Being a nonprofit health plan means to put the community first. Minnesota’s nonprofit health plans – including Blue Cross and Blue Shield of Minnesota, HealthPartners, Hennepin Health, Medica, PreferredOne, Sanford Health and UCare – are local companies with a shared mission of getting Minnesotans the affordable, equitable and quality-based care they need.

They’re always looking for ways to best serve Minnesotans

Having a nonprofit status means health plans invest their resources back into members and communities to bring wellness within reach for everyone. Much of this work is connected to what is called the social determinants of health, which are the non-medical factors that influence health outcomes. This includes working with community organizations and stakeholders to make social and environmental conditions healthier for members; providing wraparound services that support members in taking their medications, getting to their appointments on time and coping with emotional stresses around their diagnosis; ensuring that care is culturally appropriate and equitable, and supporting the broader economy through workforce growth and robust community giving. Health plans also invest in innovative models of care that incentivize providers based on quality.

They know your needs, because they’re from here, too

Local nonprofit health plans have a special connection with Minnesotans because company leaders and employees live, work and seek medical care in the same places members do. This drives their mission to get all Minnesotans the affordable care they need today and in the future. Nonprofit health plans know that the success of Minnesota hinges on the health and wellness of everyone who lives here. They do this through:

• PARTNERSHIP: Plans work with a variety of stakeholders, including people who deliver care (providers, hospitals and health systems), people who need care (children, adults and families across Minnesota) and people who work to make care better (legislators, regulators, state health officials and others) to promote policies and processes that make health care more effective for everyone.
• ACTION: Through advocacy, education and legislative efforts, nonprofit health plans take practical action today to make better health possible for generations of Minnesotans to come.
• DATA: They use and develop data to inform public policy, improve care and help manage expensive medical bills on behalf of all Minnesotans.
• COMMUNITY: Minnesota’s nonprofit health plans work together to focus on solving problems and finding opportunities to make the health care system work better because we work here, live here and our companies’ financial resources are dedicated to care for our community.
• UNDERSTANDING: Nonprofit health plans understand that health care is deeply personal, urgent and expensive. Thus, they know that having health insurance coverage helps spread out the cost of expensive health care, helping people gain access to care that they otherwise couldn’t afford.

What else do Minnesotans get from nonprofit health plans?

Nonprofit health plans pay more than $800 for medical care every second. And, on average, less than 1% of “profit” (called operating gain) per year is left over for health plans after paying all the bills. This money goes into medical reserves to pay for unexpected expenses in the future, like costs related to the COVID-19 pandemic. Unlike large national companies, Council members do not pay a dime to Wall Street shareholders. Nonprofit health plans put people over profits, and they also do a lot more work behind the scenes to protect the health and wellness of Minnesotans, including:

• Reducing our medical expenses by negotiating discounted rates with doctors, hospitals, and other providers of care; by preventing fraud and abuse; and by finding new ways to minimize paperwork and increase access to information.
• Protecting us from financial ruin if we are badly injured or become very ill.
• Providing information that helps us live healthier lives, manage our health troubles, and pursue our own well-being.
• Helping us stay well with preventive services, routine check-ups and incentives like health-club discounts.
• Helping us navigate health care choices with advice and support from caring nurses, pharmacists and other medical professionals.
• Improving the care we get by making sure it meets quality standards.
• Enabling businesses to keep their employees healthy, happy and productive.

For more information on how nonprofit health plans work in Minnesota, visit https://mnhealthplans.org/faqs/understand-insurance/.

Protecting the mental health and wellness of Minnesotans is a top priority, especially given the pandemic. PreferredOne has had a longstanding commitment in facilitating access to mental health and substance abuse services as part of its focus on complete health and wellness for members.

In 2020, PreferredOne extended its focus through a new partnership with Pear Therapeutics and its two digital products, reSET and reSET-O. reSET is a 12-week, FDA-authorized digital treatment that helps people abstain from substance abuse; reSET-O, for opioid-use disorder, is a 12-week, FDA-authorized digital treatment that is designed to help people stay in their program longer.

PreferredOne became the first health plan in Minnesota and one of the first in the nation to include digital therapeutics for members with this family of disorders. Initial response from providers and from members has been very positive.

Diversity, equity and inclusion are critical to the well-being of Minnesotans. Medica’s recent decision to put a new call center and claims processing operation in St. Paul’s Midway area is just one example of this commitment to diversity, equity and inclusion.

