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Pilot health program saves lives and money
Documentary on PBS features county efforts
MARY LANE GALLAGHER
THE BELLINGHAM HERALD
Rebecca Bryson wasn't about to call the doctor because she felt tired. She lived with heart failure, diabetes and other severe illnesses - she always felt tired.
But Bryson did tell Nancy Stothart, a nurse who checked in with Bryson each day. Stothart, a clinical care specialist, served as a health coach, care manager and patient advocate to dozens of Whatcom County residents who, like Bryson, were juggling multiple illnesses, complicated medication regimens and long lists of doctors.
The job was part of a multimillion-dollar, grant-funded effort to improve the treatment of chronic illnesses. The effort caught national attention and saved thousands if not millions of dollars - and Bryson's life.
"I don't know what she heard (in my voice), but she knew I was in trouble," she said. "And I didn't."
Bryson was tired because she was so dehydrated she didn't have enough blood in her body. She ended up going to the hospital.
"I would not have survived the weekend," she said.
But these days, the only way Bryson will see a clinical care specialist is by watching a television documentary airing Sunday. "Remaking American Medicine: The Stealth Epidemic" highlights model efforts around the country that have saved money and lives by changing the way health care is delivered.
The clinical care specialists were funded through an international, $30 million grant from the Robert Wood Johnson Foundation that ended this summer.
The documentary also illustrates another Whatcom County project funded by the grant, the Shared Care Plan, an online record-keeping system that helps patients track their own medical histories and goals. That program remains.
And while funding from Congress helped extend the life of the clinical care specialists from two to four years, there was no easy place to pay for a program in a health care financing system based on paying for what the specialists worked to avoid - visits to the doctor and nights in the hospital.
A small study of 40 of the patients who had clinical care specialists showed their hospital bills dropped by an average of $3,033 annually, said Marc Pierson, a vice president at St. Joseph Hospital who helped coordinate the grant, called Pursuing Perfection.
Another study estimated the program saved more than $2 million annually in Medicare dollars alone, he said.
"It saved lives and it saved money. But there's no billing code for it." Pierson said. "If you want to redesign health care, if you want to redesign anything that's a business, you have to redesign what you get paid for."
While the clinical care specialists have moved on to other jobs or retired, the results of their work feed the growing interest in how to improve the care of people with chronic health problems, particularly as baby boomers get older.
For example, Northwest Regional Council officials have been talking with Stothart about her clinical care experiences. The council administers Medicaid funds for chronically ill people who get in-home care. Forty of the most severely ill, whose annual care tops $10,000, will join a state pilot project to provide intensive care management services.
"We were able to see how supporting people with chronic illnesses, and kind of coaching them in their own self-management and their interaction with the health care system, could be effective - and possible - if we had enough time to do it," said Victoria Doerper, the council's executive director.
The state pilot program started in Yakima and Pierce counties, said Candy Goehring, a program manager for the Aging and Disability Services Administration of the Department of Social and Health Services. By working with a small number of clients, case managers have more time to get to know them and their families and learn about their health needs, Goehring said.
"You just can't get that kind of experience unless you're with them in ways we are with our clients," she said.
The goal is to help prevent medical emergencies - and unnecessary hospital bills. The test cases in Pierce and Yakima counties showed $3 saved for each dollar spent, Goehring said.
After her experience working with clinical care manager Stothart, Bryson feels more confident managing her own illnesses. But she worries about others in the community who are now as sick as she used to be. And there are still days when she wishes she could call Stothart and ask a quick question.
But Bryson, who served on the patient advisory board for the grant and helped shape the clinical care managers' job, is optimistic that others are beginning to see the importance of more coordinated care for chronic illnesses.
"We just didn't reach the tipping point of the payers seeing the value in a way that they would take it over and continue it," she said. "But I think that will come."
Posted by Marcus Pierson on 10/22/06; 7:44:22 AM
from the Access dept.
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