Ten years in, the Hennepin Health Access Clinic still does things differently
This article was written by Lori Imsdahl, initially posted by Hennepin Health, and republished on the Here for Life blog.
On a typical day at the Hennepin Health Access Clinic in downtown Minneapolis, Community Health Worker Mia Debbins gives a patient a new pair of shoes. She brings another a boxed lunch. And she helps a third update their resume. A fourth she just talks to.
At first glance, Mia’s work seems unrelated to medical care – there’s been no blood draw, physical exam, or prescription for a new medication. But one premise of the Hennepin Health Access Clinic is that people’s basic needs are inseparable from their medical care.
“If we haven’t taken care of a person’s basic needs it doesn’t matter what a doctor can do with, say, the cancer on their tongue,” says Krista Siddiqui, Hennepin Health Access Clinic manager. “If they’re not in a place where they have food, transportation, or somewhere safe to sleep, we’re going to do very little for their health.”
Siddiqui recalls a patient who came to the emergency room with severe low blood sugar after taking too much of their diabetes medication. Later, they were referred to the Hennepin Health Access Clinic. “A provider without time to assess a person’s basic needs might say that this is someone who doesn’t understand diabetes and change their prescription,” says Siddiqui. “But we learned that the patient let their blood sugar get low because the emergency room was a warm place to be. They didn’t have a house or shelter to go to, and they there worried about surviving the subzero temperatures overnight.”
Serving people who haven’t found success in traditional clinic settings
In 2014, Hennepin Health, a health plan that serves Hennepin County residents who are eligible for Medical Assistance and MinnesotaCare, provided funding to launch the Hennepin Health Access Clinic inside Hennepin Healthcare. Today, the clinic has 350 active patients.
The Hennepin Health Access Clinic is unique not only because of its emphasis on addressing basic needs and social determinants of health, but because it takes patients by referral only – serving Hennepin Health members who haven’t found success in traditional clinic settings.
Not finding success in a traditional clinic setting might mean missing too many appointments due to competing priorities — or never scheduling an appointment in the first place. It might also mean coming in for issues that providers at a traditional clinic struggle to address in a standard 20-minute appointment.
“Our patients may not have figured out how to access traditional clinics or had the best interactions there,” says Dr. Danielle Robertshaw, the clinic’s medical director. “We look at the whole patient, including their immediate needs: I’m hungry, I haven’t slept. We’re a smaller environment. Our front desk staff know patients by name and greet them with a warm welcome and smile.”
But Dr. Robertshaw emphasizes that the Hennepin Health Access Clinic is not permanent care; the goal is to help patients stabilize and transition to an ongoing, long-term “medical home.” That transition timeframe is different for everyone. “For some it’s one to two visits,” she says. “For a couple of patients, it’s 10 years.”
A coordinated, team-based approach
Addressing basic needs and social determinants of health, figuring out barriers to traditional health care, and setting a goal to transition out of the Hennepin Health Access Clinic takes a village. The clinic team includes traditional medical providers, nurses, and medical assistants. Additionally, it has nurse coordinators, pharmacists, psychologists, social workers, community health workers, and licensed alcohol and drug counselors.
“When you go to a traditional clinic setting, doctors may only have 20 or 30 minutes with you and they can’t address more than acute issues,” says Siddiqui. “Here, there’s a team. While Dr. Robertshaw may get 20 minutes with a patient, Mia might get an hour.”
Each week, the full team comes together to discuss their patients, bringing their unique expertise and vantage points. Patients also benefit from the clinic’s partnerships with external agencies, whose staff, says Dr. Robertshaw, “Give us more visibility into what is going on outside clinic walls.”
Hennepin Health and Hennepin Healthcare’s shared electronic medical record also helps patients. “We can see if Hennepin Health members are admitted to the emergency department or hospital,” says Dr. Robertshaw. “We can do a social visit, say, ‘We’ve missed you. Let’s make an appointment while you’re here.’”
“The beauty of the Hennepin Health Access Clinic is that we’re able to see beyond what everyone else sees,” says Siddiqui. “We have the time, resources, desire, and passion to really get to the bottom of what a patient needs, and we do the best to meet them where they’re at.”
In addition to benefiting the patient, Dr. Robertshaw believes the coordinated, team-based approach reduces pressure on medical providers and other parts of the health care system. “I don’t have more time than other doctors at other clinics,” she says. “But I can park some of the issues until Mia comes in.” Similarly, “A patient who is hungry or cold doesn’t go to the emergency room for conditions that can be addressed in primary care, when we have the right team members and resources.”
Data has shown decreases in impactable emergency room utilization and hospitalization admissions, and patients frequently express high satisfaction with the clinic and team
The clinic continues to evolve
Over the past decade, the clinic has evolved to meet patient needs. Their clothing closet for patients became an entire room. They added a dental room, a licensed alcohol and drug counselor, and a free library. They began offering boxed lunches, and work with Rise, an employment support agency.
They also hired Mia Debbins. Mia has been with Hennepin Healthcare for 34 years – and with the Hennepin Health Access Clinic since 2014.
Not long ago, Mia helped someone study for a forklift exam. The person passed and got a job.
She also helped a patient, who had been living in shelter for 7 years, style their hair for a Valentine’s Day dance. “It was a confidence boost,” says Dr. Robertshaw. “Mia was able to engage the patient in what was important to them in the moment, building trust, and later support them in connecting with housing. It’s these things that help patients move forward.”
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