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Heart of New Ulm Project

  • The Heart of New Ulm Project is one of several stories of health care transformation spotlighted at this year's Healthcare Analytics Summit in Salt Lake City, Utah. Watch "The Story of New Ulm - A Population Health Transformation" the 23-minute documentary about the project that premiered at the Summit. 

  • expand to learn moreHeart of New Ulm Project - The Story of New Ulm - A Population Health Transformation - transcript

  • The Heart of New Ulm Project

    The award-winning Hearts Beat Back: The Heart of New Ulm Project is a collaborative partnership of the New Ulm community, New Ulm Medical Center (part of Allina Health), and the Minneapolis Heart Institute Foundation. Since 2009, the entire community has been working toward a common vision—to support a culture of wellness in the community and help people make health the easy choice where they live, learn, work and play.

    Through activities, education, policies and environmental changes, people who live or work in New Ulm are supported in their efforts to get more physically active, eat more fruits and vegetables, lose weight, quit smoking, manage stress and make other healthful lifestyle choices. Efforts involve the entire community—from health care organizations, providers and individuals, to worksites, faith-based organizations, public health, local government, and civic groups and organizations.

    Find out how you can get involved! 

    For more information on The Heart of New Ulm Project, visit

    Watch the three-minute trailer of "The Story of New Ulm" documentary.

    Read the transcript for The Story of New Ulm A Population Health Transformation – trailer.

    Watch the 13-minute version of "The Story of New Ulm" documentary, focusing on the health analytics aspect of the Heart of New Ulm Project.

  • expand to learn moreTRANSCRIPT: The Story of New Ulm - Trustees Summit

  • Watch the 12-minute version of "The Story of New Ulm" documentary, focusing on the community support aspect of the Heart of New Ulm Project.


    If you were to say, so what percentage of adult Americans are at an appropriate body mass index, exercise, eat their fruits and vegetables, don't smoke, wear a seat belt, I mean, you might be surprised to know that 3% of adults over 18 do all five of those things. 3%, I mean, that's not a big number. And so we know that if we could change individual behavior, we'd have a tremendous, probably exponential impact on the health of the population.

    70 percent of people showing up with a big heart attack have no idea they had heart disease the day before. The majority of heart attacks are occurring in people who don't know they have disease. We've gotten a lot better at treating heart attacks, but it still turns out it's much better to not have one in the first place.

    The beginning vision of the Heart of New Ulm was bold. Can we minimize or eliminate heart attacks in the community? Can we get to zero?

    I think it was $10 million over 10 years was the goal, was really to reduce heart attacks. Can you impact health care in a community by focusing on very simple interventions? And we've seen that you can.

    Medical care, that's 20% of the story. So 80% of the story has nothing to do with the temples of technology that drive American medicine and has very little to do with 18% of the GDP being spent on health care. It's all about the social determinants. This is an incredibly complex sort of witch's brew of social, political, and economic problems, but it impacts health.

    The Heart of New Ulm is a 10-year project, and it does take a lot of investment on the front end. But now, it is so exciting. We're in this year seven, where the community is owning it. People know what it takes to have this population health program have an impact in their community. And they care. They're invested.

    So there's a lot of community work on getting more active as a community together, looking at our healthy meals together. Let's look at restaurant menus and see whether they can be healthy. Let's do things together as a community.

    That's the pinnacle of population health, the entire community under our care. And what can we do to empower them and to improve their cardiovascular care?

    Some people maybe don't think it's been worth a million dollars of investment every year. And what I've asked in return is, can you show me any other community anywhere in the nation that has improved by 7% the level of hypertension within a community, that has stabilized obesity, cut smoking rates, cut heart attack rates, improved physical activity, improved nutrition? And if we can find any other comparable community in the nation that's done that, then I'm able to evaluate whether the million dollar investment is a wise investment for not only this health system, but the broader health care system across the country.

    What I've loved about the New Ulm area and where I grew up in North Dakota, open space. There's freedom. I get to live in the New Ulm community, serve in the New Ulm community. And probably what other leaders don't get access to is I live literally 400 yards out the back door of the hospital.

    I'm Toby Freier. I'm the president of New Ulm Medical Center. New Ulm Medical Center is an integrated rural health care delivery system. And we're a part of Allina Health, a health care system serving Minnesota as well as western Wisconsin.

    It is a challenging time to be in health care, because every ounce of our inner being wants to pursue better health, improved health for our communities. But we also know we're tied into a reimbursement system that pays for people to be in a hospital.

    We have an income statement that reflects revenue generated on sick people being in a hospital, yet all of our mission is about how can we prevent illness across the community. OK, I think I'm going to go down to CCU first. I'll be honest, I'm disappointed in the enthusiasm for improving outcomes of the health of a community, of a population, and affordability. And I don't know that there's any way to say that we're accomplishing that without the outcomes data.

    We now have the IHP data into the data warehouse, all that claims activity. So we could be looking at ER patients, care follow-up, a piece of how could the ER physician help us with that.

    When we have access to that information, it allows you to at least have the conversations with your physicians, with your patients about the cost of health care in a meaningful way. When they learn that a swing bed is going to be $3,000 a night versus $250 a night at a nursing home, they care about that.

