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2:32 am
Wed July 10, 2013

How Oregon Is Getting 'Frequent Fliers' Out Of The ER

Originally published on Wed July 10, 2013 6:03 am

Forty-year-old Jeremie Seals has had a tough life.

He left home at 14, and his health isn't good. He had a heart attack when he was 35. He has congestive heart failure, and nerve pain in his legs that he says is "real bad."

"Long story short, I'm terminal," he says, matter-of-factly.

Seals is unwilling to divulge too much about his past. But over the years, he says his health has deteriorated to such a degree that he can no longer hold a job.

By 2011, he was sleeping in his car, and that's when his medical problems started having a big financial impact. That year, he visited the emergency room at Oregon Health & Science University in Portland 15 times and was admitted to the hospital 11 times.

"I basically lived at the emergency department," he said. "Ever since I'd had a heart attack, anytime my chest hurt, I'd either call the ambulance or go up to the hospital. And I think it was also out of desperation to just get out of my car and off the street."

His regular visits to the ER brought him to the attention of one of Oregon's new coordinated care organizations. As part of the nation's health care overhaul, Oregon has been given permission to conduct its own experiments. One way it's trying to reduce Medicaid costs is to encourage people who constantly turn up in the emergency room — so-called frequent fliers like Seals — to get their health care from regular doctors instead.

Lisa Pearlstein of Health Share of Oregon, one of the care coordinators, remembers her first meeting with Seals in 2011, when she began to guide him through the medical maze:

"He's sitting in a chair and complaining about his feet being wet. And I said, 'Why are your feet wet?' And he said, 'I have holes in my shoes.' And I said, 'Would you like a new pair of shoes?' And so I ended up getting him a new pair of shoes that day. And so we connected over those shoes."

Seals remembers it well: "Not only did she get me boots, but she got me a pillow and she got me a really awesome sleeping bag."

Oregon's health care experiment allows Pearlstein to help Seals and other patients much as a family member might. She helped him schedule doctor appointments and went with him to make sure he understood what he had to do. She also helped him get dialysis and take his medications correctly.

And she helped him with more everyday needs. She made sure he had passes for the local community center so he could shower. Eventually, she helped him negotiate a spot in adult foster care so he now has a roof over his head.

They built a rapport, and now he trusts her. It didn't come easily. "I understood that Lisa was trying to help me," Seals says. "But at the same time I had a real hard time trusting anybody in the medical field."

He says Pearlstein helped him to be more communicative with his doctor and helped him explain his needs calmly and clearly.

Seals' doctor, Christina Milano, says she's seen an amazing change. "When he has the resources available to him and when housing had stabilized for him, he is actually wanting to be adherent to the medication," she says.

With the intervention of Pearlstein and others, Seals' ER visits dropped from 15 in 2011 to four in 2012. His hospital stays went from 11 to four.

And that's how the state can save money, says Rebecca Ramsey of CareOregon, a nonprofit health plan for Medicare and Medicaid patients. "It doesn't take very many ED visits and it takes less than one hospital admission avoided, to actually more than pay for the time that Lisa spent with Jeremie," she says.

Oregon has no formal numbers yet, but the federal government has given the state almost $2 billion and five years to show it can reduce the rate of medical inflation by 2 percent.

This piece is part of a reporting partnership among NPR, Oregon Public Broadcasting and Kaiser Health News.

Copyright 2013 Oregon Public Broadcasting. To see more, visit http://www.opb.org.

Transcript

DAVID GREENE, HOST:

And let's turn to another part of the Affordable Care Act. The federal government has given some states, including Oregon, incentives to try to reduce health care costs. Oregon is hoping to cut down on visits to emergency rooms. The goal is to encourage people who frequently show up at the ER to go instead to regular doctors to receive their health care.

Kristian Foden-Vencil of Oregon Public Broadcasting followed the case of one homeless man to see if the experiment's working.

