• A Caregiver’s View of a Medical Home

    An interview with Helen Kuryllo

    By Lola Butcher

    Thanks to the medical home practice that serves her frail, elderly parents, Helen Kuryllo no longer has to struggle with walkers, oxygen tanks, and wheelchairs to take her parents to frequent physician appointments. And her parents are staying out of the hospital.



    Helen Kuryllo’s father, 89, has five chronic conditions, and her 86-year-old mother has dementia and a seizure disorder. For about four long years, Kuryllo was entirely too familiar with the New Jersey hospital where her parents were treated.

    “I was in that hospital at least once a month with one or both,” says Kuryllo, an English teacher at Montclair High School. “There were days when my dad was there in a hospital bed and my mom was in the emergency department, or the other way around.”

    The ambulance had been to her house so often that the driver honked and waved at Kuryllo when he spotted her on the sidewalk of a neighboring town.

    But in the last 18 months: not a single emergency department (ED) visit or hospitalization. “My mom hasn’t fallen in more than a year, and she was falling regularly before that,” Kuryllo says. “They haven’t had any major incidents of any kind. They’re not well, but they are stable.”

    Medical Home to the Rescue

    The change came in April 2011 when Kuryllo’s parents—who moved into her home when they could no longer care for themselves—connected with Vanguard Medical Group in Verona, N.J. The primary care practice had been designated as a patient-centered medical home by the National Committee for Quality Assurance a few months earlier. There, the Kuryllos’ primary care physician recognized that the entire family was a victim of America’s fragmented healthcare system.

    “The cardiologist didn’t talk to the pulmonologist, who didn’t talk to the physical therapist, who didn’t talk to whoever else,” she says. “Everybody was trying to get me to be the coordinator. I’m a pretty educated person, but I didn’t really have the skills or education to do that.”
    All of this changed when a population health coordinator, Janet Duni, entered the picture. An RN with 30 years’ experience, Duni works for Horizon Blue Cross Blue Shield of New Jersey, which developed the statewide medical home project that Vanguard participates in.   

    Duni helped the family find community services, including a cardiac hospice program for Mr. Kuryllo and a dementia hospice program for his wife. The two Kuryllos also now receive primary care at home thanks to Vanguard’s home-visitation program.

    “That saved my life, because I do not have to transport these two elderly, frail people to and from the doctor every three or four weeks,” Kuryllo says. “The doctor now comes here, and that means there is a primary care physician to deal with all of the specialists and who knows the whole picture.”

    Through the hospice program, a home health aide comes to the Kuryllo’s home 20 hours a week. A medical home nurse comes by once a week and a social worker checks in every few weeks. When problems arise—such as Mr. Kuryllo’s recent request for a medication that was not on his insurance formulary—Duni steps in to help figure out a solution.

    Costs Going Down, Too

    While the medical home is making Helen Kuryllo’s life easier, it is also saving money. Horizon medical home members had a 10 percent lower cost of care (per member per month) in 2011, compared with the control group on non-medical home members, primarily due to 25 percent fewer hospital readmissions and 26 percent fewer ED visits.
    Helen Kuryllo says she is one of many baby boomers facing the same situation. “How do we take care of our aging parents in a way that will keep the costs down—that’s a consideration for all of us, right? However, it’s not just numbers. They’re my parents. They are human beings.”

    Helen Kuryllo is a caregiver and teacher at Montclair High School, Montclair, N.J. 

    Access related article: N.J. Medical Home Collaborative Pays Off for Patients, Physicians, and Insurer