Quality improvement

For most people, asthma symptoms can be controlled with a combination of medications and avoiding asthma triggers. Many of the most common asthma triggers are related to housing conditions and access to resources. HealthPartners is working with our members to help them identify asthma triggers in their home and figure out what is needed to minimize the impact on their health.

Asthma is a chronic lung disease that makes it harder for a person to move air in and out of their lungs. During an asthma episode, the airways swell and extra mucus makes it difficult to breath, often resulting in an unexpected trip to the emergency department (ED). There is not a cure, but the symptoms can usually be managed by medications and by controlling triggers.

HealthPartners initially identified 211 children on PMAP or MinnesotaCare with poorly controlled asthma, putting them at risk of trouble breathing and potentially needing urgent care or ED for asthma.

HealthPartners worked with a Community Health Worker (CHW) organization to provide in-home education, home assessments and referrals for needed products and services to improve the children’s asthma care and control.

Over the course of 2023 and 2024, HealthPartners referred 82 members for asthma-related CHW services. These services include:

• A social needs assessment and referrals to resources as needed.
• A home assessment to identify potential asthma triggers.
• Education for the parent and child, when appropriate, using the EXHALE strategy. This curriculum includes:
  • Education on asthma self-management
  • Extinguishing smoking and exposure to secondhand smoke
  • Home visits for trigger reduction and asthma self-management education
  • Achievement of guidelines-based medical management
  • Linkages and coordination of care across settings
  • Environmental policies or best practices to reduce asthma triggers from indoor, outdoor or occupational sources

In 2022, significant benefits were added to Minnesota Health Care Programs to provide allergen reducing products for children who are diagnosed as having poorly controlled asthma. The home assessment was vital in identifying issues in the home that could potentially be triggers for the child and cause an asthma attack. The goal was for the CHW to complete the home assessment, identify the products that would benefit the child, and work with the provider to secure an order for the products and the health plan to order the products for the family. However, in practice, the enhanced asthma benefits proved to be a complicated process that we were unable to solve in 2023, and the first children were able to receive the asthma supplies early in 2024.

The CHW communicated the assessments and recommendations for the allergen-reducing products to the member’s primary care provider so the information could be included in the child’s medical record. The CHW encouraged the child’s parents to make sure the child was up to date with all medical care and assisted the family in scheduling a medical appointment with their PCP when necessary. The most common supplies provided to members through this program include:

• Allergen encasements for mattress, box spring and pillow
• Allergen-rated vacuum cleaner
• Dehumidifier and filters
• HEPA single-room air cleaner and filters
• Damp mopping system

Over the two years of this project, 82 children were referred to CHW Solutions for assessment and asthma educational services. This support resulted in an increase in these children attending a well child visit with their primary care provider resulting in an updated Asthma Management Plan based on their current health, and updating their Asthma Control Test, which is an indicator of if their asthma is considered in control.

• Total members referred to CHW for asthma education in 2023-2024: 82
• Accepted CHW services: 19 (23%)
  • Up-to-date ACT: 15 (79%)
  • Asthma Control Test 20+: 12 (63%)
  • Asthma Management Plan in EPIC: 13 (68%)
  • Five members qualified for / received asthma mitigation supplies

The enhanced asthma benefits provided for Medical Assistance members proved to be extremely complicated to access. Several issues needed to be worked through before we were able to provide these supplies to the members working with the CHW.

• Early in the project, it was unclear who was eligible to complete the required home assessment. We sought guidance from the state and others, but lack of clarity created delays.
• We were unable to identify Durable Medical Equipment (DME) providers who were willing to supply the products. Because the demand for these products would likely be quite limited, and as non-traditional supplies, DME providers were unclear that they would be reimbursed for them and were unwilling to keep them in stock. In the end, health plan staff worked directly with a DME provider to order supplies individually as member needs were identified and approved so they didn’t need to be kept in stock.

Members were cautious about accepting the CHW services into their home. Additionally, some members lived with relatives other than a parent and that relative was not interested in the services.

• CHW services are billable only when the child with the medical condition is present, so scheduling needed to happen around school schedules.
• Out of the 82 members referred, 19 members accepted the referral for an acceptance rate of 23%.

