Hurley Emergency Department physicians and staff noticed that many of their most frequent repeat visits came from a relatively small number of people with complex care needs. To improve care and reduce costs, they decided to change how they provide treatment for such patients. Hence, the Complex Care Clinic was born as a collaboration between Hurley Medical Center and HealthPlus of Michigan, operating two days a week from the Hurley Emergency Department. The clinic recently received the 2015 Innovations in Healthcare Award in the chronic conditions category from the National Kidney Foundation of Michigan.
One patient offered to talk about how the clinic changed his life.
Robert Warthon was a 16-year-old who loved basketball when he began experiencing severe stomach pain, vomiting, and tears in and around his bottom.
“I was always tired and throwing up – I didn’t want to eat; I lost a lot of weight and had to stop playing basketball,” said Warthon, who agreed to tell his story now that he is feeling better, thanks to the care he has received at the Hurley Complex Care Clinic Collaboration.
Warthon visited a lot of hospital emergency rooms over the next few years and spent a lot of time in hospitals. “It took them a long time to figure it out - I went through a lot of testing,” he said, adding that he missed about a year’s worth of school in two years.
“My family didn’t know what to think. I felt like I was dying or something. I was always in pain,” he said.
He eventually found that he had Crohn’s disease, a condition that can cause inflammation of the bowels, which can become infected and require surgery. Warthon had two surgeries, including a colostomy, where stool comes out in a bag, which required much training to care for it properly.
Now that he has been coming to Hurley’s Complex Care Clinic, he can feel almost normal again, he said, explaining that he had been to many hospitals before that, and he was usually admitted, then sent home, only to return with more pain and other symptoms.
“I got tired of sitting in the hospital, just staring at the ceiling,” he said. “When I came to Hurley about a year ago, they brought me to this clinic. They pay close attention to me. They monitor me more regularly.”
When Hurley’s Chief Medical Officer Michael Jaggi DO reviewed Warthon’s massive medical records from other hospitals, he recognized how the clinic could help him. He talked to Warthon about coming to the complex Care Clinic and how individualized care — with a follow-up communications plan — could help improve Warthon’s quality of life.
Specifically, clinic staff members monitor his pain levels, make sure his weight remains steady, make sure he takes his medications as they should be taken, ask about new symptoms and treat the symptoms right away.
“They’ve been doing pretty good,” he said. “I haven’t been in the hospital for a year.”
That is a huge improvement from the prior year, when he had 30+ admissions.
“It’s meant a lot. I don’t have to sit in the hospital. … I can do more stuff. I can spend more time with my son, Xy’aire, who’s 5. I can go to my son’s T-ball games on Saturday. I can go to the park with my son. He comes over all the time. … I can basically do anything, since I got healthy. I can do regular, normal things.”
Warthon’s goal was to play basketball in the summer, so that has been the goal of the Complex Care team as well. Warthon’s care included wound care, close monitoring and even transportation. It seems to be working—he has gained weight and experiences less pain.
Warthon, who on this day was in for an infusion to treat his wounds, said the care has given him a new life. After his clinic visit, he planned to play basketball with his son.
In Warthon’s case, the numbers tell more of the story. The graphs below show spending, admissions, primary care physician visits, and ED visits for Warthon - and each shows a significant improvement since he began coming to the Complex Care Clinic for primary care at the end of 2014.
The Complex Care Clinic has helped many other patients, as well, recruiting 33 patients in its first year, one third of the way to its five-year goal of 100 patients. Costs were reduced 44% for a $335,000 savings in year 1, and non-emergent ER (Emergency Room) visits in the first year were reduced by 78%.
The Complex Care Clinic is open to HealthPlus patients who are 18 years old or older with chronic, complex health conditions (such as obesity, cardiovascular disease, asthma, diabetes, kidney disease, and serious mental health or substance abuse issues), with a history of frequent, inappropriate use of ED or other health resources, no matter what the cause.
To achieve such marked improvements, the clinic implemented flexible, personalized care for each individual, starting with a social worker conversation to discover patient and families’ personal barriers to obtaining care for their complex health conditions, then devising solutions, with much follow-up and the usual, evidence-based care for their health conditions.
Common barriers included transportation issues, disabilities that make it difficult to travel or to manage medications, and poverty-related problems such as sporadic phone service, lack of nutritional food and lack of supoprt from family or friends.
Some of the solutions included providing free transportation, pill organizers, and frequent communication to ensure that patients returned for timely follow-up visits before issues became urgent.
Overall, costs were reduced; the number of non-emergent ED visits was reduced; enrollment was effective; and patients in Complex Care Clinic saw health improvements, sad Jaggi.