Providing a healthcare safety net for thousands in Minneapolis: Talking with Steve Knutson of Neighborhood HealthSource

Steve Knutson is executive director of Neighborhood HealthSource (NHS) in Minneapolis – a non-profit, multi-location, full service primary care clinic organized as a Federally Qualified Health Center. Neighborhood HealthSource has provided quality, affordable care to the community since 1971. Knutson, who was appointed executive director in 2009, has served in executive positions with a variety of Minnesota healthcare non-profits over the past 30 years.

What do you want readers who are unfamiliar with NHS to know about your organization?

We are a Federally Qualified Health Center (FQHC), a small corner of the healthcare delivery system and one that most people haven’t heard of. FQHCs are the healthcare safety net for millions of people in the country. In Minnesota, FQHCs serve tens of thousands of patients who do not have insurance or access to primary care. Additionally, 90 percent of our patient population is well below the federal poverty line and has higher-than-average rates of chronic disease.

What is the biggest challenge facing non-profits like NHS in Minneapolis?

Sustainable, reliable funding, of course, is the number-one issue for most non-profits. It is a constant struggle to secure sources of funding that allow us to maintain and grow the reach of our respective missions. Closely following that is talent. Maintaining adequate staffing – not only providers but also medical assistants, reception staff, and nurses – is becoming a bigger and bigger challenge every day. There is an acute shortage of talent, particularly medical assistants, in our market. This affects all healthcare providers, but it hits health centers in a particularly complicated way.

What trends or opportunities for solving affordable healthcare in our communities excite you the most?

Value-based care is an accelerating trend in the healthcare industry and is transforming the way providers are compensated for healthcare delivery. Instead of receiving payment on a service-by-service basis, we are seeing new models that reimburse providers for keeping patient populations healthy and out of the hospital. We are excited to play a role in leading change. The FQHCs in our market are some of the most sophisticated in the country, and NHS participates in the first successful FQHC-based accountable care organization in the nation. For example, our value-based care reimbursement model with the state for Medicaid patients has saved taxpayers $17M over the past few years. We have also seen dramatic decreases in the usage of emergency rooms and hospital care. Another exciting trend is the movement toward home-based monitoring activity for certain types of clinical conditions. Some of our patients have barriers, such as childcare or transportation, that affect their ability to come into the clinic. Personally, I think a lot of ongoing chronic care management can occur using home-based monitoring technologies to assess, for example, compliance with treatment for conditions like diabetes or hypertension. This has the potential to save costs and increase patient satisfaction and clinical quality. I think we will see rapid expansion of this capability in the next three to five years as both technology and reimbursement models evolve.

How does NHS use technology to further its mission?

Since the introduction of electronic medical records (EMRs) 10 years ago, technology has fundamentally changed how primary clinics operate and how patients interact with providers. Today, we use EMRs to measure quality and design improvement initiatives based on the data we collect. Providers use technology to record patient diagnosis and treatment information and to identify potential care paths and treatment regimens. In fact, there are providers today who don’t know what it is like to make handwritten chart entries. Patient portals and other forms of electronic communication allow us to reach patients in new and more efficient ways. For example, we can send appointment reminders or treatment notices to hundreds of patients at once. We increasingly use technology to track patients’ progress and utilization of treatment regimens, as well to understand the other providers they are using. Five or six years ago, it was challenging to keep up with what was happening within our clinic walls. Now, we know what is going on with patients outside of our clinics – when they go to the hospital, when they use a specialist – and we can use that insight to improve outcomes and save unnecessary costs. I believe technology-enabled monitoring activity will drive the next phase of transformation in healthcare.

How can the Minneapolis business community engage with NHS?

While we always welcome financial contributions, one of the most valuable ways the business community can support NHS is by volunteering to serve on our board or various project committees. Volunteers provide an important source of business, legal, healthcare, and other expertise that helps us define policies and plan effectively for the future. For example, various legal issues come into play in our operations, from employment law to patient confidentiality/HIPAA regulations. Other areas where we welcome outside expertise include technology, capital financing, and strategic planning. Members of our community can also engage with NHS as patients. Our clinics serve everyone, not just the uninsured and impoverished. We have many patients who come to us because they believe in supporting an organization that serves those less fortunate. By becoming our patients, persons with insurance indirectly support our ability to care for uninsured patients.

What is your favorite thing about living and working in Minneapolis?

This is a vibrant place to live and a perfect place to raise a family – if you can tolerate the winters! It’s a very dynamic atmosphere and progressive environment with a population that cares about our purpose of eliminating health disparities. They want to be involved and want to help, even if they don’t personally experience the issue firsthand.