This program has proven impactful for the families who have accepted the services offered. Initially limited to a specific zip code, we have expanded the area to allow for additional children to be referred to this ongoing program.

Having a healthy pregnancy is one of the best ways to have a healthy birth and a healthy child. Things like getting early and regular prenatal care and support from ancillary services such as care coordinators or doulas can play a role in helping women have a healthy birth outcome. Women on Medical Assistance and women of color are less likely to receive early prenatal care and other supports and are more likely to have a negative outcome for themselves or their baby. HealthPartners is working to improve access to prenatal care and supports for pregnant women, especially women of color to reduce these disparities.

HealthPartners Healthy Pregnancy program supports members who are pregnant and have a higher risk for complications in their pregnancy. Members who enroll in this program get extra support from a nurse throughout their pregnancy.

• We expanded how we identify women for the program to be more inclusive of known high-risk populations.
• We offer a Healthy Pregnancy assessment where women can answer questions about their current health and their pregnancy, including support services they may benefit from.
• We offer Medical Assistance members an incentive to take the Healthy Pregnancy assessment and an incentive to complete at least three calls with a Healthy Pregnancy nurse.

We created the My Pregnancy experience which offers online education and support to all members during their pregnancy.

• Members regularly receive relevant information based on their answers to the healthy pregnancy assessment and their due date.
• We created content that covers topics important to people on Medicaid such as benefits for car seats, doulas, breastfeeding support, insurance coverage for newborns and postpartum health issues.
• Resources are personalized based on the member’s race and ethnicity, preferences identified in the assessment, and their location in Minnesota.
• We connect members to online educational materials and videos about pregnancy, including information about nutrition, breast feeding, newborn care, mental health and well-being, and pregnancy complications like preeclampsia and gestational diabetes.

Doulas are a covered benefit for women on state health insurance in Minnesota, but a lot of people do not know that. We wanted to make doulas more available to anyone who would like to work with one.

• HealthPartners created a video, Value of a Doula , that explains what members can expect when working with a doula and how to get a referral to a doula. We translated the video into Somali, Spanish and Hmong so more members can learn about this benefit. We also created an educational blog about doulas for the HealthPartners website to help spread awareness of the value of a doula.
• HealthPartners worked with our primary doula agency to certify several more doulas to serve women on Medical Assistance, focused on training doulas who are Black, Indigenous and other women of color. The agency went from having 40% of their doulas being Black, Indigenous and people of color, to 70%. This increases access to doulas of color for women of color.
• We gave grants to two organizations with a doula program so they could cover the costs for continued development of their programs as they grow.
• We educated our staff about the availability of doulas and our provider network about the value that doulas can bring to women, especially women of color.
• We increased the amount we pay for doulas who work with our Medical Assistance members.
• We supported legislation to remove barriers for doulas to bill for Medical Assistance services and increase the reimbursement rate for the service.

To encourage members to complete their postpartum care appointment, we offer Medical Assistance members an incentive to complete their postpartum appointment. We reach out to all members after they deliver to let them know about the incentive and the incentive their child can receive if they get all their immunizations by the time they turn 2 years old.

HealthPartners sent information to our provider network about the disparities that women of color face, the availability of the Healthy Pregnancy program and the value that doulas offer pregnant women.

We collaborated with the other Minnesota Medical Assistance health plans to offer webinars to providers about racism in health care and how to achieve health equity. These webinars were well attended, and people who attended felt they learned new information and skills.

It can be hard to identify and contact women early in their pregnancy to tell them about available services. Sometimes women cannot get scheduled for their first prenatal appointment timely and we do not receive claims until much later, so we do not know they are pregnant.

We often do not have a current mailing address, email address or phone number for members. The Healthy Pregnancy program outreach is phone call based so people may not want to use their limited minutes to talk to the Healthy Pregnancy nurse.

The amount of payment by Medical Assistance for doula services is much lower than for doulas who are privately paid. This discourages doulas from agreeing to serve women on Medical Assistance. The changes to the Medical Assistance reimbursement rate in 2024 should help to alleviate that barrier. However, the process to register with the state as a Medical Assistance provider is very complicated and may still be a barrier for some.