    The access to data analytics, to health information at the fingertips of caregivers, at the fingertips of frontline leaders is extremely important.

    Turns out that Toby and his team have probably used the data warehouse in ways that we had never anticipated, where people are getting care, what are the ways we can influence their care, how can we find out where high utilization is going on, and hotspotting around. Are there pockets of diabetes or obesity that we could focus resources in a different way?

    So one of, I think, the great wonders is out of this small community, this very sophisticated sense of who the patients are and who the people are in the region and what are their health care needs and how can we shape our system to meet their needs, rather than just guessing at what they might be.

    Focusing on Triple Aim and having access to the health system I think has been important. Without the resources of the system and having the electronic medical record, which allows us to do patient registries, which then allows us to get down to the quality of care that we're providing, I don't think we'd be able to do that without the resources of an entire system behind it.

    It turns out, for people that are healthy, they don't spend a lot of time with their physician. And they shouldn't be, necessarily. If you think about a person over a given decade, they're going to spend about a total of two hours with the doctor. And the idea that two hours is somehow going to determine their health for that decade is really pretty unreasonable.

    If we're going to intervene in people's health, we're going to need to do something more than just their annual physical. We're going to need interventions at a population level. We're going to need interventions in their workplace and in their community and in their homes.

    And they're going to need the critical education as well and the clinical visits, but, in general, it's going to have to be a broad-based intervention. We need really a collaborative effort from multiple different entities in order to pull something like that off.

    And it's just not physicians and health practitioners that are driving health. It is the community grocery store. It is the school. It is the workplace. It is the park. It is the roads. It is all those things.

    Improving population health at the community level, I mean, literally it takes a village. And the health care system at this moment is really in transition. Is this a hospital-based activity? Is this a public health department? Is this a grocery store? Is this in the schools? And the short answer is it's all of the above.

    So it's a complex notion. I mean, our country is so big and so heterogeneous and so diverse, bringing together these forces, even in a relatively small community like New Ulm, is a formidable task.

    Lasting change happens when more people embrace it. And so the Heart of New Ulm, while it was started as a research project, and it was a partnership with Minneapolis Heart Institute Foundation and the medical center, for lasting impact, for lasting change, it needs to be embraced by the community.

    Businesses are complicated organizations with a lot of moving parts. And I think what the Heart of New Ulm has really allowed them to realize that their people are their most important resource, and investing in their employees really would make a difference.

    Margins are tough in the restaurant business. And it's a lot easier to cook a frozen burger or frozen fries and keep them in stock. And when you start talking about produce and healthy foods, it's expensive. And those products are a little bit harder to serve. I was very hesitant to begin with, because I didn't want us to be forced into doing anything. And we really dug our heels in and said, absolutely not, until you can prove to me that this is going to make some money.

    And so the same with the New Ulm residents. I think they'd feel the same way. I feel like if this was pushed on them, it would be a little bit harder pill to swallow. But it's just been a lot of opportunities and removing roadblocks, as far as finding ways to be healthy. And it's worked for our town.

    I get to be one of those community members that's on the Heart of New Ulm Executive Committee. Who's all on that? Well, you have everybody represented of the city, the hospital, the schools, community members. Make a well representation of the different aspects of the community to come together to plan, what should we be doing differently here.

    So we look at what is important for kids? What's the most important we need to make sure we give them each day? What are we doing with them physically? We encourage them to walk to school or bike to school. We encourage healthy meals, healthy snacks.

    If the kids do walk to school in the morning or bike to school, their minds are ready. They've already physically done the exercise. They're ready to sit down, to settle down for their morning routines in the classroom. So our job, if we're going to teach them academics, is to first get their minds set and get them ready. And being physically active is one of those keys.

    The health care system is trying to turn the battleship around inside the Panama Canal. I mean, that's the visual that you have to have. And it's colliding with the on-the-ground tactical reality of certain communities being able to make progress.

    And we have to make it easy for people to do the right thing. That's what I was so impressed in getting a deeper understanding about what's going on in New Ulm, that they've made it the default, easy, right thing to do, to exercise, to buy healthy food, to ride your bike. I mean, there are some amazing social change happening in that town.

    It's easy for a doctor to prescribe a medication. A doctor telling a patient how much to eat or what to eat and how much to exercise, there's plenty of evidence that that doesn't work very well. It's hard to change people's behavior at a clinic visit. It's much easier to change people's behavior by changing their environment.

    There's no question that it can be done in a larger community too. You have to define the community. You have to establish the relationships. You have to establish what your goals are. But we can take those learnings from the outstate and certainly scale them to larger communities too, using the same secret sauce that they have used, just on a different scale and with different parameters.

    This could be a national model for population health and where health care is going in the country. In our community, health outcomes have improved almost across every health indicator across the community. Health care quality within the health care system has improved. We've lowered admission rates into the hospital by nearly 20%, 50% lower admission rates in our community compared to other comparable communities. Overall, $1,000 per Medicare patient lower cost of health care in our community.

    So I think we're seeing early signs the Triple Aim is achievable, better health, lower costs for a community. And I hope one day that New Ulm is this beacon for the nation, that this is the place where maybe more than any other community, someone could say, if I lived there, I could realize my full health potential and have health care that truly is affordable in this country.

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