Winona Community HUB Joins Provider Network at Blue Cross and Blue Shield of Minnesota

In first-of-its kind agreement, payment structure for traditional clinical care expands to include coordination services from Winona nonprofit

WINONA, Minn. and EAGAN, Minn., Sept. 15, 2022 /PRNewswire/ -- In a health first for the state of Minnesota, Winona Community HUB (the HUB) has entered into an agreement with Blue Cross and Blue Shield of Minnesota (Blue Cross) to pay for community health worker (CHW) services via a Pathways Community HUB Institute (PCHI) model using the same claims-based system as traditional medical care.

Under the new agreement, Blue Cross will pay for health education services as an extension of a member's benefit plan, based on eligible services submitted by the HUB, with no cost to the individual. Traditionally, budgets for CHW programs like those offered by the HUB are generated through grants, hospital-based community benefit programs and other fundraising initiatives.

With health disparities and chronic conditions adversely affecting traditionally underserved populations, Winona Community HUB helps to provide essential services that fall outside the scope of standard medical care. From addressing basic needs like housing and transportation to more complex support like social service referrals and access to mental health resources, the HUB acts as a central registry of local care coordination.

Established in 2019, Winona Community HUB is a service-coordinating nonprofit organization housed under the Winona Health Foundation focused on social determinants of health at the individual and family levels. Its work addresses the complex needs of families experiencing a variety of challenges, including food or housing insecurity, mental health concerns or not being established with a medical home by coordinating access to local resources that can help to drive better health outcomes.

Additionally, the HUB is in the process of becoming the first organization in Minnesota to be certified in the Pathways Community HUB Institute model — the leading quality improvement framework for communities across the country in building local and inclusive networks of care coordination.

The HUB is governed by the Winona Wellbeing Collaborative, a collection of public, private, nonprofit and community partners committed to improving the lives of residents in and around Winona, Minnesota.

"Winona Health and other Winona Community HUB partners have been doing this groundbreaking work since 2016, because it is the right thing to do for our community," said Jessica Remington, associate vice president, business development at Winona Health. "Winona Health's vision is to create the most inclusive, compassionate and self-generating community health movement in the nation. Contracting with payors of health care like Blue Cross is key to the stability and long-term success of this type of health care model."

Vanessa Southworth, director of Live Well Winona and Winona Community HUB, added, "Receiving payment for our services brings more predictability to operations and allows us to focus more time and attention on what matters most – working directly with people to help them improve their lives. The HUB's evidence-based model continues to gain national attention as a gold standard for community-based care coordination. We're proud to be transforming health care for our community."

"With more than 80 percent of a person's health happening outside of the health care system, we want to help break down barriers that can prevent people from living a healthy life," said Amy Bloomquist, director of sustainability design at Blue Cross. "Looking at the larger picture, the types of services coordinated by the HUB are just as important to a person's health as the quality of care they would receive in a hospital or clinic. And yet, until recently, the health care system has kept those areas separate from a reimbursement perspective. We're proud that Blue Cross is among the first health plans to pay for outcomes-based community services in the same way we can with medical care." 

The contract between Blue Cross and the HUB reflects the growing trend of outcomes-based payment models, as opposed to the traditional approach of transactional fee-for-service. For example, under this agreement, when the HUB coordinates safe and stable housing for a family in need, payment from Blue Cross would be contingent on demonstrating that health pathway is completed or "closed" and is effective in driving better health.

The Blue Cross provider network includes thousands of providers from across the state, representing the full spectrum of care. More than 98 percent of all health care providers and 100 percent of all hospitals in Minnesota have contractual agreements with Blue Cross.

About Blue Cross and Blue Shield of Minnesota

For nearly 90 years, Blue Cross and Blue Shield of Minnesota (bluecrossmn.com) has supported the health, wellbeing and peace of mind of our members by striving to ensure equitable access to high quality care at an affordable price. Our 2.7 million members can be found in every Minnesota county, all 50 states and on four continents. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association.

About Winona Health 
Winona Health is a community-owned, not-for-profit healthcare system in Winona, Minn. In addition to a primary care and multi-specialty clinic in Winona, Winona Health has a cash-based quick care clinic in downtown Winona and a primary care clinic in Rushford, Minn. Winona Health also provides care for the community through its 49-bed hospital and senior services including assisted living, long-term care and hospice services. For more information about Winona Health, visit www.winonahealth.org.

About Winona Community HUB
Winona Community HUB (the HUB) connects vulnerable populations with the resources to address root causes that negatively affect health and well-being. The HUB focuses on Winona County with a comprehensive strategy using the Pathways Community HUB Institute (PCHI) model, data-measuring software, and community health workers (CHW) at care coordination agencies (CCAs) across the community. To be enrolled in the HUB, participants must meet specific criteria. The HUB currently operates in partnership with four CCAs–Winona Health, Hiawatha Valley Mental Health Center, Family & Children's Center, and Winona Volunteer Services and is currently onboarding another nonprofit organization. The HUB launched in June 2019 and continues to expand into the Winona community.

SOURCE Blue Cross and Blue Shield of Minnesota