A new, groundbreaking initiative launched by a Michigan health system is addressing one of the most expensive and challenging problems facing the U.S. healthcare system – the overuse and abuse of hospital emergency rooms by patients who should be using primary care services.
Spectrum Health System, a not-for-profit managed care health organization based in Grand Rapids, Mich., has created a new multispecialty clinic to assess and treat high-frequency patients – the ER’s heavy users – at area emergency departments.
The new clinic began taking patients on Monday and is expected to save the Medicaid and Medicare programs $12 million to $15 million annually in charges from Spectrum Health patients alone.
At Spectrum Health, about 950 patients use the emergency rooms of Butterworth Hospital and Blodgett Hospital, both in Grand Rapids, more than 10 times in a given a year, accounting for more than 20,000 total visits and $40 million to $50 million in costs annually. Throughout its entire system, Spectrum Health has about 190,000 adult visits to the emergency department per year.
The new clinic, called the Spectrum Health Medical Group Center for Integrative Medicine, will assess issues facing chronic emergency department users. By using enhanced medical management, aggressive social services and intensive psychiatric evaluation and treatment, the clinic will aim to identify, accurately diagnose and develop a care plan for each patient. The base of the program will be effective care coordination and case management, says emergency and addiction medicine specialist Dr. R. Corey Waller, the medical director for the new center.
Many of the health system’s frequent emergency department patients have mental, substance abuse and chronic health problems and most are insured by either Medicaid or Medicare.
“People do want help,” Waller says. “It’s just that they don’t really show that until they’re in a place where they know they’re going to get it.”
After a preliminary study in 2008 of 30 patients who recurrently overused Spectrum emergency departments for care, Waller found four major factors that influenced patients’ behavior when it came to how they used health services and how well they followed care plans.
Those four factors were lack of transportation, a regular income, appropriate education and consistent, safe housing. Waller says the patients who used ER services most were more likely to be lacking in one of more of those four areas.
With the results from that study in mind, Waller’s new clinic attempts to help patients in those areas. For example, upon discharge, a case manager will help a patient locate a bus route or arrange transportation if a patient has that need.
After an ER visit, patients at the clinic will go through a four-hour interview process – including a one-hour checkup with a doctor, another hour with a case manager plus time for seeing other providers.
When treatment is stable and the patient has successfully followed up with a primary care physician, the patient will be transferred into a primary care office.
“We’re dealing with patients who need an in-depth care plan and a continuum of care that can’t be delivered efficiently in an emergency department setting,” Waller says.
In addition, the clinic will coordinate other services, such as home care nurses and case managers who can go into patients’ home to do health education outreach.
In the immediate future, Waller says the goal of the clinic is to improve patient outcomes and lower costs, but in the long run, he hopes that the Spectrum model can be duplicated elsewhere.
“We want to make the clinic sustainable financially,” Waller says. “The goal is to build a sustainable model that can be repeated.”
Based on the results of a previous pilot project, which saw emergency department visits decrease by 85 percent, Waller estimates that Medicare and Medicaid could expect annual savings of $150 million to $250 million statewide if the initiative were copied throughout Michigan.