A patient at MedStar Harbor Hospital in South Baltimore has uncontrolled asthma. Another had a chronic skin infection related to an autoimmune condition. Their diseases are different but cause the same problem.
Jenna Everett, a physician assistant in Harbors’ emergency department, said they’ve had to go to the emergency room a lot. Getting resources to them is essential.
Those resources come from an initiative that Everett is helping to build at four MedStar hospitals starting in 2021 called the Multiple Visit Patient Program. It addresses underlying medical conditions as well as social and behavioral issues that can lead to poor health outcomes in individuals and put additional pressure on already overburdened emergency departments. Data shows it’s working: The program has cut emergency visits in half among the patients it serves.
This concept is not new; The program is modeled after a multi-year effort in Boston and also mirrors programs at other Maryland hospitals, officials said. MedStar now hopes to expand to more hospitals within its system and has begun negotiations with other health systems in Baltimore about collaborating on common goals to reduce emergency room use.
Hospitals have partnered with community groups in a statewide pilot program that provides housing and supportive services to help people stabilize their lives and overall health. There is interest in other collaborations that address the needs of patients who come to the hospital or before they need it, said Dr. Chuck Callahan, vice president of population health at the University of Maryland Medical Center. arrive.
Callahan said one possibility is to expand the program the center has with the Baltimore City Fire Department, which sends paramedics and nurses to people’s homes when they call 911 to address concerns and avoid trips to the hospital. institute. They found only 5% still needed transport to the hospital, freeing up emergency room and ambulance space.
They could also revive a pilot program in which medical staff and nurses visit patients within days of discharge to prevent complications that could cause them to return. He also wants to establish a citywide health system coordination office to assess trends and come up with common measures.
There are about half a million people living in Baltimore, and we are responsible for their health and well-being,” Callahan said. It is shared. Today they are in Maryland, but tomorrow they could be cared for in [Johns] Hopkins or Mercy [Medical Center].
The hospitals aim to help people like Christina King, a 45-year-old Brooklyn mother whose recurring flare-ups of diverticulitis have sent her to Harbor Hospital multiple times this summer. King said she lost her job and health insurance at the beginning of the year. She continuously went to the place she trusted most to resolve the pain of infection in her abdomen.
King said after her third or fourth visit in a month, she received a text from the hospital asking what she needed. King said a MedStar representative then helped her navigate the state’s medical exchange to qualify for coverage the next day. They found her a primary care physician and specialist and scheduled her an appointment.
I explained that I don’t have insurance and I found that [exchange] confusing website, and she said, “I can help you,” said a grateful king. I also suffer from anxiety and depression, and with insurance, I can stay on medication.
Experts say the percentage of patients who need such assistance is relatively small, especially in states like Maryland that have expanded Medicaid, the federal health program for low-income residents. However, the numbers are increasing slightly, since the official end of the coronavirus pandemic state of emergency and more and more people have been cut from Medicaid rolls.
Patients like King have a huge impact on the healthcare system, especially when the cases are not as easy to treat as hers. People with unresolved mental health or substance use disorders and housing and food instability can be much more complicated, time-consuming, and expensive for health care workers. international.
As Everett said, If there are 50 people in the waiting room, who has time to research housing programs?
Until recently, there was also little evidence of efforts It’s worth it, said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, which has funded similar programs.
A study of a nonprofit community program in New Jersey called the Camden Alliance, which operates programs with similar goals as those in Maryland, found that it failed to reduce overall hospitalization rates. But when researchers took a closer look at the people most likely to visit the emergency room, once called superutilizers, they found a significant drop in hospital readmission rates. These findings were published in 2019 in the journal JAMA Network Open.
There are still repeat users; Hempstead said no one claims to have solved all of those problems. But it helps people think about things differently.
Logan Kelly, senior program officer at the Center for Health Care Strategies, which collects and shares information about successful efforts, said these programs have become more popular nationwide as there is evidence.
But she agrees that it can be difficult to gauge how well they work at first. Figuring out how to pay for the programs or get insurers reimbursed for the services is still a work in progress. She doesn’t even know exactly how many programs exist.
The challenge is keeping track of them, Kelly said, because they are all embedded in different systems, have different names and work with different populations, and there is no clear definition of who needs the services. program and who is receiving assistance. But they have common themes and we are learning from them.
There are some examples in Maryland, such as Harbor, that flags people in the emergency room for service. At Luminis Health, Transitional Care The program applies to patients presenting to the emergency department as well as patients admitted to Anne Arundel Medical Center or Physicians Community Health Center in Prince Georges County. According to Steve Blau, the system’s senior director, patients in the Luminis program had just a 1% unplanned readmission rate over the past year, down from an expected readmission rate of about 20%. , by ensuring that patients receive timely follow-up care. care management and transitional care.
A program at LifeBridge Healths Sinai Hospital in Baltimore and Northwestern Hospital in Randallstown also uses navigators to connect their highest users to services. At Carroll Hospital, a program for special emergency patients allows them to receive same-day or next-day follow-up appointments.
The MedStar program is funded by grants and resources at four hospitals, including Harbor, Good Samaritan, Union Memorial and Franklin Square. They assisted 250 patients who were flagged at registration for having four visits in 90 days.
There are many people who coordinate medical and non-medical needs, including case workers, community health advocates, and peer recovery counselors.
Jackie White, one of those counselors, was called upon to help build trust and direct people to help. People with substance use disorders often need time to accept help, she said.
“I’m easy to talk to,” she said. I hear their problems. I planted a seed.
Employees understand that sometimes they have to be patient, said Dr. Lucas Carlson, director of healthcare transformation at MedStar in Baltimore. But he said they are buoyed by progress.
No one woke up and spoke. I wanted to go to the emergency room, said Carlson, also an emergency physician at Union Memorial. They have some unmet needs. How do we address that need outside of the emergency room so they don’t have to come back?
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