WILLMAR — For many years, Kandiyohi County Health and Human Services has provided care coordination services to hundreds of seniors on Blue Cross Blue Shield's Blue Plus program for older residents on state health care programs.

Care coordination makes sure those enrolled in Blue Plus receive the care they need, from medication to appointments and nursing services, with the help of a case manager. Kandiyohi County does this work on behalf of Blue Cross Blue Shield thanks to a contract between the two parties. The work is part of the local department's Home and Community Based Services program.

"We opted into this several years ago," said Jennie Lippert, Kandiyohi County Health and Human Services director.

Kandiyohi County Health and Human Services director Jennie Lippert.
Erica Dischino / West Central Tribune file photo
Kandiyohi County Health and Human Services director Jennie Lippert. Erica Dischino / West Central Tribune file photo

However, with increasing caseloads and future unknowns on how care coordination and other home- and community-based services programs will be done, Lippert is asking the Kandiyohi County Board of Commissioners to make a difficult decision — whether to continue with the contract or terminate it.

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"This is a big decision," said County Administrator Larry Kleindl when members of the County Board met June 1 as the county's Health and Human Services Committee. "We've been talking about it quite a bit."

One of the main concerns is the rising caseload and the impact it is having on staff. Lippert said the care coordination case management staff is being loaded down with too many clients. In June alone the five-member staff will have to complete 43 new assessments or reassessments.

"We are at a need right now for added staff, because the caseloads are too high," Lippert said.

At the same time, there are staff needs in other areas of Home and Community Based Services which are state-mandated, unlike care coordination. If the care coordination contract is terminated, those staff members could be reassigned, keeping staff levels steady.

"When you add layers of staff, layers of supervision, it gets rather costly," Lippert said.

While the Blue Cross Blue Shield contract has paid the county well for the work it is doing, Lippert believes having to add even more staff won't add up financially for the county. The increase in staff would also probably mean a remodel at the Health & Human Services building to house those increased numbers.

"We are at max capacity for the number of personnel and the number of cubicles we have in our offices," Lippert said.

She is also worried that eventually — if the reimbursement for the program changes or the county decides later to terminate the contract — those new staff members would then have to be laid off, something she wants to avoid.

There would be some benefits to continuing the program, including continuing care for a vulnerable population.

"Our staff have done a tremendous job building relationships with these clients and prescribers," Lippert said.

Blue Cross Blue Shield requires 130 days' notice before the contract is terminated. Due to a pending training deadline for the impacted staff, Lippert said the County Board will need to make the final decision in the next few weeks.

The county has spoken with Blue Cross Blue Shield about trying to figure out ways the county could still provide services without having to dramatically increase staff. Lippert said Blue Cross Blue Shield has been very complimentary of the Kandiyohi County staff and the work it does, but has been unable to find any long-term solutions to the county's concerns.

"They didn't have a lot of options for us," Lippert said.

If the county decides to terminate the contract, services would continue unchanged during the last 130 days, but afterward Blue Cross Blue Shield would need to find another partner to provide the service. Kleindl said the county isn't making this decision lightly and it isn't easy.

"In a perfect world, we would like our staff to continue to do the jobs they love," Kleindl said. "We are probably at the point we have to make some adjustments."