An HFMA Healthcare Financial Pulse Resource
With hospitals in Texas, Louisiana and New Mexico, CHRISTUS Health serves communities that have among the highest rates of poverty and the largest uninsured populations in the nation.
Health system leaders have recognized that charity care alone does not address the needs of those living without insurance and suffering the burden of chronic illnesses.
In fiscal 2008, CHRISTUS Health provided more than $194 million in charity care. Beyond that, the system is working to be more effective and efficient in its delivery of care for the uninsured and underserved.
“Our goals are to provide expanded access to primary care for the uninsured and provide community-based care management for the chronically-ill uninsured” says Kimberly Camp, RN, MSN, director of care management in CHRISTUS Health’s community health department. “Instead of having a patient come to our hospital with complications of diabetes and requiring amputation of an extremity, let’s be proactive and prevent that from happening.”
The community health program provides culturally competent community-based care management for uninsured patients ages 19-64 with chronic conditions. The program uses certified community health workers to help patients navigate the healthcare system and support them to self manage their chronic illnesses and overall health.
Across the system there are 12 community health workers providing care navigation management; the average salary is $13 an hour. The community health workers--who are supervised by a RN—help patients access primary care, obtain prescription medications, and connect with other social services.
“Our focus is the patients and their physical, psycho-social, and spiritual needs,” Camp says.
Patients are referred to the program if they show up frequently at a CHRISTUS emergency department (ED) or inpatient bed. Members of the ED or case management staff call a community health worker, who meets the patient at the hospital to invite him or her to participate in the care management program.
Connecting with patients at the point of care is effective, Camp says, because patients are focused on their health status and concerned about receiving the services they need.
More than 300 patients have referred services through the program. A recent analysis of data for 100 patients enrolled in care management shows their ED visits have been reduced by 59 percent and hospitalizations by 63 percent. The average cost of care has been reduced by 76 percent, and the return on investment is $2.28 for each $1 invested in the program.
The community health worker identifies barriers to living a healthy life with the patient. The CHRISTUS system has created “pathways” that guide the community health worker as these barriers are addressed.
“If transportation or depression is a barrier, there is a pathway that includes the steps the community health worker should take with the client,” Camp says.
For example, the workers use a two-question screen for depression and, depending on the result, refer the patient to a physician for further depression assessment and treatment. Other pathways provide step-by-step protocols to guide community health workers find a medical home for a client, to screen for alcohol dependency, to obtain prescription medication assistance, to address family violence and other services.
Meanwhile, the workers also connect their clients with community resources that allow them to access health care services. In one rural community CHRISTUS serves, a church started a Healthy Roads Program in which church members volunteer to take patients to their doctor appointments. In more urban areas, the community health workers provide bus tokens and coach their clients on how to get to their appointments on time and be active participants in the interaction with the physician.
“One thing that we stress to the community health worker is that consistency and follow-up are critical or you lose the trust of your client,” she says. For example, one community health worker’s weekly calls—every Monday—remind a certain patient to stick with her medications and follow other healthy habits and coaches the patient to make her health a priority. The result: the patient has stayed out of the hospital for eight months—a dramatic departure from the past.
Camp points to patient satisfaction survey results that show care management is a winner with uninsured patients. The scores are high, but the personal testimony is what Camp values.
“They will write little comments on their surveys that say, ‘My community health worker helped me so much. She listens to me and has made such a difference in my life.’ This is important because people feel like someone really cares for them. "
Interviewed for this article: Kimberly Camp, RN, MSN, is director of care management for CHRISTUS Health: Community Health in Houston, Texas (kimberly.camp@christushealth.org).