Jimmie Bishop lived a life of homelessness for two years, punctuated by frequent trips to the emergency room as he bounced from crisis to crisis caused by uncontrolled mental illness and addiction.
"When you are by yourself, you think nobody cares about you," Bishop said. Battling depression, he would begin "thinking that nothing is ever going to get better."
But things did change for the better two years ago, after Bishop enrolled in Hennepin Health, a project created by Minnesota's largest county to take health care far beyond the front door of a hospital.
By adding services that have nothing to do with medical care — helping clients find a job or an apartment — the project has shown it can improve patients' health while saving money and greatly reducing the number of times they turn up at the ER in crisis.
"Simply put, we are trying to prevent avoidable hospitalizations and emergency room visits, capture those dollars and invest them in an upstream model of taking care of people," said Ross Owen, Hennepin Health director.
Now its success is drawing attention from national health policy researchers, including a University of Minnesota professor who expects to publish a study on the program soon.
"Hennepin Health is something people are very interested in at the national level," said Nathan Shippee, an assistant professor of public health at the U. "It pulls together a lot of pieces that a lot of programs nationally are doing more in isolation."
Hennepin Health, a branch of the county's proprietary HMO, starts with a challenging population: about 10,000 county residents on Medical Assistance, the state health insurance program for the poor. About half are homeless or at risk of homelessness, and many struggle with mental illness and drug or alcohol addiction. Simply organizing their daily lives — job interviews, medical appointments — can be a challenge.
To do that, the program brings many partners under one umbrella: the county's big public hospital, Hennepin County Medical Center; county social workers and public health staff; the hospital's satellite medical clinics; NorthPoint Health and Wellness Center, and Metropolitan Health Plan, an HMO owned and operated by the county.
Finding housing for some of its homeless members has already yielded significant dividends. Among a group of about 120 members tracked by Hennepin Health who had secured housing, per-person spending on inpatient hospital stays dropped 72 percent and emergency department spending fell 52 percent.
"Being homeless is incredibly traumatic and it is very stressful," said Dr. Danielle Robertshaw, medical director of the county's health care program for the homeless. "There are a lot of patients who just aren't able to fully address their health needs when their lives are just that chaotic."
Altogether, Hennepin Health has helped about 500 members with housing.
Couch surfing
Two years ago, Bishop was on the street and "going from couch to couch, living with friends."
He would get discharged from the hospital after he was stabilized, but the cycle of emergency treatment and release would recur because the health care system wasn't equipped to deal with his chaotic personal life.
"I was in the emergency room probably once every two or three months at least," said Bishop, 50.
After finishing addiction treatment, he signed up with Hennepin Health after hearing about it from others at the county's mental health clinic. Within six months, the program found him an apartment near Loring Park.
"I was trying to get on track myself," he recalled. "But it was just that little extra assistance that I needed."
Today, the crises that led him to the emergency room have abated and instead he sees a primary care doctor for his medical needs.
Hennepin Health had an incentive to watch ER visits and other costly forms of care by its members. As an HMO serving the Medical Assistance population, Hennepin Health is paid a set amount by the state to care for its members.
Using electronic medical records, it identifies the most at-risk members — about 7 percent of its membership base — who generate the most costs.
Although the program's most complex cases require a hands-on, staff intensive response, Hennepin Health's approach has so far saved money despite investing in care coordinators, social workers and other forms of assistance.
While it devotes most resources to the riskiest cases, the program also emphasizes strong primary care coordination for all 10,000 members, including screening members for social or behavioral problems that could develop into costly problems over time.
Lives transformed
Hennepin Health also works with nonprofit organizations where its members can turn for help.
One organization, Rise, provides individualized job services. It does everything from career planning, arranging interviews and writing resumes to negotiating job offers.
"We see time after time where people's lives have been transformed by going to work, not just in terms of their health but in terms of their well-being," said Robert Reedy, Rise's director of vocational services.
Like many other players in American health care, Hennepin Health is now waiting to see if government health programs will change significantly under the incoming Trump administration. Some Republicans in Congress have suggested that Medicaid could become a block grant, where each state receives a fixed annual sum of money, rather than having the federal government share each state's outlays on health care for the poor.
"If Medicaid converts to a different structure, like block grants, it calls into question our business model," said Owen, who noted that programs like Hennepin Health actually save money by investing in prevention.
"We have been much more efficient with taxpayer dollars across the board by intentionally managing this population," he said.
As for Jimmie Bishop, he's now going to college and wants to become an addiction counselor.
"Hopefully I can help people who were in my position," he said.
Reporting for this story was supported by a grant from the Commonwealth Fund through the Association of Health Care Journalists.
Glenn Howatt • 612-673-7192