In 2024, a total of 35,494 My Pregnancy messages were delivered with education customized for the trimester of their pregnancy. An additional 11,426 visited the other content and resources on the My Pregnancy site.

• The most common page visited was the benefits page, followed by the delivery preparation page.
• The average time spent on the site per visit was 18.8 minutes.

The HealthPartners rate for women who get prenatal care early in their pregnancy remains fairly steady, but the number of members who seek postpartum care continues to decline. We will continue to educate our members about the importance of this visit for their overall health.

Much of this work started in 2021 and is ongoing. We will monitor prenatal and postpartum care rates and other measures of birth outcomes to see how effective these programs are. We will continue to work with our provider network, our Healthy Pregnancy program and the community to improve pregnancy care and reduce disparities in birth outcomes for all women.

Colorectal cancer screening can find cancer early when it is easiest to treat or even prevent it by removing polyps that could develop into cancer. But many people worry about the screening process. We wanted to make it easy for our members to access an easy, at-home option to screen for colon cancer.

Nearly everyone should have a colon cancer screening beginning at age 45. When colon cancer is caught early, it is easier to treat. Screening can also prevent colon cancer from occurring by removing small growths called polyps before they become cancerous. A screening test can find cancer when there are no symptoms. Screening guidelines have recently changed, so not everyone is aware of when they should begin getting screened for colorectal cancer. We looked at our data and saw that people who don’t have a primary care clinic have lower screening rates than those who have a regular health care provider. While there are a few screening tests for colorectal cancer, this project uses fecal immunochemical test kit, also known as a FIT kit, an in-home test kit that screens for the presence of blood in the stool, which can be an early indication of colorectal cancer.

We wanted to create a high-quality program and have real-time access to data, so we worked with HealthPartners Central Lab and our online care provider, Virtuwell , to create an end-to-end process to provide the service and meet the needs of our members. We launched the first iteration of the program in 2021 and continually assess program performance to improve program quality.

Through this program, our members experience three key touchpoints from us:

1. Eligible members will receive an e-mail from Virtuwell inviting them to order a kit.
2. Central Lab mails the kit to the member, and the member completes the kit and mails it back to Central Lab for processing.
3. And then once processed, the member receives their results from a Virtuwell clinician.

In 2022, we identified that a lot of members were ordering a FIT kit but not returning it. We conducted one-on-one interviews with members to understand why a member might not return the kit after requesting it. Through these interviews, we learned two primary reasons that people were not returning the FIT kits:

• Members would receive the kit but not recognize that it was the FIT kit because the envelope was generic or they thought it was junk mail.
• The member knew that it was their FIT kit, but they were not in a rush to complete it and return because they did not know that the kit had an expiration date.

Understanding these barriers, language was added on the outside of the kit envelopes to call out that the contents are time sensitive while still maintaining member privacy. With this change, our return rate increased from 53.1% in 2022 to 67.4% in 2023. Return rates dropped to 58.4% in 2024 and as a result, we made additional changes to the 2025 campaign to strengthen the reminder communications we send members. We also made other improvements to the 2025 campaign, including making it easier for members to tell us which address we should use to send them the kit (a helpful option for snowbirds) and adding information about how members can help their family members get screened.

Through in-house automation, we have been able to deliver a sustainable, high-quality and highly reliable colon cancer screening process to our members. Year over year, we have been able to increase our outreach and the number of FIT kits sent, without impacting the resources needed. In 2024, we shipped over 4,200 kits and had nearly 2,500 of those kits returned to us by members. Our Central Lab team was able to send out a kit to a member, on average, in just half of a day after receiving the kit request and was then able to process the kit in one day once receiving the completed kit back.

Additionally, we are finding that members are very satisfied with the FIT kit experience, especially as our consumer base moves to wanting a more hybrid approach to care that is still reliable and personable. We have heard from our members numerous times that our program is easy, fast and efficient to participate in. They also feel that FIT kits provide a convenient way to screen for colorectal cancer that results in comprehensive but easy to understand test findings and recommended next steps.

HealthPartners is committed to encouraging our members to receive routine colorectal cancer screenings starting at age 45. We will continue to send screening reminders to members when they are due as well as offer the option of a FIT kit for colorectal screening to those members that it is appropriate for.