- How can a program help Medicaid beneficiaries with debilitating social and emotional problems?
- What’s the evidence that such a program can improve outcomes and save costs?
This resource is a case study of Hennepin Health, a safety-net accountable care organization (ACO) in Hennepin County, Minnesota, that aims to reduce costs and improve outcomes for Medicaid beneficiaries with complex needs, including those with serious mental illnesses and substance abuse problems.
- Hennepin Health receives per-member per-month Medicaid payments to cover the costs of medical, dental, and behavioral health services.
- The ACO’s partners — medical providers, the county’s human services and public health agency, and a Medicaid managed care plan — exchange medical, behavioral health, and social service information via a shared electronic health record.
- After identifying patients most likely to incur high costs, the ACO assigns them a primary coordinator — either a community health worker, nurse, or a social worker — who works to stabilize their lives and encourages them to seek care for neglected health conditions.
- Those deemed at highest-risk — the 3 percent who account for 50 percent of all medical costs — are referred to a specialized clinic for more intensive intervention. The ACO also partners with nonprofits and social service agencies to meet nonmedical needs.
- Emergency department visits decreased by 9.1 percent between 2012 and 2013, while hospital admissions remained stable. Medical costs have fallen on average about 11 percent per year since 2012, enabling the ACO to achieve savings even after a $1.6 million investment in new staff and data infrastructure.