President Obama has called for meaningful health care reform by this October that will achieve universal coverage, provide more effective patient-centered care and go after key drivers of health costs, such as unmanaged chronic diseases, unnecessary hospital readmissions and excessive emergency room use. Two HHC programs are poised to serve as models that provide more effective healthcare while keeping costs down by redirecting patients away from the emergency room and connecting them to the primary care they really need.
Nearly 80,000 patients visit the busy Queens Hospital Emergency Department each year, yet many of the ailments that bring them there, such as new-onset diabetes, congestive heart failure, skin infections and asthma, are better treated by a primary care physician or home care services. Beginning in spring of 2008, Queens ED physicians began an approach developed by Dr. Mauvareen Beverley, Associate Executive Director of Care Management, to identify patients who could benefit from working with a Care Manager who would guide them to the best level of care for their condition.
In the first ten months of the program, the ED care manager assisted more than 1,300 ED patients, connecting them to a primary care doctor, and helping secure important medical equipment or financial assistance to pay for medication. And with an HHC Health and Home Care nurse assigned to work daily in the ED, patients in need of home health services were also able to get connected quickly.
"I'm really their bridge to every service," said Cynthia Cantos, RN, Queens ED Care Manager. "I also connect patients to specialties in our hospital, like geriatric medicine or physical rehabilitation services. If they have any questions, they can always call me directly. And they often do!"
The effort yielded approximately $350,000 in savings over 10 months by reducing hospital admissions. Patients received the care they needed at a fraction of that cost, while remaining out of the hospital and in their communities, close to the support of their friends and family.
A similar effort at HHC's Morrisania Diagnostic and Treatment Center in the Bronx was able to reduce healthcare expenses for more than 100 high-cost patients by 90% between 2007 and 2008. The team there identified more than 100 patients who had two or more visits to the ED, had been hospitalized and had not seen a primary care doctors in the last year. The goal was to work with patients to find the best way for them to get reliable primary care and reduce their reliance on the Emergency Department.
Dr. Orfelina Castro, a Health Priority Specialist at Morrisania, helped them navigate the process for scheduling visits with their primary care doctor, let them know they could come to Morrisania for urgent care on a walk-in basis rather than using the ED, and referred them for financial counseling if they needed to recertify their health insurance coverage. Patients were encouraged to call if they had questions.
At the end of the pilot effort, ED visits for the group were down by 83% and hospitalizations were reduced 92%. Patients were surveyed and 96% said they were satisfied with the new program.
"They really appreciated the individual attention from someone they knew," said Dr. Castro. "If they are confident in the system, they don't feel the need to call as often."
June 2009
