'Will You Lose?' campaign lays out HCMC's fiscal challenge -- and its potential effects throughout Minnesota

Last month, freelance creative designer Blair Fellman stared down a tall order from Hennepin County Medical Center.

Though Fellman worked previously on the Save This Brain campaign to tout HCMC's brain injury programs, this time he was being asked to help preserve health care for the poor at the state's largest public safety-net hospital.

And he was being asked to do it with a $30,000 marketing budget.

"I gulped real hard," said Fellman, whose business is called Creative Wingman. "Hmm, I thought, how do we try to solve this problem? It's so much bigger than a marketing problem. The important thing is to energize the base out there and get people talking so that it all starts to snowball."

The result is the "Will You Lose?" campaign, which includes a website by the same name that went live Nov. 20 — along with social media (Facebook, Twitter, YouTube), some print advertising and a couple of upcoming billboards.

The website includes an interactive "fallout" map, which quantifies how HCMC serves each congressional district in Minnesota, a place for people to share their stories, and video clips of a 1976 film about HCMC narrated by the late Vice President Hubert Humphrey, a former Minneapolis mayor. "Webisodes" also are in the works, Fellman said.

An estimated $42 million loss in 2010
HCMC, in downtown Minneapolis, faces an estimated $42 million loss in state funding in 2010 and $50 million in 2011 — less than 10 percent of its $550 million annual budget — because of the scheduled March 1 elimination of the General Assistance Medical Care program. GAMC currently covers medical care for 36,000 impoverished uninsured adults without dependents in the state. Gov. Tim Pawlenty used his line-item veto last spring to cut $381 million in second-year funding and has said the program won't be restored in its current form.

The prospect of losing GAMC funding has mobilized advocates ranging from hospital CEOs to homeless-shelter workers and their charges. And the predicament has led to campaigns ranging from videos of GAMC enrollees on St. Stephen's Human Services website to a weekly email from Regions Hospital — the state's second-largest safety net hospital — featuring a GAMC patient's story, the costs of caring for the patient and the number of days to the start of the Legislature.

Now there's the "Will You Lose?" campaign. Since the launch, the site has drawn 1,800 unique visitors, 650 Facebook fans, 70 Twitter followers and 100 names on its e-list. It's unclear how many dollars have been raised through the donate button.

HCMC's role in state
HCMC's new Hennepin Health Foundation awarded a $30,000 grant to call attention to not only the loss of GAMC funding but also to show HCMC's "unique statewide role," said Tom Hayes, director of public relations for HCMC.

"We just feel it's important that we illustrate what's at risk," he said.

Besides caring for the poorest residents, he said, HCMC trains thousands of medical professionals in Minnesota and offers a Level I trauma center, the most critical-care burn beds, a hyperbaric chamber and poison control, among other services. 
 
"HCMC isn't just this hospital in Minneapolis," Fellman said. "It affects a lot of people all over the state, along with offering state-of-the-art care. … A lot of people think HCMC is an inner-city hospital that treats the poor, and there's so much more than that."

A 'fallout' map

But how does a designer show that effectively? Fellman chose a "fallout" map, whose concentric circles resemble those Cold War impact maps of an atomic blast. As a user rolls a mouse over a congressional district, these details pop up: number of visits to the emergency room, number of uninsured patients and the cost of caring for them, and even a tally of calls to the poison control center.

The heaviest fallout is in the Twin Cities, where more than 40 percent of the state's GAMC enrollees seek care — many of them at HCMC.

Early this month, the Minnesota Department of Human Services announced that GAMC enrollees on March 1 would be switched to MinnesotaCare, an insurance program with sliding-scale premiums and co-pays for low-income Minnesotans. Premiums are to be paid by counties for six months, which means Hennepin County could be on the hook for more than $600,000, said County Board Chairman Mike Opat.

The problem with the switch, Opat and critics say, is that MinnesotaCare doesn't work well for a transient population (28 percent of GAMC enrollees are homeless). MinnesotaCare also has a $10,000 annual cap on hospitalizations, and it doesn't offer immediate coverage and reimbursement as GAMC did for uninsured patients who seek care at a hospital emergency room.

Delayed reimbursement
In effect, after GAMC funding ends March 1, care for new uninsured patients won't be reimbursed until they are declared eligible for MinnesotaCare, said DHS spokeswoman Karen Smigielski, who acknowledged the eligibility process could take some time.

In the interim, providers are on the hook for paying for that care. At present, 5 percent of GAMC patients at HCMC require hospitalization, but their care constitutes 70 percent of GAMC payments to HCMC, Hayes said. Half of the hospital's GAMC patients are seen at HCMC clinics.

Since HCMC lost $12 million in funding in a state unallotment in December 2008, the hospital has cut 200 of its 4,700 jobs through attrition, eliminating open positions and layoffs, and could cut another 150 to 200 jobs in 2010, he said.

The Hennepin County Board of Commissioners is considering a 3 percent property tax increase to help cover the gap in funding for HCMC, which would raise about $18 million, Opat said. (Hennepin County taxpayers provide 5 percent of the hospital's $550 million annual budget.)

But even with the potential new tax revenue, job cuts and elimination of some programs, HCMC is left with a $25 million funding gap next year if a GAMC solution isn't found after the Legislature convenes in February, Opat said.

Coalitions seeking solutions
Community and safety-net provider coalitions have met in recent months to come up with alternatives to present to the Legislature. And HCMC and Hennepin County officials have been meeting with other hospital representatives.

"None of us are under the illusion that GAMC will be restored in full," Opat said, adding he expects a proposed solution to be announced in coming weeks.

If no GAMC funding is restored, HCMC would no longer provide "non-emergency outpatient pharmacy services or clinical care" for uninsured residents outside of Hennepin County, Hayes said. Also on the chopping block: the outpatient cardiac rehabilitation program and the senior care clinic, the latter of which would be folded into another clinic.   

Meanwhile, HCMC is trying to build up the coffers of its new foundation to help cover uncompensated care. A "Together We Can" campaign raised $270,000 in employee contributions through payroll deductions next year, he said.

And there's hope that the community will get involved and/or donate to the Hennepin Health Foundation after seeing HCMC's reach described at willyoulose.org.

Casey Selix, a news editor and staff writer for MinnPost.com, can be reached at cselix[at]minnpost[dot]com. Follow her on Twitter.