Georgia’s Community Health Works program improves health, cuts emergency room visits

Community Health Works (CHW) in Forsyth, GA, which works for five hospitals in seven central Georgia counties, has been improving or stabilizing health for its members while generating hundreds of thousands of dollars in fewer annual health care charges. 

Greg Dent, CHW chief operating officer, tells State Health Watch the program was developed in 1999 by a number of central Georgia health care leaders who asked themselves how they could work together to better serve the uninsured than they had been doing separately.

CHW serves people between the ages of 19 and 64 who earn less than 200% of the federal poverty level and have no health insurance coverage. The organization has screened more than 4,500 people since it opened its doors in 2001 and has served more than 2,500 eligibles. 

As a nonprofit network of 90 physicians, three clinics, five safety net hospitals, two regional behavioral health providers, district and county health services, local Family Connections, and several county governments, CHW provides medical homes as well as access to needed specialty care, labs, diagnostics, hospital services, and pharmaceuticals for patients with hypertension, heart disease, diabetes, and depression. 

The average CHW member has two comorbidities, an 11th-grade education, an annual income of less than $7,000, and a need for five prescriptions per month. Those drugs are delivered for an average cash outlay per month of less than $20.

A program evaluation by William Custer, associate professor of risk management and insurance at Georgia State University in Atlanta, found 95% of the patients served reported stabilized or improved health. And when compared to a national control group of Medical Expenditure Panel Survey respondents with similar characteristics, CHW patient members, who average three chronic illnesses and five prescriptions per month, use the emergency department and hospital services 13% to 27% less than Medical Expenditure Panel Survey respondents who have one chronic illness. 

CHW says that translates to more than $500,000 in fewer uncompensated care charges per 1,000 people served, and the trends suggest that utilization will continue to fall. Mr. Dent tells State Health Watch that plan members are referred by either a physician or family member. Once screened and accepted, they are assigned to a primary care doctor and a case manager. The case managers provide links between doctors, pharmacies, and hospitals to keep their patients moving smoothly and effortlessly through the system. They develop care plans that are specific for each of the disease states CHW works with. "We focus on coordinating as much care as possible and finding a way to get that care paid for," Mr. Dent says. Patients receive regular calls from their case managers timed to the severity of their risk. Thus, those at high risk might be called once or twice a week, while those with medium risk are called once every one to two weeks, and those at low risk are called monthly. For diabetes patients, for instance, case managers will make sure they are watching their diets, using the glucose monitor, and have a sufficient supply of test strips.

The CHW pharmacy benefit works to enroll patients in all available drug company assistance programs as well as other programs and buys drugs for those who can’t obtain them through any other source. 

According to Mr. Dent, the services provided by CHW cost $300 to $400 per patient per year and generate savings in excess of that amount through reduced hospitalization and emergency department rates.

He says CHW has more care management capacity available but is limited by physician capacity. 

Similar effort for cancer patients

The organization has spun off the Central Georgia Cancer Coalition that covers 25 counties and does a similar kind of work for those affected by nine forms of cancer. It also has become involved in advocating in the public policy arena for the uninsured, who often don’t have anyone to speak up for them.

For those in other communities who would like to do what CHW is doing, Mr. Dent says it is important to have committed leadership with a long-term vision of what can be accomplished. He says CHW has learned that it is easier to deal with not-for-profit hospitals because they understand that they will have to treat the uninsured one way or another. For-profit hospitals have a harder time coming to grips with the concept, Mr. Dent says, because they generally manage for next year and can’t see the long-term savings that will accrue by keeping people with chronic illnesses out of the hospital. 

He adds that it helps to be able to leverage resources, such as foundation grants or government funds, because seed money helps to bring people to the table to plan and implement a program.

[More information is available on-line at www.chwg.org. Contact Mr. Dent at (478) 994-1914.]