Health care payment and delivery models that challenge providers to be accountable for outcomes have fueled interest in community-level partnerships that address the behavioral, social, and economic determinants of health. We describe how Hennepin Health--a county-based safety-net accountable care organization in Minnesota--has forged such a partnership to redesign the health care workforce and improve the coordination of the physical, behavioral, social, and economic dimensions of care for an expanded community of Medicaid beneficiaries. Early outcomes suggest that the program has had an impact in shifting care from hospitals to outpatient settings. For example, emergency department visits decreased 9.1 percent between 2012 and 2013, while outpatient visits increased 3.3 percent. An increasing percentage of patients have received diabetes, vascular, and asthma care at optimal levels. At the same time, Hennepin Health has realized savings and reinvested them in future improvements. Hennepin Health offers lessons for counties, states, and public hospitals grappling with the problem of how to make the best use of public funds in serving expanded Medicaid populations and other communities with high needs.

Objective. To project the impact of population aging on total U.S. health care per capita costs from 2000 to 2050 and for the range of clinical areas defined by Major Practice Categories (MPCs). Data Sources. Secondary data: HealthPartners health plan administrative data; U.S. Census Bureau population projections 2000–2050; and MEPS 2001 health care annual per capita costs. Study Design. We calculate MPC‐specific age and gender per capita cost rates using cross‐sectional data for 2002–2003 and project U.S. changes by MPC due to aging from 2000 to 2050. Data Collection Methods. HealthPartners data were grouped using purchased software. We developed and validated a method to include pharmacy costs for the uncovered. Principal Findings. While total U.S. per capita costs due to aging from 2000 to 2050 are projected to increase 18 percent (0.3 percent annually), the impact by MPC ranges from a 55 percent increase in kidney disorders to a 12 percent decrease in pregnancy and infertility care. Over 80 percent of the increase in total per capita cost will result from just seven of the 22 total MPCs. Conclusions. Understanding the differential impact of aging on costs at clinically specific levels is important for resource planning, to effectively address future medical needs of the aging U.S. population.

The objective of this study is to evaluate the effectiveness of a small group intervention in improving knowledge, feeling of control, and behaviors related to self-management of diabetes. The intervention includes educational content on diabetes self-management as well as discussion of attitudes, feelings, and motivations about living with diabetes. The authors randomized volunteers into an intervention group that participated in the small-group learning activity and a control group that received a diabetes self-care book. A survey was conducted by telephone before and after each intervention and the difference in change over time between the groups was assessed for each outcome. Compared to the control group, participants in the small-group activity reported significant changes on all three outcomes adjusting for demographic differences between the groups. Because facilitating the learning session does not require clinically trained personnel, this type of intervention could broaden the resources available to people with diabetes.

The purpose of this study is to estimate the impact of population aging on medical costs over the next five decades in the United States. Specifically, we focus on the impact of aging on the chronic and/or expensive conditions most often included in disease management programs: coronary artery disease (CAD), congestive heart failure (CHF), diabetes, asthma, pregnancy, psychiatry, and chemical dependency. We apply estimated age-, gender-, and condition-specific annualized costs to the projected US population in each age and gender group for future years, through 2050, to provide an estimate of future healthcare costs. The primary data sources are pooled claims and membership for 2002 and 2003 for HealthPartners, a large midwestern health plan. Secondary sources are US annualized medical costs for 2003 and US Census Bureau demographic projections for the next five decades. Using the Episodes Treatment Group (ETG) grouper from Symmetry, we grouped HealthPartners data into 574 clinically meaningful episodes of care units. We then aggregate selected ETGs into the conditions reported in this study. Using data for all types of health services, we find that aging will have a greater impact on per capita costs for diseases where the ratio of costs for older versus younger ages is greater, such as CHF, CAD, and diabetes. In addition, we project that aging of the US population will actually reduce per capita costs for pregnancy and infertility, chemical dependency, and psychiatric conditions. Aging will have more of an impact on care for specific chronic diseases. These projections can inform health policy and planning as providers of health care, health plans, disease management vendors, and the government anticipate meeting future US healthcare needs.

Missed appointments have been linked to adverse outcomes known to affect racial/ethnic minorities. However, the association of missed appointments with race/ethnicity has not been determined. We sought to determine the relationships between race/ethnicity and missed appointments by performing a cross-sectional study of 161 350 patients in a safety net health system. Several race/ethnicity categories were significantly associated with missed appointment rates, including Hispanic/Latino patients, American Indian/Alaskan Native patients, and Black/African American patients, as compared with White non-Hispanic patients. Other significant predictors included Mexico as country of origin, medical complexity, and major mental illness. We recommend additional research to determine which interventions best reduce missed appointments for minority populations in order to improve the care of vulnerable patients.