Gaining control LG Health launches new project aimed at helping 'superutilizers'
BY CINDY STAUFFER, Staff Writer
A crisis was looming. Jesus Alvarez knew it. His doctors knew it ,too.
The 46-year-old Lancaster Township man weighed 475 pounds. He was battling heart problems and leg ulcers and was on the brink of having a leg amputated. His medical bills had ballooned to almost $1 million from repeat visits to the emergency room and multiple hospitalizations.
"I got scared," said Alvarez, a genial man whose nickname is "Chino."
Lancaster General Health, and health systems everywhere, have hundreds of patients like Alvarez, who are dealing with complex needs, struggling to get the right care and accumulating huge charges along the way.
Across the country, anywhere from 5 percent to 10 percent of all patients account for 50 percent of all health care charges. In 2008-2009 alone, 450 patients at LG Health accumulated $36 million in charges.
Some of those patients have a significant illness, such as cancer. Some have been in a catastrophic accident. But others have a mix of medical and social challenges that are not being efficiently and adequately met by the traditional medical system.
Nicknamed "superutilizers," they cycle in and out of hospitals and multiple doctors' offices while their problems seem to multiply.
Now the county's largest health care system is testing a new method of medical care already being used in places such as New York state; Camden, N.J.; and, closer to home, Chester County and York.
Instead of hopscotching from doctor to doctor, patients are seen by a consistent team composed of doctors, a psychologist, a social worker, a pharmacist, a lawyer and a case manager, through the Superutilizer Project.
Launched in September 2011 at a first-year cost of $71,000, the project is small and has served about 30 patients so far. But organizers are optimistic about the results.
The total numbers of health care visits for those patients dropped 13 percent; emergency room visits decreased by a third.
Costs were a more mixed bag, going down for emergency room visits but up in other areas, with a total increase of 47 percent.
Because the initial group of patients was so small, one hospitalization could throw off the numbers, said project director Dr. Jeffrey R. Martin, the associate director of of Family and Community Medicine at LG Health.
Over time, similar programs in other areas have reduced charges 30 percent to 50 percent on average, he said.
Organizers now are looking for grants and other funding to try to expand the project, which has caught the attention of the state public welfare department and could serve as a model for other counties.
The Superutilizer Project treats patients who often have numerous health issues such as high blood pressure, congestive heart failure or diabetes, often mixed in with difficult social issues such as homelessness, family difficulties, emotional problems and drug addiction.
Picture a patient who is on multiple medications, doesn't speak English and lives in his car.
"We try to start with what is most important to you," said project coordinator Audrey Martin, "and break it down to what's most important and what can reasonably be fixed."
Social workers try to hook a patient to a transportation service. A pharmacist goes over medications. Housing, benefits, legal issues -- all are examined in turn and addressed.
Compassion and connection are important elements, too. Patients have Audrey Martin's telephone number so they can call her if they need to talk through a problem, rather than reflexively going to the hospital.
Jeffrey Martin said the project's team is "worrying with people. They're walking with them through every aspect. They're going to their homes and seeing where they live."
It's not always an easy road.
"The process can take time," Audrey Martin said. "We hope to work with patients for six to eight months."
The project decided to hold graduation ceremonies for patients who have learned to successfully manage their health care.
Alvarez is among the first group of graduates.
A lawyer on the team helped him resolve a tangle of issues surrounding his benefits, addressing his large medical debts. Weight-loss surgery, which had seemed like one more giant bill, then seemed feasible. He had it, and lost 130 pounds in a year.
A pharmacist makes sure he is keeping up with medications; he gets the dressings he needs for his leg ulcers.
He hasn't been in the hospital since he entered the program, which is a big change for him.
Now that he's healthier, he volunteers at the Lancaster General Suburban Outpatient Pavilion in East Hempfield Township. He would like to get off disability and go back to work someday.
"It has been like the bright light at the end of the tunnel," Alvarez said of the program.