The new call center, where the company will hire 50 people, was strategically placed in an area of St. Paul with a diverse workforce, yet grappled with high unemployment. More than 1,000 employee hours went into the effort, and company leaders met with community groups to better understand the needs of the community, as well as the experiences of the diverse people who live in the neighborhood.

Medica is committed to hiring full-time workers for the Midway office and to prioritize jobs to workers who live in the five ZIP codes surrounding the office. It hired female- and minority-owned building contractors to help prepare the new office in St. Paul, which will occupy a 7,000 square-foot space in the Wilder Foundation building. Geoff Bartsh, Medica senior vice president, left, and Rob Geyer, Medica chief operations officer, are pictured in the Midway where the center will be located. The two leaders led the charge on this project.

Education is a social determinant of health that promotes success in life overall. In partnership with the GED Testing Service, UCare offers free GED tutoring, support and tests through the GEDWorks program for its Prepaid Medical Assistance Program (PMAP) and MinnesotaCare members.

The program, which expanded statewide this year, is intended to help lift its members out of poverty by providing them with better career pathways and employment opportunities. In addition to expanding geographically, the organization offers additional career planning services for members.

Through GEDWorks, participants have access to practice tests and other study tools in English or Spanish. They also are paired with an adviser, who provides moral support and shepherds them through the process of studying for and signing up to take GED tests. In 2020, 23 members earned their GED through the program. Pictured is Irene, a graduate of GEDWorks.

Whole-person care is at the forefront of what nonprofit health plans do. Hennepin Health and Hennepin Healthcare, the provider system that includes Hennepin County Medical Center (HCMC), worked to expand access to housing navigation and to reduce the readmission rate for Hennepin Health members experiencing homelessness and inpatient at HCMC.

The team gathers data about housing status and use of other assistance programs. Hennepin Health navigators then visit members in the hospital to confirm eligibility and introduce them to outpatient community care management. If members participate, they are added to the navigator’s case load and are often visited again while they remain hospitalized.

Through the first 37 weeks, 380 members were screened, 69 were visited while inpatient and agreed to participate, and 40 were engaged in care management for at least 30 days following discharge. No engaged member was readmitted within 30 days. Also, 16% of participants were housed and connected with other services. Hennepin Health received an award from the National Association of Counties (NACo) for this initiative.

Suicide is an unthinkable tragedy and nonprofit health plans are doing their part to aid in its prevention. HealthPartners’ Suicide Risk Calculator helps behavioral health case managers proactively reach out to members who may be at increased risk of suicide or self-harm.

The calculator, developed by researchers at HealthPartners Institute and two other U.S. groups, analyzes members’ health data for indications of depression, self-harm, substance use disorder or other drug use. The algorithm then predicts and identifies members at high risk of attempting suicide.

Between August 2019 and August 2020, the HealthPartners behavioral health team used the Suicide Risk Calculator to identify 500 members who they believed to be at elevated risk of attempting suicide. The team reaches out to identified members to talk about mental health issues and help them make connections to providers and other specialists for support.

Nonprofit health plans play a key role in ensuring that Minnesotans have what they need to be well in life overall – and addressing food insecurity is just one of these critical needs. The Giving Gardens at Blue Cross and Blue Shield of Minnesota have played an important part in helping the community by providing Minnesota food shelves with fresh, locally grown produce.

Blue Cross associates volunteer their time and talents by working in the gardens to plant, care for and harvest produce. This produce is then donated to a variety of organizations throughout Minnesota, including The Open Door Pantry in Eagan, Interfaith Action’s Department of Indian Work in St. Paul and Quad Cities Food Shelf on the Iron Range.

In 2020, the Blue Cross Giving Gardens produced more than 1,500 pounds of produce that was donated to local food shelves and was a record growing season for the Giving Gardens despite the COVID-19 pandemic. Pictured are Blue Cross employees in the Giving Garden.

In Minnesota, there are generally three types of health insurance: fully insured plans, government-sponsored plans and self-funded plans.

Fully insured: If you have a fully insured plan, either you (through an individual market plan) or your employer pay a premium each month to an insurance company. Your insurance company then pays your medical bills with that money. If your bills are more than you have paid in premiums, your bills still get paid. Typically, smaller companies offer fully insured plans to employees. About 26% of Minnesotans are fully insured.

