Hennepin Health Newsletter August 2015


August 2015



Ross Owen

Julie Bluhm
Clinical Program Manager

Lori Imsdahl


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Hennepin Health is an innovative health care delivery program that was launched in January 2012.

The program is a collaboration between Hennepin County Medical Center (HCMC), NorthPoint Health and Wellness Center (NorthPoint), Metropolitan Health Plan (MHP), and Human Services and Public Health Department (HSPHD) of Hennepin County.

Hennepin Health members receive care from a multidisciplinary care coordination team. Other innovative features include a common electronic health record, and tiered care that is based upon a member’s identified needs.

Find eligibility and enrollment information at the MNsure website.


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Event at downtown library

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In August, Hennepin Health held an event at the Minneapolis downtown library to thank county and community partners for their care coordination efforts  — and to hear from staff about what works and what could be improved. This event comes five months before Hennepin Health’s fourth birthday. 

event 2

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Mental Health Center integrates behavioral health and medical care

In April 2015 Erica Weiss, an internal medicine doctor from Hennepin County Medical Center, began providing primary care at the county’s Mental Health Center two half-days per week. Weiss’ services are funded by a 2015 Hennepin Health reinvestment initiative which seeks to integrate behavioral health and medical care. A grant from the Minnesota Department of Health also helped -- allowing the center to remodel its space to create a medical exam room, and a lab room for services like blood draws and vaccinations. 

mhc crop

Adding primary care to the Mental Health Center has been a team effort. Staff nurses Michelle Valento, L.P.N. and Sarah Keaveny, R.N. have worked hard to incorporate medical care and lab services into their mental health work.

Amber Morgan, an R.N. care coordinator, has also been instrumental. Morgan uses Hennepin Health’s electronic health record -- and referrals from Mental Health Center clinicians -- to identify clients without a primary care provider (PCP). She then refers them to Weiss. If a client without a PCP is already at the center, Weiss and Morgan attempt to provide them with primary care services on-the-spot. 

On the day of their appointment, Morgan escorts clients to the exam room, takes their vital signs, and starts a health conversation – capitalizing on relationships she’s already built. The client then meets with Weiss for a comprehensive, hour-long health assessment. Afterward, Morgan helps the client order medications, schedule follow-up appointments, and connect to other medical, behavioral health, and social service resources.


From left: Weiss, Morgan, and Valento

The project reflects Hennepin Health’s commitment to behavioral health and medical care integration, a feature that is often lacking in U.S. health care organizations -- including accountable care organizations (ACOs). According to the Dartmouth Institute for Health Policy and Clinical Practice, over one-third of ACOs have no relationship with behavioral health providers, and only 14 percent are fully integrated.

Integration is important because research shows that medical and mental health conditions often co-occur; according to the 2001-2003 National Comorbidity Survey Replication (NCS-R), more than 68 percent of adults with a mental health disorder reported having at least one general medical disorder.

More than 88 percent of Mental Health Center clients are living at or below the federal poverty level, and poverty – which leads to homelessness, food scarcity, and lack of reliable transportation – also causes or exacerbates medical issues.

Going forward, the Mental Health Center has applied for a federal grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), and will find out if they received funding in September 2015. The money would allow the center to expand primary care services to five days per week, during all the hours that the center is open. 

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Intern analyzes member follow-up and readmission rates


In 2015, Alex Knutson-Smisek, R.N. — a University of Minnesota doctorate student and Hennepin Health intern — analyzed Hennepin Health claims and encounter data to determine how follow-up care after hospitalization affects patients’ readmission rates. Alex focused his efforts on Hennepin Health patients with a mental health diagnosis.

A few findings:

  • Nearly 30 percent of patients who have ever been on Hennepin Health have had a mental health diagnosis at some point during their care
  • Within the mental health population, older adults (ages 40 to 60) and adults of American Indian and White race are overrepresented
  • Hospital readmission rates within the Hennepin Health mental health population are greater than the rates within the Hennepin Health non-mental health population -- as well as the rates within the general Hennepin County Medical Center population
  • Patients with a chemical dependency diagnosis or a chemical withdrawal or mental health condition are significantly more likely to be readmitted
  • Males with a mental health diagnosis are significantly more likely to be readmitted than females (16.2 percent vs 9.1 percent); this difference does not exist within the non-mental health population.
  • Follow-up for patients after they are discharged from a mental health related inpatient stay remains a difficult area to improve

During his project, Alex created additional metrics to track Hennepin Health’s readmission and follow-up rates over time. Measurement of mental health patients' medication adherence and no-shows for follow-up appointments is now also possible. By observing these measures over time, Hennepin Health will be able to see the effects of initiatives targeted toward the mental health population.

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2015 Leaders in Health Care awards

Hennepin Health is a finalist for two 2015 Leaders in Health Care awards from Minnesota Business Magazine. The program is one of three finalists for the magazine’s Community Outreach Award. And Julie Bluhm, Hennepin Health's Clinical Operations Manager, is one of three finalists for the Champion Award. An average of 200 nominations were received in each award category. Winners will be announced at a gala on October 29. Read more here.

julie bluhm

Julie Bluhm

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