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'This is an absolute crisis': Essentia leaders talk mental health care, opioids, high costs

Essentia Health executives Friday described what the provider was doing to tackle some of Minnesota's thorniest problems, including the opioid abuse epidemic, mental health care, and extreme health care costs.

Essentia Health Central Region President Adam Rees updates community members on Essentia's operations Friday morning at Essentia Health - St. Joseph's Medical Center in Brainerd as Dr. Henry Pate, Essentia Chief Medical Officer, looks on. Zach Kayser/Brainerd Dispatch
Essentia Health Central Region President Adam Rees updates community members on Essentia's operations Friday morning at Essentia Health - St. Joseph's Medical Center in Brainerd as Dr. Peter Henry, Essentia Chief Medical Officer, looks on. Zach Kayser/Brainerd Dispatch

Essentia Health executives Friday described what the provider was doing to tackle some of Minnesota's thorniest problems, including the opioid abuse epidemic, mental health care, and extreme health care costs.

The Essentia leaders addressed a community gathering of legislators, city officials, businesspeople and other community notables at Essentia Health-St. Joseph's Medical Center in Brainerd.

In response to a question on what Essentia was doing for mental health, Adam Rees, Essentia Central Region president, spoke bluntly.

"This is an absolute crisis across the whole state, if not the whole country," he said.

Typically in the universe of health care, Minnesota ranks near the top of all 50 states, Rees said-except when it comes to mental health care.

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"We are rated 50 out of 50, we are the bottom of the barrel," Rees said.

Mental health reform was Essentia's No. 1 priority when talking to legislators, Rees said. In recent years, the state started reinvesting in mental health care, but much more money is needed, he said. The current lack of mental health care available means people in a mental health crisis show up in Essentia's emergency department and in encounters with police.

A Crow Wing Energized survey showed one in four adults in the county is struggling with some form of mental health issue, Rees said. The single most important thing any given person can do to help the care crisis is to de-stigmatize mental illness, he said.

"People are afraid to tell even their own family members what they're struggling with," Rees said.

Dr. Peter Henry, Essentia Health System chief medical officer, described more concrete steps the provider is taking to combat mental illness. Essentia is looking into adding additional social workers who can immediately connect patients to mental health professionals, he said.

"We're looking at partnering with some of the mental health care providers right here in our community, to embed those people in our clinic," Henry said.

Progress on painkillers: 40 percent drop

Henry is also one of the main brains behind an inter-hospital initiative that began about a year and a half ago, with the hope of tamping down the prescriptions of opioids-that is, painkillers. If used improperly, they can lead to addiction, crime and death. Morrison County has 160 known heroin addicts, Henry said, and he estimated that Crow Wing County had an equivalent number. Heroin addicts often start out as prescription painkiller users.

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To make sure less opioids are prescribed in the first place and prescriptions are monitored when painkillers are in fact prescribed, Essentia and its partner hospitals have implemented programs that track prescriptions and shift to alternative treatments. Essentia handed over its protocols on curbing opioid prescriptions and misuse to other hospitals for free, so they can duplicate the program in their geographical area.

So far, Essentia's program has worked: it caused a nearly 40 percent reduction in the amount of opioids prescribed, Henry said.

A new post-surgery opioid reduction program would be implemented within the next month or so, he added.

The addiction treatment effort could benefit from the drug Suboxone, which helps people come down from opiate or heroin addictions, Henry said. However, government regulations place an undue burden on providers by requiring detailed paper logs on how they dispense the medication. It takes five years or more to wean someone off illicit drugs using Suboxone, Henry said, but the results are worth it.

Your bill shouldn't be painful

There's another practical benefit to hospitals and patients from reducing opioid distribution: drugs are expensive, and the less drugs people need, the less it costs to everyone. Other than labor costs, pharmaceuticals are the single highest expense to Essentia, at 10.6 percent of total costs.

Essentia also has a broader-based program designed to lower medical costs to its Medicare patients: the Essentia system is classified as an Accountable Care Organization, or ACO. It means caregivers are held more accountable to patients and the government. For example, consider a hypothetical Brainerd senior who has their primary care doctor at Essentia but goes to Florida in the winter, where health care is more expensive. Furthermore, let's say that while in Florida, that Brainerd resident is involved in an unfortunate altercation with a pelican. In an ACO, the resulting health care costs would still be "attributed" to their primary doctor in Brainerd, even though they received the care in Florida. Since that counts towards the Minnesota patient's "total cost of care" examined by the Medicare program, the doctors and hospitals have an incentive to get that patient the cheapest and best options possible, which ideally are local because they can control how much the patient pays. That's in addition to the obvious moral incentive of helping the community and patients by keeping health care costs down.

Essentia is a stage three ACO, meaning whatever amount of money it saves Medicare patients relative to benchmarks, gets split between it and and the government. However, if Essentia falls under the benchmark, the reverse happens and it gets penalized relative to how much it went over.

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