People are complicated, and helping them get — and stay — healthy requires support in all aspects of their lives.
Jennifer DeCubellis, Minnesota Department of Human Services assistant commissioner of community supports, knows this better than just about anyone. She came to the state from Hennepin County, where, as assistant county administrator for health, she headed Hennepin Health, a pilot program for high-risk, high-cost Medicaid patients. The program took what DeCubellis calls a “whole-person” approach to clients with a multidisciplinary care team that focused on supporting key elements of their lives — like housing, health care, transportation and employment — that contribute to overall health.
In her role at DHS, which was created this year, DeCubellis has been charged with bringing disparate state divisions together to create new supports for Minnesotans, many who face addiction and mental health concerns. Her administration includes mental health services for children and adults, alcohol and drug abuse services, services for people with disabilities, deaf and hard-of-hearing services and HIV/AIDS and housing.
DeCubellis explained that her division’s wide range is designed to address the complex lives of the people they serve. She believes rearranging the way the state approaches services will improve care, reduce waste and save money.
“It’s a whole-person approach. We are looking at the things that people need to live successfully in their communities, the things they need to support general health and wellness. If we are able to touch all aspects of their lives, we are able to help them in a more lasting way.”
DeCubellis talked to me earlier this week about her job and her hopes for the future.
MinnPost: You started this job on January 2. Do you feel like you’ve settled in?
Jennifer DeCubellis: When I was at Hennepin County, they told me I could consider myself a newbie for two to three years. Here at the state, they said I’d have 90 days to get settled in. So I’m no longer a newbie here. Not even close.
MP: Assistant commissioner of community supports is a new position at DHS. Could you describe your areas of focus?
JD: This position brings together several areas that in the past weren’t under the same administration. We are bringing together chemical health and mental health and disability services, which includes HIV-AIDS and autism. Deaf and hard-of-hearing services has also been added to this group, and another new area is housing, which wasn’t part of the state system until now.
MP: That’s a wide range of focus areas. Why are have they been brought together under one umbrella?
JD: We’ve brought them all together because we think these are all areas that directly impact the quality of people’s lives. We think it is key to have these systems working together in order to improve people’s lives along a continuum. We’re not changing the programs, but we’re making sure that they are all working together.
We want to create programs that wrap around people. We want to create a continuum of care that doesn’t just drop people between programs. We want a system in this state that operates from a whole-person perspective.
MP: Did your work with Hennepin Health make you a particularly appealing candidate for this job?
JD: I do believe that my work with Hennepin Health was of interest to Commissioner [Lucinda] Jesson. At Hennepin County, we weren’t working within a siloed system, and that was appealing. We were having payers work directly with systems that in the past had been set aside and separate with their own funding streams. We brought them together to say, “We need to use our dollars smarter.” And that worked.
What I think commissioner Jesson is saying is, “Let’s pull together all of the state systems that touch individuals’ lives in different ways. Then we can align them all here, under one area.”
MP: Is this combined approach to services unusual? Has it been tried in other states?
JD: I would say that Minnesota tends to be ahead of the curve in a lot of areas. Our disability services are known as national leaders. When we go to national conferences, our health care and mental health and chemical health services are seen as leaders, too. With this new approach, we’re making sure that we are using best practices and breaking down silos of funding and program streams to make sure we are using our dollars smarter. That is a new approach that hardly any other state is taking.
MP: It sounds like you have made some big changes in your first few months on the job. How has that been received inside and outside your department?
JD: Honestly, at first, everybody worried, “What do these changes this mean to me?” It’s natural. They thought, “Am I going to lose my piece of the pie?” Change makes everyone worry about the potential negative impacts. But in the last few months we have changed that story dramatically. People are coming together in a natural way now, and they can see that we are making a positive impact on people’s lives.