Government-sponsored: If you have government-sponsored coverage, you are enrolled in programs like Medicare (which serves people who are 65 and older or younger people with certain disabilities), Medicaid (which serves low-income families and individuals) and MinnesotaCare (also serving those who are low-income, but may require them to pay a monthly premium depending on income level). Through these programs, the federal or state government pays for the coverage each month and the health plan pays medical bills. About 36% of Minnesotans have government-sponsored insurance.

Self-funded (or self-insured): If you have this type of insurance, your employer is paying your medical bills with its own money, thus the term “self-funded.” Companies and organizations that fund their own plans hire a health insurance company to do the administrative services for their employees. This includes sending out health insurance cards, contracting with doctors and hospitals and answering questions from employees. Larger companies that have significant financial resources – and can take on the financial risk of insuring employees themselves – typically offer self-funded plans. About 34% of Minnesotans have self-funded insurance.

Generally speaking, you and your health insurer share costs up to a certain point. What you pay depends on your deductible, copayment, coinsurance and out-of-pocket maximum. Each health plan will have different combinations of these costs. The deductible is the total amount you need to pay before your insurance plan starts paying your bills, the copay is a flat fee you pay for specific services, coinsurance is a percentage of costs that you cover for certain health care services and the out-of-pocket maximum refers to the most you will pay for covered services each year.

What do you get for the money you pay each month? Although your health insurer pays on average more than $800 for medical care every second, it does a lot more work behind the scenes, including:

• Reducing medical expenses by negotiating discounted rates with doctors, hospitals and other providers to offer quality care at a lower price.
• Protecting us from financial ruin if we are badly injured or become very ill.
• Helping us stay well with preventive services and incentives like health-club discounts.
• Improving care by creating new models of payment that pay providers based on the quality of our health, not the quantity of service.
• Working with community organizations and stakeholders to make social and environmental
  conditions healthier.

For more information about how health insurance works in Minnesota, read our Health Insurance 101 fact sheet.

Through all of the challenges the year 2020 brought us, I’m heartened by the way Minnesota’s nonprofit health plans have stepped up to support our state.

Health plans have always put the health and safety of Minnesotans first, but we all know that 2020 was radically different. The COVID-19 pandemic – as well as the racial unrest that ensued after the murder of George Floyd last summer – pushed the health care system in ways that no one could ever have imagined. Not only were enrollees of our member health plans impacted, but the community overall. We knew we needed to come together to help Minnesota heal.

One of the first things health plans did in response to the pandemic was waive any cost-sharing component for COVID-19 testing. Health plans quickly recognized that testing is at the center of preventing the spread of the infection – so typical cost-sharing was lifted to avoid any financial barrier to seeking a test. Congress has since mandated this strategy nationwide, but it was an important move that I’m glad Minnesota health plans took on voluntarily.

Health plans moved quickly to cover the cost of COVID-19 in-patient treatment, as well. COVID-19 has not just affected our health, but our economy – and the last thing we want is to have anyone hospitalized by this disease worry about a bill. Health plans recently extended cost-sharing to the end of March and will continue to revisit this as the health emergency continues.

The murder of George Floyd was also a major turning point in which our health plans looked within to see what more we could be doing to promote racial equity and inclusion in our communities. We have a lot of work to do in this area, but health plans are looking at everything from workforce diversity and training to the ways in which we are delivering care to communities of color. To that end, member health plans have formed a new Health Equity Committee with the task of significantly reducing health disparities – which we know are far too prevalent in Minnesota.  We have high hopes that the coordination we are leading will bring everyone together in a way that will bring much needed progress toward these goals.

Finally, health plans accelerated community giving efforts in 2020. The health of Minnesotans can be largely dependent on whether their basic needs are met, and thus, health plans provided millions in assistance last year related to social isolation, mental health, food insecurity and other issues.

Looking ahead to 2021, I’m confident that health plans will continue to be there for Minnesotans in meaningful ways. We’ll continue to be innovative – utilizing cost-saving care delivery like telehealth to provide enrollees with high-quality health care. We’ll position health equity at the forefront of everything we do, finding ways to broaden access to care for underserved communities. Health plans will also continue to find ways to beat back COVID-19 in our state. Already, our health plans have committed to cover the new COVID-19 vaccine at no cost to enrollees as it becomes available across the state this year.

With that, I want to wish everyone across Minnesota a safe and happy start to 2021. I truly appreciate the resolve Minnesotans have shown over the past year and want all of you to know that Minnesota health plans will always work to provide the best care possible. We are here to help our state heal, and we look forward to being your partner in making 2021 the year we all want it to be.