Disease management plan helps unfunded patients

Hospital system manages care of chronically ill

A disease management program helps chronically ill unfunded patients cared for by the North Broward Hospital District, with headquarters in Fort Lauderdale, FL, avoid hospitalizations and emergency department visits.

The hospital system started the program eight years ago to help alleviate the number of unfunded patients with chronic illnesses who were coming to the emergency department because they didn't have a primary care provider and were not getting the care they needed to keep their condition under control.

The program focuses on patients in the community who may have access issues, financial limitations and who may never have been to a primary care provider. "It's a win-win situation for everyone," says Lori Kessler, BSW, MHSA, district manager for disease state management programs. "We get these patients established with a doctor or a nurse practitioner and make sure they get the right care."

The patients are healthier, and they keep patients who have no ability to pay out of the hospital and the emergency department, Kessler says. "Our strategy was to ensure a healthier community, and it has worked," she says.

The program illustrates the benefit of educating people with chronic illnesses about their conditions and helping them stay healthy, Kessler says. "We did a cost-avoidance analysis, and the program has paid for itself," she says. People with chronic illnesses who don't take their medications, monitor their conditions, or keep their appointments with their primary care provider are likely to be hospitalized, Kessler points out. "By monitoring these chronic illnesses, we are improving the quality of life for these patients and cutting down their medical costs at the same time," she adds. North Broward Hospital District has five acute-care facilities and 11 primary care sites. The nurse case managers are located at the primary care site and coordinate care for patients with asthma, hypertension, congestive heart failure, HIV-AIDS, breast cancer, and high-risk pregnancies. Patients without insurance and those with Medicaid are eligible for the chronic illness program. There is no charge to the patient for participating in the program.

When a patient is referred to the program, the nurse case managers find out if the patient has a medical home. If patients have been hospitalized or visited the emergency department and don't have a medical home, the case managers help them find a physician at a convenient location and ensure that they get the follow-up care they need. The nurses stratify the patients based on psycho-social issues, use of health care resources, and clinical indicators. In addition to seeing them in the clinic, the nurse case managers contact the patients at regular intervals, depending on the patient's risk for a decline in health status and other factors.

The case managers are assigned to patients by location, rather than disease. "So many of these patients have comorbidities, so it's better to have one nurse coordinating the care for all of the conditions," Kessler says. "The nurses can always call on others for help and often co-manage patients with complicated diseases like HIV or cardiovascular disease."

In addition to conducting one-on-one education, the nurse case managers in the program arrange regular group sessions for patients with a particular disease, and they often partner with other resources in the community. For example, the program organizes "Foot Days" and invites all the patients with diabetes to participate. Kessler brings in a podiatrist from Nova University to help with the education sessions and to conduct foot examinations. She gives the participants little mirrors and encourages them to check their feet regularly. "We get the patients educated and their feet checked for free, and the Nova University students get good experience," she says.

(Editor's note: For more information, contact Kessler at lkessler@nbhd.org.)