Community CMs get medical care for needy
Hospital partners with free primary care clinic
Through a partnership with a community free clinic, a community case management program at Hoag Memorial Hospital Presbyterian in Newport Beach, CA, helps needy residents learn to negotiate the health care delivery system and get the care they need.
"We work with the underserved and under-represented population to facilitate access to the medical care they need. What is unique about our department and our program is the dedication we have taken on in order to provide care to the underserved population," says Rebecca Barnard, RN, MSN, case manager in the department of community medicine at the 498-bed acute care hospital.
Hoag's Department of Community Medicine provides two other programs to the underserved population in addition to the community case management program: a community counseling program, which employs bilingual, master's-prepared social workers who provide short-term individual counseling and support groups, and a faith-based health ministry program, which partners with parish nurses working within their congregations.
In fiscal year 2006, 837 people received case management services from Hoag's Community Medicine program, an increase from 550 in 2005.
Barnard, who is bilingual and bicultural with a background in public health, works as a liaison between the hospital, the Share Our Selves (SOS) Free Medical and Dental Clinic, uninsured patients, and other providers in the community.
"Many local residents do not use available resources due to language barriers, lack of insurance, and lack of awareness about existing health care resources. The purpose of my job is to make sure the connection and follow-through occur as the patient moves from the clinic to the hospital and back to the clinic. I work on facilitating access to services," Barnard says.
The hospital has created a unique partnership with the clinic, which is less than a half a mile down the road and works with the clinic staff to close the gaps in care and decrease barriers to accessing the health care system for indigent patients. In addition to providing primary care, the SOS clinic staff facilitate access to community resources and services such as food, housing, and other social needs.
The medical director and associate medical director of the SOS clinic are Hoag employees who work at the clinic as the hospital's in-kind contribution to the clinic.
The physicians provide medical care to the patients at the SOS medical clinic and assure that the patients receive a level of care that is no different from what they would receive at a private physician office, Barnard reports.
The purpose of the program is to empower patients to learn to access the health care system and get the care they need, to provide education so they can lead a healthier lifestyle, and to rely less on costly emergency care, she says.
The program is staffed by people whose background and experience help them create a rapport with the population they serve. "The fact that we are bilingual and bicultural enables us to communicate more effectively with our patients. We look like them. We sound like them. We are a reflection of the population we serve," Barnard says.
Barnard works to facilitate access into the hospital for patients who receive primary care from the SOS clinic and to make sure that patients who are treated at the hospital receive follow-up care.
When a charity patient being treated by a private physician needs access to hospital services for a procedure that can't be performed within their network, Barnard facilitates access to Hoag services.
If a patient is admitted to the hospital and is not eligible for any other type of funding, the hospital case managers can contact Barnard for assistance in ensuring that the patient receives any necessary follow-up care.
Often this involves helping the underserved patients find a medical home for primary care.
If the SOS clinic is the closest, Barnard coordinates with the clinic physicians to make sure they can provide the care the patients need.
"If the SOS clinic is not the closest clinic for the patients, we help them connect to other clinics nearer their home," she says.
Barnard has educated hospital case managers and other staff about community resources and collaborates with them on helping patients find the services they need after discharge.
"The hospital provides acute care for patients. Our challenge is to look at the broader perspective to help patients stay healthy in the community," she says.
When patients need extensive post-discharge services that can't be provided by the community clinics, the hospital case managers call on Barnard for assistance in coordinating outpatient services.
For instance, when one patient who was recovering from a stroke no longer needed an acute level of care, Barnard investigated post-acute options and concluded a discharge to home with home health care was not an appropriate option.
"The wife was very attentive but it is overwhelming to take care of a stroke patient and deal with all the issues that go along with it. The patient needed the kind of therapy that a rehabilitation facility could provide. The rehab stay gave the family time to receive education so they felt more confident in their ability to care for him. It gave them a chance to access the community resources they needed in order to get things set up to take care of him at home," she says.
Barnard found a rehabilitation facility that would take the patient and negotiated the fee that the hospital would pay for the patient's rehab care.
"The patient had no means of funding but no longer required acute care. The best thing for him and the hospital was to transfer him to a rehab facility until it was safe for him to go home," she says.
Barnard followed up with the family after the patient was discharged from the rehabilitation facility to make sure they were satisfied with the rehab stay and reported back to the receiving facility.
Barnard's department includes a financial screener who assesses the uninsured patients and works with the clinic to confirm patients' eligibility for funding sources and programs.
She educates patients who are employed on how to navigate their private insurance networks.
If the patient is eligible for insurance, Barnard's department coordinates the application process and makes referrals for services.
(Editor's note: For more information, contact Rebecca Barnard, case manager, department of community medicine, Hoag Memorial Hospital Presbyterian, e-mail: [email protected].)
Through a partnership with a community free clinic, a community case management program at Hoag Memorial Hospital Presbyterian in Newport Beach, CA, helps needy residents learn to negotiate the health care delivery system and get the care they need.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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