KRISTIAN FODEN-VENCIL, BYLINE: Jeremie Seals is only 40, but he has the health problems of a much older person.

JEREMIE SEALS: I have congestive heart failure. I have cardiomyopathy. I have neuropathy in both my legs really bad. I had a heart attack when I was 35. I am - a long story short - terminal.

FODEN-VENCIL: Seals won't divulge much about his past, but over the years, he says his health has deteriorated to such a degree he can no longer hold a job. By 2011, he was sleeping in his car.

SEALS: Ever since I'd had a heart attack, anytime my chest hurt, I'd either call the ambulance or go up to the hospital. And I think it was also out of desperation to just get out of my car and off the street.

FODEN-VENCIL: That year, he visited the emergency department at Oregon Health and Science University in Portland 15 times, and was admitted 11 times. And that's what brought him to the attention of Oregon's new coordinated care organizations, a network of health care providers, like doctors, hospitals, dentists and mental health clinics that are working together to provide Medicaid services. Specifically, Seals came to the attention of Lisa Pearlstein, who works for one of Portland's coordinated care organizations, Health Share of Oregon. Pearlstein's job is to first guide patients like Seals through the medical maze, but it's more. She met him at a doctor's appointment in 2011.

LISA PEARLSTEIN: He's complaining of his feet being wet. And I said: Why are your feet wet? And he said: I have holes in my shoes. And I was, like, would you like a new pair of shoes? And so I ended up getting him a new pair of shoes that day. And so we connected over those shoes.

SEALS: This was during, like, mid-winter. My feet were getting saturated. They were freezing. And not only did she get me boots, but she got me a pillow and she also got me a really awesome sleeping bag.

FODEN-VENCIL: Oregon's health care experiment allowed Pearlstein to buy non-medical items for Seals, like a subzero sleeping bag. It also allowed her to take on his case, much like a family member might do. So she helped him schedule doctor appointments, and went with him to make sure he understood what he had to do. She also helped him get dialysis and take his medications correctly. And then she helped him take care of everyday needs.

PEARLSTEIN: He and I would always meet on a Friday to plan his weekends, because those were the toughest times. So we made sure he had a place to park his car, that he had a library card so he could go to the library.

FODEN-VENCIL: She made sure he had passes for the local community center so he could shower. Eventually, she helped him negotiate a spot in adult foster care, so he now has a roof over his head. They built a rapport, and now he trusts her, he says, but it didn't come easily.

SEALS: I understood that Lisa was trying to help me. But at the same time, I had a real hard time trusting anybody in the medical field.

FODEN-VENCIL: But he says Pearlstein helped him to be more communicative with his doctor, to explain his needs calmly and clearly. Dr. Christina Milano says she's seen an amazing change.

DR. CHRISTINA MILANO: When he has the resources available to him, and when housing had stabilized for him, he is actually wanting to be adherent to the medication regimen that I have recommended for him and that his specialists have recommended for him.

FODEN-VENCIL: So, remember that in 2011, Seals visited the emergency department 15 times and was admitted to hospital 11 times? Well, in the year afterwards, while working with Pearlstein and Milano, he was in the ER only four times and in hospital three times. Rebecca Ramsey of CareOregon says that's good for Seals and the system.

REBECCA RAMSEY: It doesn't take very many ED visits, and it takes less than one hospital admission avoided to actually more than pay for the time that Lisa spent with Jeremie.

FODEN-VENCIL: Oregon has no formal numbers yet, but the federal government has given the state almost $2 billion and five years to show it can reduce the rate of medical inflation by 2 percent. If the state fails, it faces some heavy fines. For NPR News, I'm Kristian Foden-Vencil, in Portland.

(SOUNDBITE OF MUSIC)

GREENE: Kristian's story was part of a partnership of NPR, Oregon Public Broadcasting and Kaiser Health News. Transcript provided by NPR, Copyright NPR.