Minnesota Department of Human Services commissioner pays visit to Worthington

WORTHINGTON -- Counties from across the state, and particularly those in southwest Minnesota, can share horror stories about clients on publicly funded health care over-using and abusing the system. At the same time, stories can be told about clients who can get the help they need in a neighboring county, but who are denied that access because the state does not reimburse agencies for transportation costs.

In essence, the system is broken and in need of a major overhaul. The healthcare industry is not sustainable on its present course.

While that was part of the message delivered to Minnesota Department of Human Services Commissioner Lucinda Jesson during a Friday morning meeting in Worthington, county commissioners and human services leaders from a 12-county area also brought forth what they hope can be part of the solution.

Since 2005, counties from across southern Minnesota have shared ideas on ways to improve the delivery of health services to low-income and disadvantaged residents. They've watched as neighboring counties have banded together in the PrimeWest and South Country Health Alliance to improve purchasing power and now, they've come up with a plan of their own.

The Southern Prairie Community Care (SPCC) joint powers has been signed by 12 counties, including Rock, Nobles, Jackson, Murray, Cottonwood, Lincoln, Lyon, Redwood, Yellow Medicine, Chippewa, Swift and Kandiyohi. Another three counties --Martin, Faribault and Watonwan -- are still considering joining the group.

"We have a history of working together," said Richard Larson, a Kandiyohi County Commissioner. "We look forward to the future. I think we're on the right wave with community care, and I think we're in a good position right now to take advantage of some of these things."

The SPCC wants to have more local control in the decision-making process and put more emphasis on proactive, rather than reactive, care for its residents.

Jesson commended the group for developing an innovative model in the health purchasing system.

"We have so much to learn as a state from what is happening in rural Minnesota," she said. "We have the opportunities to get more and better coverage for people. We're facing an aging population, and we're in an economy that is struggling. What that tells me is we've got to change."

Minnesota's health reforms of 2008 have "set the stage" for what Jesson says the state wants to do now, including how it purchases health care.

"We need to change the incentives for intervening early, for prevention and for making sure (people) get the care they need," she said.

A diabetes prevention program under way in the metro area is testing the effectiveness of those incentives, and Jesson said counties and collaborations need to try different things to see what works.

Scott Leitz, Minnesota's assistant commissioner of health care, said by focusing on keeping people healthy, the state will see savings, which will then be shared with health care providers.

"Your key concepts are a wonderful road map of where we need to go," Leitz told the more than 25 people in attendance. He said the federal government has given states a "real opportunity" with innovation grants to provide states with funding of new models to support population health.

"We want the ability to go forward and contract directly with counties rather than private care," Jesson added.

Keith Halleland, speaking on behalf of SPCC, said the group has developed several strategies to make a multi-county health partnership work, from payment reform to improved public reporting of health plan and provider performance.

"In 2010, the legislature enacted the law authorizing DHS to approve alternative and innovative health care delivery systems organized by providers ... for groups of patients for an agreed upon total cost of care," Halleland said.

What SPCC needs now is authorization from DHS to move its plan forward.

"We think there are several opportunities in this project," said Mary Fischer, executive director of SPCC. "Our model values transparency and true collaboration."

At the same time, she pointed out some concerns, most notably the ability to share data between the partnering healthcare agencies.

"We see this is our biggest body of work -- to break down the barriers," Fischer said.

Jesson said there needs to be some legislation at the state level to make data sharing easier for counties wanting to collaborate and offered her assistance to SPCC to work on that effort.

"We want to help out where we can," she said. "We really are excited about the opportunities here."