As healthcare costs continue to rise, stakeholders are looking for ways to bring down costs. Dallas is one of the most expensive places in the country to receive healthcare, and emergency room visits and hospital admissions are two of the most expensive contacts a patient can have with the healthcare system. Consumers, payers, and even health systems are looking for ways to reduce these high cost visits.
One might think that hiring more nurses or social workers might provide patients contact that could help keep them out of the hospital, but at Baylor Scott and White, a grant has helped them hire over 100 community health workers and the organization preferred to hire those without healthcare experience. These workers make contact with high-risk and high-cost patients, attempting to prevent emergency department and readmission rates among the targeted patients before they happen, allowing providers who are already stretched thin to focus on other issues.
Baylor focused on 35,000 patients, many of whom were older than 65 and using Medicare Shared Savings health plans, but there are also uninsured community members who benefit from the program as well. This high-risk population benefits from a high level of contact with the healthcare system in order to avoid hospital admissions. Baylor intentionally hired non-medical community health workers who were older in order to better facilitate a peer relationship between the patient and worker. The worker gets to know the patient, their fears, priorities and obstacles to health. They help the patient navigate the healthcare system, remember their appointments, understand their medication, work their equipment, find healthy food, and more.
The workers receive more than 160 hours of training covering the medical system, relationship building, communication, and more, and they make calls and visits to their set of patients to establish a trusted relationship. They are part of a team that includes social workers, chaplains, and pharmacy experts.
There are certain costs to implementing a high-touch program such as this, and the overall savings are probably a few years down the road, but the impact is already apparent. In the Garland and Dallas locations, contact with the community health worker reduced patients with confirmed primary care visits by 60 percent after contact with the community health worker. Overall the program saw a 17 percent reduction of emergency departments and a 37 percent decrease in inpatient visits for those in the program.
Mae Centeno is System Vice President of Chronic Care Continuum and Quality Improvement at Baylor Scott & White Health and helps organize the community health worker program. She says that between June 2017 and June 2018 the community workers attempted to reach 12,000 patients, making contact with just under 50 percent of them. Half of those patients scheduled an appointment to see a doctor. These are not the easy patients, as the program targets community members who haven’t been to the doctor in a while and are disconnected from the healthcare system.
These workers have served 29,000 high risk patients and helped distill the information they receive from their physicians. “The program makes it to where they feel like they can take action when they go home,” she says.
Because of the navigation and intervention of these workers, they have reduced ER visits, readmissions to the hospital, increased controlled diabetes, and increased depression screening over the last several years. Many of these elderly patients are socially isolated, and if something goes wrong, they call 911 to get a ride to the emergency room rather than have a friend or family member take them, even in non-emergency situations. The workers’ knowledge of what triggers patients to head to the hospital can also help avoid hospital visits and bring down costs.
“The community health workers are good at building trust,” says Baylor Scott and White vice president of community health Niki Shah. “Sometimes they uncover issues that we might not be aware of, which helps them proactively avoid long term costs.”
Even though the grant is ending this year, Baylor is hiring all of the community health workers to continue their efforts full time, and see future cost savings justifying the addition. “It is very sustainable,” Centeno says. “And we are expanding to Central Texas after the grant is over.”
Centeno says the workers come from all walks of life, from former lawyers to retired corporate executives, but they all share a common mission: “Their desire and realization that they want to do something bigger than themselves.”
Even though Baylor Scott and White is a nonprofit health system, they still have to be concerned with the bottom line. One might wonder then, why the system would invest so much time and money into reducing trips to the emergency room that are often hospitals’ biggest money-makers.
But for Baylor, many of the patients they see in their emergency room are uninsured, resulting in uncompensated care. Some of the costs of treating these patients are not reimbursed, says, Baylor Scott & White Quality Alliance Leadership President Dr. Clifford Fullerton. “We have some risk for all the care in that population, and we have the opportunity to try and figure out more efficient ways to deal with them,” he says.
For better-insured patients, Fullerton admits that reducing hospital visits is lost revenue, but fits in with Baylor Scott and White’s overall strategy to drive the cost of care down. “It meets our mission, and we believe that strategically, it is the direction for us to go.”
As government and commercial payers move away a fee-for-service model, Fullerton says providers will be forced to depend less on frequent hospital admissions to pay the bill. “We are accountable to delivering a higher value product, and we are trying to get in front of that.”