Reducing ER Visits and Unnecessary Hospital Admissions
NTSP cares for more than 70,000 seniors in Texas and North Carolina. Many of our patients have chronic health conditions and the existence of these chronic conditions, combined with patient age, complicates the care process.
Patients with chronic health conditions are more likely to be readmitted within 30 days of a hospital procedure, more likely to be admitted for overnight observation in the ER if they don’t feel “normal,” and may tend to overutilize the ER when they feel panicked or somewhat ill. All of these situations add enormous weight to the nation’s health care bill and can create financial burdens for patients.
We believe that efforts to enhance care and efforts to reduce overutilization of expensive health care resources, such as the Emergency Department, are not mutually exclusive.
NTSP, in partnership with two of the area’s leading emergency service providers, has reduced ER visits and unnecessary hospital admissions.
The program involves a specialized team of medics and care managers who help enrolled patients determine if they truly need emergent care when their health conditions change. This is very much like concierge medicine for chronically ill patients.
We are concentrating first on working with seniors who have asthma, congestive heart failure, cardiopulmonary disease, diabetes and hypertension, especially if they have been recently discharged from a hospital, or have experienced four or more avoidable ER visits in the past 12 months.
Patients with chronic health issues are acutely aware of the need to monitor their health condition. Sometimes, in monitoring their condition, they may notice small or sudden changes in their health. Rather than discounting how nervous this can make a patient feel, or leaving them to make their own decisions about an ER visit, our program engages experts who can help assess the situation and proactively direct the next steps and reassure the patients that the necessary steps will be taken.
This program is just one of many initiatives NTSP sponsors to help patients with chronic health conditions manage their health.
The key ingredient that makes the program powerful? Easy access to patient health information for any provider who may touch an enrollee, immediate involvement by specially trained medics who are alerted anytime an enrollee contacts 911, and the ability to quickly triage with NTSP primary care physicians and specialists to get an accurate assessment of the patient’s health condition.
A foundational element of the program is a home visit or series of home visits by Community Health Program (CHP) Medics. Through these visits, a medic can develop a sense of the patient’s health status, living environment, disease management skills, frame of mind, coping strategies and support network. The medic is then better prepared to respond if and when an enrollee contacts 911.
Rather than contacting 911, enrolled patients have the ability to call a non-emergency number 24 hours-a-day, seven days-a-week, if they have a question about their health status. The CHP medic or a member of the care management team can help evaluate the patient’s situation and take any necessary next steps, even if this requires a home visit for a health assessment by the medic.
Through the community program, NTSP has demonstrated that it’s possible to raise the quality of care we offer people with chronic health conditions while simultaneously reducing the cost of care for patients, ambulance providers, hospitals and Medicare. It’s a win all the way around.