Houston health innovation center reduces ER trips
A new program of identifying patients who most frequently go to Houston-area emergency rooms and then coordinating their medical care has reduced ER visits by 85% in just three months, according to preliminary findings released today by the Primary Care Innovation Center (PCIC).
PCIC research is based on patients identified as "superutilizers" – patients who use emergency rooms across Houston more than 10 times in one year. During the three months before the PCIC program, eight of those patients visited an ER a total of 65 times.
During the pilot project, PCIC worked with each of the patients to begin an intensive program of coordinating their medical care. PCIC discovered the patients' medical problems and then addressed their needs with regular visits to a primary care physician, enrollment in financial assistance programs, and more.
In the three months following PCIC intervention, those eight patients visited the ER just 10 times, down 85% from previous three months. In addition, their medical costs from their ER visits alone dropped from $130,000 to $20,000.
"We're thrilled by these preliminary results. It shows the project works," said Dr. David Buck, PCIC's director and a professor at Baylor College of Medicine's Department of Family and Community Medicine. "We've shown that just by listening to these patients and really understanding their often chronic medical problems, we can get them the help they really need. Not only does it keep them out of emergency rooms and lowers the burden on taxpayers, it also has a dramatic effect on the patient's health and well-being."
For example, in the three months before entering the PCIC program, a patient known as Mr. Randle, visited the ER eight times at a cost of $58,000 for the emergency room and one hospitalization (there are others). He even had a finger amputated due to complications of diabetes. After being diagnosed with diabetes, high blood pressure and a disabling mental health condition, PCIC's project coordinated his care with regular visits to a primary care and other doctors, as well as a pharmacy. They assisted him with social services and housing. But, Mr. Randle says it best, "I don't trust everybody and whenever my mind begins to wonder or I get sick, you all were just a phone call away," Mr. Randle wrote to PCIC staff. "Thank you for helping me in almost my darkest hour."
In the three months enrolled in the PCIC program, Mr. Randle has not visited an ER once and has kept his diabetes under control.
PCIC is working with other programs across the U.S. that have shown dramatic decrease in ER utilization and hospitalization improving care while lowering cost. Texas remains one of the most expensive states in the country for superutilizers, where the average cost is 50% more than the rest of the U.S. ($134,000/member/year vs. $90,000/member/year)
An analysis of the city's 2014 EMS data showed four patients used the emergency room 179 times at 19 different hospitals. One patient had a total of 56 visits to 10 different ERs. There is currently no other system that is working with the most costly patients who are going to multiple hospitals. Each hospital may address visits within their system, but do not coordinate care between systems. This is where savings and health outcomes can be improved.
This savings represents the tip of the iceberg. Due to incomplete cost data, these savings represent an underestimate of the true cost avoidance.
For more information or to schedule an interview with Dr. Buck, contact Dr. Nathalie Folch, director of operations at PCIC, at This email address is being protected from spambots. You need JavaScript enabled to view it. or 713-798-8635.
Published On: Feb 11 2015 in the Houston Chronicle. Read the complete article here.
