Our Mission

We are dedicated to creating an organization which trusts in the common sense of its members, provides participation for and builds leadership from seniors themselves.

Uniting seniors and their organizations, we act as our own body of peers, leaders and decision makers to influence policy and give information to benefit people of all ages.

Seven County Senior Federation develops membership benefits that enhance an independent, affordable and dignified lifestyle for seniors.

Our Vision

Seniors in the 7 County area will have access to affordable health and medical care, services, housing, and choices in community and social opportunities. Our seniors will live free of fear, with dignity, independence, and respect.

1. Background: Basics of the Low Income Programs

Medicaid (Medical Assistance);   MinnesotaCare;  plus others (GAMC; Medicare-combined programs)

2. How these services are Delivered:

A. Fee For Service

Dept. of Human Services (DHS) pays health care providers a standard fee each service, and decides what the fee is.  The providers send their bills to DHS, and then DHS pays them directly.

This was the original way that all Medical Assistance was delivered.  There is still a little bit of Fee For Service payments by DHS, but not very much, for a couple of counties, and some disabled people.

B. Pre-paid

DHS gives, in advance, a monthly payment to an HMO or county system, which they use to pay the medical providers for the services to their enrollees.  The payment is based on an amount for each enrollee, with some adjustments for things like the person’s age and overall health condition.   There is one formula that DHS uses statewide to calculate the monthly payment. The HMOs have a big input as to what the payments are.  The HMOs or counties decide on their own how much they want to pay the medical providers for each service.

If the HMO or county pays out, in total, more money than what they got from DHS, then they lose money.  

If the HMO or county pays out less money than what they got from DHS, they keep the difference.

An HMO or county can stop running these programs, if they give the state one year’s advance notice.

Overall, the HMOs and counties have made money from the programs – especially quite a lot for the HMOs, since they have been doing most of it, and for the longest period of time.  A ballpark guess is a few hundred million dollars total; perhaps more.

(1) Private HMOs

Private HMOs get the vast majority of the DHS prepaid money, about 87%. Their total is about 2 billion dollars a year.    The biggest ones are Blue Cross/Blue Shield of MN, through its Blue Plus division;  Medica; and U Care.  Next in size is Health Partners and U Care.  There are two others that are fairly small: First Solutions, which is another division of Blue Cross; and Group Health.

The amounts that the private HMOs pay the medical providers for each service is secret.  The HMOs’ books are also secret, although they must give financial reports to the state.  However, the state does not look at the HMOs’ books.

(2) County systems

County systems get the remaining, about 13%.  One of these is technically an HMO, not a County-Based purchasing system:  Metropolitan Health Plan, which is owned by Hennepin County.  They created their HMO before the CBP law was passed.

The others are County Based Purchasing systems.  There are three of them, with a total of 28 counties:

1) Itasca Medical Care, which is just one county – Itasca. The headquarters is in Grand Rapids.

2) South Country Health Alliance, which is jointly run by 14 counties. The headquarters is in Owatonna.

3) Prime West, which is jointly run by 13 counties.   The headquarters is in Alexandria.

The amounts that the counties pay the medical providers for each service is not secret.  Also, their books are not secret.

3. Why should Counties run these programs at all?

A. They are more efficient:  Their administrative cost, which is about 8%, is around half or less of what the HMOs’ administrative cost is.  This is because they have:  Lower executive salaries; less fancy office buildings; smaller marketing budgets; and they don’t have staff whose job it is to hassle with medical providers and enrollees, delaying or denying procedures and payments.

B. Enrollees get better services:  IM Care and Prime West pay dentists enough money so that enough of them participate to provide an adequate amount of services.  This also is more financially efficient and humane than the private HMOs, whose enrollees end up going to emergency rooms because dentists aren’t available.

C. More productive relationships with the providers:  They build cooperative partnerships, and let them help decide how services should be delivered and how the money should be spent.  The private HMOs often have antagonistic relationships with the providers.

D. Local Self-Sufficiency:  Many rural public officials see county-based purchasing as a way to have local control, instead of Twin Cities HMOs controlling the health care system.  A related motive is wanting to see local health care providers stay in business, and not be put out of business or swallowed up by the big HMOs.

E. Better Motives and Ethics:  A true concern for public purpose and public health, instead of the private HMOs’ motive of maximizing their revenue above all else.  Especially since the upper limit of HMO reserves was removed, they have an extra incentive to try to keep as much of the state payments for themselves as they can

4. Who is For, and Against, Counties running the programs?

FOR:  * County officials who believe they can care for their residents better than the big HMOs can;  

* Medical providers who believe they will be treated (and/or paid) better than under the HMOs;

* Enrollees who want better services, like dental care;

* Anyone who believes that health care should be administered by the public sector instead of private

   insurance companies.

* Some rural conservative public officials who like “local control” and want to protect local providers.

AGAINST:  * The HMOs who don’t want to lose business (“market share”) to the county systems;

* The State agencies who are supposed to be regulating the HMOs but are allies with them;

* Governor Pawlenty, and some legislators, who are allies of the HMOs and are ideologically against the

   public sector running health care programs.

5. How does County Based Purchasing work?

The county or counties in a system form their own arrangements with local health care providers, to set what services will be provided and what the payments will be.

