Minnesota Accountable Community for Health Saves Money through Local Opioid Prevention Initiative
As the opioid crisis continues across the country, state health policy makers understand that health is more than health care. In order to maximize health benefits, and save on costs states are looking for innovative ways to address this crisis. Several states are implementing ACH models that emphasize prevention and work with community and cross-sector, cross-agency partners to address health-related social needs such as safe and healthy housing and access to wholesome food. In Morrison County, Minnesota, the Unity ACH — one of 15 ACHs created by the state and supported by Minnesota’s State Innovation Model (SIM) Testing grant — saved Medicaid $2.7 million through reduced emergency room visits and prescription opioid claims. The innovative model, which takes a whole-person approach to prevention, may hold helpful lessons for state policymakers seeking to develop sustainable community-based prevention initiatives in their own states.
Minnesota’s designated ACHs are community-based organizations with flexibility to implement projects that meet the clinical and social needs of defined populations, such as individuals who are homeless, developmentally or intellectually disabled, or living with chronic conditions like diabetes or mental illness. ACHs in Minnesota are locally planned and governed by a leadership team comprised of local providers, community partners, and members of the population served. Each ACH in Minnesota received $370,000 in start-up funding for a two-year period (2015-2016) through Minnesota’s SIM grant. Accountable Care Organizations (ACOs) are the only entity with whom the state requires ACHs to partner. This partnership also enables ACHs, such as the Unity ACH, to develop sustainability models and gain access to crucial health care data.
The Unity ACH Model: What It Is and Why It Is Working
The Unity ACH includes local health care providers, pharmacies, insurers, local public health and social services agencies, and local law enforcement. The model is centered around a Controlled Substance Care Team that works closely with providers and patients to coordinate patient care and help patients safely manage their medications. The care team also identifies the health-related social needs of patients and connects them with services for housing, transportation, insurance, and mental health. The Unity ACH initiative initially targeted Medicaid beneficiaries age 55 and older with multiple opioid prescriptions. After the first year, the initiative broadened its target population after realizing that the problem was not confined to older beneficiaries.
- The Unity ACH reports early Medicaid savings of $2.7 million over eight months (from September 2015-April 2016) among Prepaid Medical Assistance Program (PMAP) patients due to fewer opioid claims and ER visits. The ACH gauges savings by measuring reductions in the number of opioid prescriptions filled and tracking emergency department diagnoses for therapeutic drug monitoring. The percent of Medicaid beneficiaries with eight or more opioid claims declined in the area served by the program from 14.8 percent to 12.8 percent in one year’s time.
- Unity ACH has been able to calculate cost savings by leveraging data sharing with its ACO partner, which is contracted to serve Medicaid patients in Morrison County, and therefore has access to cost and utilization data for these patients.
- This cost savings gained the attention of U.S. Congressman Rick Nolan. Upon the Congressman’s invitation, on July 12, 2016, the Unity ACH team participated in a Congressional briefing in Washington D.C., to present this successful care model.
- The Unity ACH model has also led to local-level policy change. Providers are standardizing their screening processes and increasingly using the Minnesota Prescription Monitoring Program, an information-sharing system that helps providers track patients’ prescriptions, to inform their prescribing practices.
Demonstrating financial impact and making the business case for sustaining grant-supported prevention and population health initiatives outside the scope of Medicaid covered services can be challenging for states. Results can take time to manifest, as long-term improvements to health and well-being unfold at their own tempo, and do not always keep time with budget cycles. Accessing needed cross-agency and cross-sector data can also be a barrier in evaluating programs and determining savings. Even once states demonstrate financial savings, tracing the flow of savings between ACOs, ACHs, Medicaid, managed care organizations, and other delivery system networks is challenging. There may not be a clear model for determining where the savings accrue, or how to reinvest those savings into health programs.
The Unity ACH is addressing many of these challenges, and, together with the state, is currently considering how savings might be reinvested to support health-related social needs such as transitional housing and healthy food. By incorporating a focus on community health within its health care delivery reform, Minnesota may provide a model for other states seeking to reinvest savings in prevention and build community capacity to achieve the Triple Aim of better health for populations, better care for patients, and lower costs.