A group of CEOs from 13 of Minnesota’s largest health care systems — organizations that provide care to some 80 percent of state residents — have announced plans to collaborate to develop solutions for two of the state’s most pressing social concerns.
The group, known as the Minnesota Health Collaborative, will devote time and resources to addressing opioid overuse and mental health treatment.
An extension of the Institute for Clinical Systems Improvement (ICSI), a Bloomington-based collaboration of 50 medical groups and hospitals representing 8,500 clinicians in Minnesota and surrounding areas, the Minnesota Health Collaborative represents a well-established statewide ethic of cooperation among health care providers, said HealthPartners CEO Andrea Walsh.
“We’ve had a long history in Minnesota of health care organizations coming together to provide better care for our patents and members,” Walsh said. “We’ve found that by sharing information and working to solve problems together, we are able to spread best practices and tackle tough issues.”
That history of collaboration sets Minnesota apart, added David Herman, M.D., CEO of Duluth-based Essentia Health.
“This state is unique in that that people have a culture and a tradition of working together even when payers and providers are in direct competition with each other. We’re willing to work together to make health care better in the state Minnesota.”
Tough issues addressed
The two issues that the Minnesota Health Collaborative has chosen to address are some of the thorniest around, Walsh acknowledged.
“I can’t think of a more tough issue than what do we do around the epidemic of opioid addiction,” she said. “And improving access to mental health treatment also represents a serious challenge.”
The state’s health care community has long struggled with identifying the best way to provide appropriate care for people with mental illness. Perhaps because of long wait times for inpatient treatment, the first stop for many people in acute mental health crisis is often the emergency department at their local hospital. These facilities are often overcrowded and ill prepared to treat patients with mental illness. Health Collaborative members say they would like to use their collective power to influence the creation of new in-patent mental health care facilities and to rewrite treatment protocols for people in the early stages of mental illness.
“Our collaborative work around mental health has focused less on medication and more on how do we identify better options for patients who present in acute crisis at our hospitals,” Walsh said. “In the EDs, patients face long delays in accessing care. We know we’ve got a lot of work to do within Minnesota to make sure that people with mental health needs can access care at the right level. Together, we think we can help create significant change.”
Establishing prescription standards
On the issue of opioid overuse, the 13 systems have already collaborated to develop a set of shared community prescribing standards that are now in effect or soon to be in effect with several systems.
The goal behind creating these standards is to lower the number of people at risk of developing opioid addiction by limiting instances when the drug is prescribed, and when prescribing opioids are deemed appropriate, providing a limited amount of the drug to patients. Making the standards as universal as possible reduces the supply of the drug in the state.
“Our belief as a group is that we should implement a shared community standard for those first opioid prescriptions,” Walsh said. “Our objective in to reduce the number of patients at risk for developing substance use disorder statewide by prescribing the smallest amount of opioid-based pain medication possible.”
Minnesota Health Collaborative opioid prescribing standards are:
- For acute prescribing, the standard will be: Starting with non-opioid therapies (e.g. NSAIDs, acetaminophen) whenever possible. The first opioid prescription for acute pain should be the lowest possible effective strength of a short-acting opioid, not to exceed 100 morphine milligram equivalents (MME) for the total prescription. Three days will often be sufficient.
- For post-operative prescribing, collaborative members are testing a nuanced approach to post-operative opioid prescriptions, which divides procedures into five levels and assigns an appropriate level of MMEs for each level.
Members of the 13 systems have all pledged to abide by these standards. Some larger organizations like HealthPartners have already put them into effect; others are in the process of shifting processes to fully comply.
“Each of the systems are in a different place in implementing these community standards,” Walsh said. “At HealthPartners, we’ve put the standards in place across our organization and already seen good results. We’ve reduced the number of opioids that are prescribed across our system. We’ve been able to offer alternative options to our patients to help them manage their pain.”
Benefits of collaboration
The hope is that eventually, this “we’re all in it together” approach to social crises will eventually lead to improvement and innovation statewide. And when systems work together, they can learn from the failures — and successes — of their peers.
Several years ago, at Essentia Health, for instance, careful monitoring of prescription histories led physicians to note a rise in patients “fishing” for opioid prescriptions. This led to the adoption of Chronic Opioid Analgesic Therapy (COAT), a treatment program designed to help people with a history of chronic opioid use reduce or eliminate their dependence on the medications for non-cancer-related pain. The program has proved effective for at-risk populations.
Herman hopes that Essentia’s participation in the Minnesota Health Collaborative will be a way to pass this successful program on to other participating health systems.
“Essentia Health was one of the first organizations to build an application into the medical record so that providers can go in to a patient’s history and see how many opioids have been prescribed already,” Herman said. “We came up with a set of common standards, and hopefully others can learn from what we’ve already established.”
Working together is the best way to take on such daunting problems, Walsh said. If health care systems can learn from others’ successes and put those standards into practice, all Minnesotans stand to benefit. “We have a long history of implementing community standards in other areas of care like diabetes or primary care,” she said. “We’ve got a track record as health care systems in developing community standards and putting them in to practice.”
This ethic of cooperation over competition serves the people of this state well, she said: “Minnesota has some of the highest quality care in the nation. It is due in part to the fact that our health care organizations work so well together.”