The E.C.H.O Program helped reduce the overuse of the emergency department (ED) as a primary care provider (PCP) by uninsured and underinsured patients.
Collaborator (Non-Members)Janine Mcelroy
Lee Memorial Health System noticed a trend in uninsured and underinsured patients over-utilizing the ED as their PCP. Reasons for this included lack of financial resources, lack of PCPs and lack of knowledge about the community resources that were available to them.
Location: Lee Memorial Health System (LHMS), Fort Myers, Florida.
Setting type: Non-profit health system.
Payer mix: 50 percent Medicare, 22 percent Medicaid, 28 percent commercial payer.
Population served: All.
In addition to having four acute care hospitals, Lee Memorial Health System includes a rehabilitation hospital, a skilled nursing facility and a home health agency.
What We Tried
We did a six-month pilot with 25 patients who had four or more ED visits within a six-month period. A social worker and an ED case manager were assigned to work with these patients four days every two weeks to set up medical appointments, arrange transportation, conduct in-home visits, provide disease-management education, accompany patients to appointments as needed, provide appointment-reminder phone calls and troubleshoot barriers to care. We collaborated with agencies in the community to provide help with needs such as food, substance abuse, medication, transportation and dental care.
The interventions provided in this six-month pilot demonstrated a cost savings of $47,000. Since the pilot, the program has been expanded and now employs two full-time community health workers (Licensed Practical Nurse and Bachelor of Social Work). For patients who were enrolled in the program long enough for us to review their utilization six months before and after the program start date, there was a decrease observed in both ED and inpatient utilization as well as direct variable cost (the cost associated with the direct care of the patient). We partnered with our process analytics and finance departments to determine the cost per patient. Inpatient discharges decreased by 21 percent, ED outpatient visits decreased 35 percent, and the direct variable costs decreased by $108,349. Since the program’s inception in April 2013, 4,163 interventions have been performed. The breakdown is as follows:
- Phone follow-up – 1216
- Home visit – 531
- Medication – 349
- Hospital visit – 329
- Scheduled appt. – 324
- Transportation – 288
- Housing – 213
- Mental health – 193
- PCP established – 179
- Insurance issues – 132
- Provider visit – 105
- Food – 68
- Substance abuse – 57
- Relocation – 38
- Dental – 14
- Jail visit – 2
- Other – 125
Hire the right person! This person must have the skills to develop trusting relationships with patients and community agencies. Collaborate with social-service agencies in the area to provide the appropriate services. Track your efforts, so you can demonstrate the value of the program to the bottom line. Partner with the process analytic and finance departments to determine the direct variable cost.