speak multiple languages, they come from diverse cultural backgrounds, and they bring diverse skill sets to their role.

“Our team members have become trusted resources for our members during a stressful, confusing time,” Garber said.

For rural and underserved communities, there are a number of barriers that can prevent equitable care.

Lack of transportation, especially in outlying areas, is a significant challenge. Financial constraints can force tough decisions about how to pay for care and prescriptions. Communication challenges can also prevent members from understanding and participating in their care.

Sanford Health Plan is helping its members overcome these obstacles with an assist from dedicated staffers who join members in their health care journey. The organization uses Health Guides and Health Navigators to identify member challenges and develop solutions to connect them to the resources they need. Health Guides are available to all members, while Health Navigators are a resource for members of Medicare Advantage from Align powered by Sanford Health Plan.

“The Guides and Navigators form personal relationships with members to get to know their priorities and challenges and ensure they’re able to access appropriate care,” said Julie Smith, Executive Director of Value Strategy and Clinical Operations at Sanford Health Plan.

Sanford Health Plan serves patients and plan members across 250,000 square miles, which include Minnesota communities such as Thief River Falls, Bemidji, East Grand Forks, Canby and Worthington.

Sanford Health Guides, a no-cost benefit to plan members, help connect members to their providers, help them follow care plans and build relationships with them to better understand their barriers to care. Other services include:

• Helping members with financial and prescription assistance
• Identifying barriers and creating solutions to address them
• Building relationships with members’ care teams
• Attending appointments and advocating on members’ behalf
• Connecting members to resources in their communities

Health Navigators help Medicare Advantage members complete health assessments, explain benefits and answer questions. Both the Health Guides and the Health Navigators provide personalized service to members by connecting them with both the medical and non-medical resources they need to improve their overall wellbeing.

“Having resources who are familiar with the entire Sanford health system, and help our members take advantage of it, is a great example of what integrated care between the health system and the health plan should look like,” Smith said.

The Minnesota Legislature and Gov. Tim Walz recently took decisive action to pass an extension of the reinsurance program before the April 1 deadline to meet the federal requirement to continue the program. What does this extension mean for the health, wellness — and pocketbooks — for Minnesotans? We answer a few key questions on what the overall impact will be. 

What was the final deal? 

The legislature passed and fully funded a three-year extension of reinsurance, ensuring the program will continue to hold down premiums and stabilize the individual market for 2023, 2024 and 2025. The program parameters were restored to the original 80% coinsurance rate, meaning that rates will be 20% lower on average than they would be without the program. 

Who does reinsurance help? 

Reinsurance helps everyone who purchases health insurance on their own instead of receiving it as a benefit from an employer or through a state public program. This includes farmers, small business owners, lower-income workers who do not have access to employer-sponsored coverage, Minnesotans who are in-between jobs, and those who retire early and are not yet eligible for Medicare. Approximately 167,000 Minnesotans purchase health insurance on their own.  

What does this deal mean for Minnesotans who buy insurance on their own? 

The extension of the program means that Minnesotans who buy insurance on their own will see rates 20% lower on average than they would be without the program. If reinsurance had not been extended, Minnesotans would be facing double-digit premium increases throughout the state.  

What does a 20% reduction mean in terms of actual dollars? 

The exact impact of the program varies by age, geographic location, and plan type, but in real dollars, Minnesotans will be paying between $500 and $4,600 less than they otherwise would pay without reinsurance. 

What is the impact of reinsurance on the individual market? 

Reinsurance brings certainty and stability to the individual market. Reinsurance pays a portion of high-cost medical bills — costs that are otherwise built into monthly premiums. An estimated 10,000-15,000 Minnesotans were projected to drop coverage due to premium increases if reinsurance was not renewed.