I just met with a group of chemical health stakeholders. People who haven’t historically worked with one another are working together now. It’s all in the name of helping people who need our help. For instance, there is a group in Deaf and Hard-of-Hearing Services who work with young people with mental health needs. These young people had been on waiting lists for some specific mental health services for a very long time. By working directly with people at Mental Health and figuring out how we can bridge the gap, they have been able to make sure we meet the critical needs of these youth and get them enrolled in these programs.
MP: Is working together in these new arrangements energizing?
JD: Historically, most people have been focused downward, looking at their own departments. It’s natural, but we are moving away from that. When we looking at the continuum of care, when we come together and figure out how we can close gaps for the people we serve, we are forming a true partnership. It’s exciting.
At Hennepin Health, I called it “Heads-Up Healthcare.” When people take a pause from what they are doing and look up to see the impact of their work on the lives of others, they see the potential problems that lie ahead. They can figure out how to work with others to solve those problems, and they have more satisfaction and are more inspired by their work.
MP: Is this “looking down” approach typical in health care?
JD: This happens all the time in health care. People are busy and they tend to keep their heads down and do the work that’s part of their program. But they forget that patients’ lives really aren’t that simple. Individuals have a lot of needs that stretch across departments. I could be working in the best program ever, but if I weren’t lifting up my head and looking at the person I’m serving as a whole human being, I might just drop them the second they leave my program. But if I did that, I could lose 100 percent of the ground we gained with those we’re serving. What we’re working on is building bridges between programs, so that people will be served seamlessly. This way we can really make positive changes for everyone.
The goal is to take a “whole-person” approach instead of a “program” approach. A program isn’t going to be successful in impacting a person’s life unless you look at their whole lives and understand every aspect that needs to be addressed.
MP: Can you tell me more about what it means to take a “whole-person” approach to integrating health care with other services?
JD: Keeping somebody healthy takes more of a whole-system, or a “whole-person” approach. Let’s look at physical health and mental health. We have historically carved out physical health and mental health as these two separate things, but the truth is you can’t be truly healthy if your brain is not functioning as it should be. It’s all connected. We are complicated beings.
You can’t stabilize a person who is manic, for instance, if you aren’t also treating their blood pressure. And if they don’t have stable housing and access to other services, they are going to have a hard time feeling emotionally healthy. You aren’t going to gain ground in their recovery if you don’t look at everything that’s involved in helping an individual achieve optimal health. If we can take a system approach we can get stronger outcomes for people.
MP: This approach sounds expensive.
JD: In the long run it actually saves money. At Hennepin Health, we went by the motto of “Smart Government.” We wanted to create incentives that work and eliminate waste. We’re trying to make sure our dollars are spent wisely. Cooperation lowers the odds of duplicating services. By working together, we were able to reduce costs for people, but more important than that, we were also able to see better outcomes for lower costs.
MP: Tell me more about your professional background.
JD: My background is in special education. My first job out of college was in a Montessori program in Chicago. I was working with 8- to 21-year-olds in special education all in one classroom.
They were put in an alternative program. I was featured on the front page of the newspaper for all of a getting some great individual outcomes for these kids. After that, I was called in to speak with the principal because what I was doing was not promoting the school’s model. They didn’t like that my approach — which did not fit their model — was featured.
I felt that the program’s model didn’t work for my students. My work there taught me early on that there is not always just one way to achieve a goal. I ended up resigning that program and going back into clinical psychology.
I’ve learned that my passion is about systems work. How do you give the people the right tools to be successful rather than be wed to one model? That one-size-fits-all model doesn’t always work. It needs to be a flexible and innovative approach.
MP: Are you satisfied with what you’ve been able to accomplish so far?
JD: Every quarter, I look back at what I have accomplished and what I need to accomplish for the next quarter. I would say that one of the big accomplishments has been changing the discussion about our work, making sure it is about the people, not the programs. Every time we make a policy, we want it to be centered on helping people. If our work is just about checking off a box, then we haven’t accomplished what we set out to do. We want to touch lives.