LIMA — A few months ago, Donald McCormick was what he calls a “pretty bad diabetic.”
He only checked his sugar once every few weeks and he didn’t watch his diet.
Now, he checks his sugar three or four times a day and he tries to eat better. That’s because he is part of a program through St. Rita’s Medical Center and Mercy Health that “reminds you to do your best.”
Other local hospitals and health systems are also taking on this focus on community health and transitional care. They say it is “the right thing to do” for patients, and it also helps hospitals when it comes to Medicare and Medicaid payments.
McCormick is part of a program called Tel-Assurance, which helps monitor patient’s health in between doctors visits. Each morning, McCormick dials in and answers a few questions with his touch-tone phone.
If any of his answers hint at something going wrong, or something unusual, a nurse will call him back and talk to him. Though it hasn’t for McCormick, the calls could lead to a visit to his doctor or even a trip to the hospital.
The program is one part of a clinically integrated network Mercy is creating in the state. It recently partnered with Summa Health to link providers in a network, created to improve chronic care management, lower the cost of care and shows a bigger focus on population health.
“I think it really reflects the long tradition St. Rita’s has had in Lima,” said Dr. Brent Asplin, chief clinical officer at Mercy Health. “It’s really our mission to improve the health of communities served … Patients and members of the community are going to be better supported.”
REDUCING
RE-ADMISSION
At Lima Memorial Health System, each patient admitted is assigned a case manager who helps determine what the patient needs upon discharge, said Anita Good, service line director at population health and care coordination.
They also call the patient once they are discharged and make sure they’re doing OK, she said.
There are also case managers at some of the private practices within the health system, who make sure patients get in to see doctors within seven days of their discharge from the hospital, Good said.
The case managers also make sure that patients are taking their medication and getting their prescriptions filled.
Lima Memorial has a program called Med to Bed, which brings patients their prescriptions, filled at the hospital pharmacy, before they even leave the hospital.
Not taking medication is one of the biggest reasons people get readmitted to the hospital, Good said.
The hospital is also using home health to help patients, as some “get home and then they panic,” and go back to the emergency room, Good said, it can be a “vicious cycle.”
These programs and others help reduce patient readmission into the hospital, Good said.
“We have seen a reduction in our readmission rate, from double digit to single,” Good said. “I think it’s important because it keeps patients healthier, if they’re healthier they’re not going to come back in.”
At Bluffton Hospital, a part of Blanchard Valley Health System, health care providers are also working to make transitions of care easier and costs lower.
The hospital offers a number for people to call if they need a primary care physician and has care navigators to help patients with chronic conditions, said Chris Keller, Chief Administrative Officer at Bluffton Hospital.
“The payment system nationally is moving more toward incentives for population health,” she said. “We feel it’s the right thing to do, but payment wise … (these are) things most health systems are focusing on today.”
Programs like Tel-Assurance help reduce visits to the hospital for patients, thus reducing the cost of their care.
If care is more closely monitored and more efficient, it helps the patient stay healthier and pay less.
Mercy has made it so treatment plans are shared between providers, at the hospital and throughout the steps after that, said Deborah Roegge De Vita, chief network integration officer at St. Rita’s.
“It makes the care process more efficient and the transition easier,” she said. “There is a decrease in costs of care related to the redesign of the clinical process.”
The hospital can help patients manage conditions outside the hospital, Asplin said.
PATIENTS HAVE
PEACE OF MIND
The Tel-Assurance program has helped McCormick, 67, be healthier, and he would recommend it to others.
“It’s a great program,” he said. “They’re very good, if your (sugar is) elevated, they don’t give you a big spiel … they’re very understanding and they want to know why your sugar is up or why it’s down.”
The program has also reduced the amount of money he pays for care, as he “could have been hospitalized, probably a couple times,” he said.
“By monitoring more and keeping care of it, it’s a lot better system,” McCormick said. “It helps you keep in contact with the medical community.”
Programs like Tel-Assurance and the other programs the hospitals offer are “important because it keeps patients healthier,” said Good.
“It’s not less care, it’s care in the right setting,” she said.
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