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Community joins forces to care for uninsured
Hospitals, agencies collaborate on post-acute care
In Lee County Florida, providing healthcare for the uninsured and under insured is a community-wide effort, according to Chris Nesheim, RN, MS, CMAC, system director, case management, Lee Memorial Health system with headquarters in Ft. Myers, FL.
Located in Southwest Florida, Lee County has been one of the country's areas hardest hit by the economic downturn. Many residents in the construction, real estate, and hospitality industry have lost their jobs in the past few years, and the area also is home to a tremendous number of Medicare recipients, both retirees and "snow birds" who spend the winter months in the area.
"We have a 10.2% rate of unemployment, which was 13% at its highest, and an increase in residents with no insurance or minimal insurance benefits. We coordinate with a lot of community organizations to find places where patients can get the care they need to avoid inappropriate hospital admissions, and be discharged to another level of care when they no longer meet inpatient criteria," she says.
Lee Memorial Health System, one of the largest not-for-profit public hospital systems in Florida, includes four acute-care hospitals and two specialty hospitals with a total of 1,600 acute care beds. The health system experiences nearly 80,000 admissions a year with 47% of them coming through the emergency department.
Case managers and social workers in the emergency department coordinate community services and facilitate placement for patients who do not meet criteria but cannot be safely discharged. They work with "special needs" patients who have frequent emergency department visits to develop a plan for care in an appropriate setting.
In 2007 Lee Memorial Health System sponsored a community-wide collaborative, Community Health Visioning 2017, to create a decade-long vision and initiatives for healthcare that would improve the health status for residents of Lee County with each partner in the collaborative contributing their own unique assets.
For instance, the hospital system collaborated with Lee Mental Health, Southwest Florida Addiction Services, the Salvation Army, and the Lee County Sheriff's office to develop a Behavioral Triage Center and a Low Demand Shelter. The triage center, operated by the Salvation Army with funding from the hospital provides post-acute medical care for the homeless and provides law enforcement and hospital emergency departments with alternatives to jailing, or hospitalizing people with symptoms of mental illness.
When patients don't meet admissions criteria but can't go home safely, the hospitals may send them to The Salvation Army's 10-bed medical respite unit for homeless patients who need skilled nursing services such as IV infusion, dressing changes, and medical care.
Managed by the Salvation Army, "We Care," the latest collaboration between Lee County Health Department, Family Health Centers, the Lee County Medical Association, and the Southwest Florida Community Foundation, provides specialty medical care at no charge to Lee County residents with a medically necessary/life altering condition that cannot be managed by a primary care physician. The patients must be unemployed or the working poor, and must meet financial eligibility standards. Patients are referred to the program by primary care physicians, participating medical specialists, or emergency department physicians. When an eligible patient presents to the emergency department, the case manager or social worker calls the "We Care" coordinator who sets up an appointment with a participating specialist.
In addition, the hospital system has partnered with the community and has opened two indigent clinics (Lee Physician Group Clinics) for the uninsured in buildings that also house United Way agencies that can provide help with social needs such as housing and utility assistance, signing up for food stamps, medical assistance, and other services. The hospital refers patients who use the emergency department for primary care and hospitalized patients with no funding to the clinics for follow-up care. "The collaboration between the health system and the community agencies makes it possible for people to get many sources of needed assistance in one location," Nesheim says.
The health system has contracts with local pharmacies to subsidize the cost of medication until patients can get long-term solutions through Family Health Centers, Lee Physician Group Clinic or other programs, and is working to open its own outpatient pharmacy and to develop a medication assistance program for patients who can't afford their medications, Nesheim says.