The county system gets the monthly payments from DHS according to the enrollees that it has.

The county system sets up some managed care systems for its enrollees.

If it’s a rural county, then they run all of the Medical Assistance program themselves.

If it’s an urban county, then they have to compete against the HMOs for Medical Assistance.

Regardless if it’s a rural or urban county, the HMOs are allowed to compete against them for Minnesota Care and other programs.    Each enrollee picks if they want to get their coverage through the county, or through an HMO.

6. How does a county get started with it?

A county on its own, or a group of counties (by creating a Joint Powers Agreement) decide to do it.   Next, they talk with local health care providers to seek agreements on the services they will provide and what they will be paid for them.  The participating counties need to agree to loan some start-up money, which they can expect to get back within 4 to 5 years.   They create a business plan to predict how the finances will go.   They need to expect to get at least 5,000 enrollees in order for it to work out.

The county (or group of counties) then has to apply to the state Health Dept. and the state DHS to get approval to start up their system.   After the state agencies have given approval, then the federal government needs to give approval.

Counties might be able to join up with an existing system, if that system wants to include them.  Otherwise, a county by itself, or together with others, must start a new system.

7. Stage Two:  Expanding to cover other people

Once a county based purchasing system has established itself and is working well, it could decide to start offering coverage to people beyond the low income public programs.  In other words, offer a “public option” insurance for local business and households in the counties’ territory.

It would not have state subsidies, but it would likely offer better coverage value for the money than private insurance policies, because of the county’s lower administrative cost and better attitude to health providers compared to the private insurance companies.  If most everyone in the county area joined this plan, then in effect it could become a local, “mini” single-payer.

What is Seven County? It depends on who you ask.

To some folks, Seven County is the building at 47 Park Street North in Mora. To others, it is the friendly folks who work at that office. To yet others, it is the hundred or more volunteers that make things happen at the office and at the One More Time stores. Another group may say that Seven County is the 1600(plus) of card carrying members who make use of the services or who help guide the organization and keep it on track with its mission. All of these answers are partly right. It’s all of the above plus a bit more.

An organization created to serve the people must continue to rely on those same members to help steer the ship. They must be there to create ideas and direction; they must supply energy for issues and impetus for programs. The staff of Seven County is in place to carry out the plans of the organization as far as the day-to-day operations are concerned. The members vote each year and set priorities for the group’s efforts and resources for the coming year. Staff may suggest different ways of accomplishing what the group decides to do, but the ultimate decision is up to the voting members within the organization.

Most people have heard the axiom: “You only get as much out of something as what you put into it.” It certainly holds true with organizations such as ours. There are a committed group of people who put countless hours of their time and effort into making this organization work, and then there are others who are happy just getting their ECHOES each month. There are also a number of others in between. Sooner or later everyone is asked to participate a little more in the process. Some respond, while others don’t. It will always remain up to the committed group to make things happen and keep things moving. That doesn’t mean you give up asking for more participation from more people, it just means that you’re never going to get 100% participation. It’s unrealistic to expect 100%, but it’s not unrealistic to try to improve those numbers every day.

If you have ever received something from Seven County that helped make your life a little better or a bit easier, maybe now’s the time to give a little something back. Maybe you could get involved in an issue near and dear to you, or maybe volunteer some time for a project, or maybe tell a friend that they need to join as a member, or maybe you just need to make a donation to show your support. Above all else, Seven County is people… people just like you (well, not exactly like you). To quote another saying “many hands make light work.” We can always use some more hands.

The following resources should help seniors locate affordable health and medical care, senior resources, senior advocacy groups, and county-based services.

Health Care Resources

• SCSF - Senior Partners Care
• GMHCC Prescription Partnership Program

Senior Resources by County

These links include government resources, advocacy groups, senior centers, chore services, meal delivery, nursing homes, and more.

• Senior Services in Aitkin County
• Senior Services in Chisago County
• Senior Services in Isanti County
• Senior Services in Mille Lacs County
  
     Alternative Care Program
     Elderly Waiver Program
     Long Term Care Consultation Services

Seven County Partners

Our partners offer local and regional discounts and services of their own; including area-specific pharmacy and health care benefits, social events, chore service connections, and thrift stores.

• Arrowhead Economic Opportunity Agency (AEOA)
• Central Minnesota Council on Aging (CMCOA)
• Central Minnesota Senior Federation
• Lakes and Pines Community Action Council
• Minnesota Citizens Federation NE
• Senior Community Services (SCS)

Healthcare and Social Justice Advocacy Partners

These organizations advocate for seniors and/or issues of importance to seniors, such as health care.

• Physicians for a National Health Plan
• Universal Health Care Action Network (UHCAN)
• Minnesota Board on Aging (MNAGING)
• Physicians for a National Health Program - MN  (PNHP-MN)
• Campaign for the Minnesota Health Plan
• Growth & Justice

County Websites

County websites frequently provide useful links and contact information.

• Mille Lacs County
• Chisago County
• Pine County
• Isanti County
• Aitkin County
• Carlton County

Other Sites

These regional sites provide a variety of resources

• East Central Senior Resource Center
• Employment and Training (ETC) Help Finder
• Isanti County SACS Commission on Aging