At HCMC, healthy doesn't mean more costly

HCMC social worker talked with a patient.
Christina L. Larson (right), a social worker at HCMC, talked with a patient about her living situation.
Mark Zdechlik | MPR News

At a time when the phrase "reducing health care costs" typically means "slowing the growth of health costs," Hennepin County Medical Center has done something significant: It has actually lowered the cost of caring for its patients.

The heart of the medical center is its ever-expanding downtown Minneapolis headquarters, which currently sprawls over five city blocks. Hundreds of thousands of people get care from HCMC and its network of primary care facilities. Increasingly, what's taking place there has nothing to do with the conventional practice of medicine.

"When you come into our clinic we're not just going to talk to you about your health needs," said Melissa Kaufhold, a senior community health worker at HCMC's Whittier Clinic in south Minneapolis. "We want to know about all of your needs."

"When you come into our clinic we're not just going to talk to you about your health needs. We want to know about all of your needs."

Kaufhold explained that it's difficult to make health care a priority for someone who lacks safe housing or food. Once those basic needs are identified and met, "Then we can really focus on the health needs," she said.

A visitor can see that approach in HCMC's downtown clinic for people with HIV-AIDS. In an examination room there, social worker Christina Larson recently met with a patient in her mid-60s.

Instead of talking about her test results, they discussed the patient's living situation, her housing and money problems. The patient was upbeat. At her feet was a bag of groceries the clinic had given her. She needed the help.

"It's hard for me to have enough veggies and fruit, and I'm trying to do this weight-loss program," she said.

After Larson had finished, pharmacist George Konstantinides popped in. "Good to see you," he said. "How's your day going?"

"It's going fine, you know," the patient replied. "I picked up my meds already while I was waiting." "Awesome," the pharmacist said. "Let me look at your med list. "

This is coordinated care — a team of people addressing a range of potential problems in addition to the sore throat or whatever brought the patient to the doctor.

The approach has helped HCMC reduce the cost of care for people on medical assistance, like the woman at the HIV-AIDS clinic. State officials say HCMC reduced Medicaid and MinnesotaCare spending by nearly $18 million last year.

The entrance to Hennepin County Medical Center
The entrance to Hennepin County Medical Center in downtown Minneapolis.
Mark Zdechlik | MPR News

The lessons learned on the public side are also reducing the total cost of care for patients with private insurance. According to the research group Minnesota Community Measurement, HCMC's cost of care for those patients dropped 4 percent last year. That's significant, considering the state average came in at a 3 percent increase.

"Those results are really promising," said Nancy Garrett, HCMC's chief analytics officer.

Garrett said there's no one thing she can point to as an explanation. But HCMC has been doing several things differently in hopes of making patients healthier without spending as much money.

Some measures are relatively simple. For example, if someone shows up at the emergency department wanting treatment for something that could easily be handled through less expensive primary or urgent care, that's where they're sent. Pharmacy costs are down sharply, which Garrett suspects is a result of the growing use of electronic medical records and technology that matches patients with the most cost-effective medications.

HCMC is also working to bring more people into primary care. That, and better management of expensive chronic conditions such as asthma, help keep medical problems from escalating into expensive emergency room visits and hospital stays.

Minnesota Community Measurement President Jim Chase said he hopes clinics and hospitals will pay attention to the group's findings and learn from the providers that are holding down costs and improving outcomes.

HCMC's Whittier Clinic
HCMC's Whittier Clinic is one of the health system's 15 primary care facilities.
Mark Zdechlik | MPR News

"Before, I think many clinicians would have said it really wasn't their job to worry about the cost — that was why health plans were there," Chase said. "But there's been a change, I think, in recognition that something needs to be done to help manage the cost."

For providers, a lot of money's at stake. The Affordable Care Act rewards hospitals and clinics for improved care and lower costs. HCMC gets to keep $3 million of its 2014 public program savings, and it's on track to get $1 million more.

Hennepin County might become a model for other hospitals and clinics. When it comes to clients with commercial insurance no other provider system generated as much in savings last year.

But Whittier's medical director, Dr. Ayham Moty, said the model is not an easy one for some medical professionals to adopt.

Whittier's Medical Director Dr.  Ayham Moty
Whittier's Medical Director Dr. Ayham Moty is convinced care givers can do more with less.
Mark Zdechlik | MPR News

Coordinated care means all kinds of people are working with patients, not just doctors and nurses. Moty said some doctors are reluctant to cede control.

"The whole concept of team-based care — it's still new and not everybody's buying into it," Moty said. "We need to change the culture."

But doing so is not an automatic plus for a system's finances. The picture is still unclear at HCMC.

Thomas Zachary, director of revenue development, said that saving taxpayers more than $17 million reduced the hospital's revenue. But it's hard to quantify the amount. Also, more people are insured due to the Affordable Care Act, and the hospital has more paying clients.

Regardless, Zachary said he's convinced providers have no choice but to change the way they deliver care, because those footing the bill — taxpayers and insurance companies — are demanding higher quality care that keeps costs in check. "All of the models are moving in that direction," he said.

Providers that want a future, he said, have to find ways to do more with less.

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