Taking the barriers out of health care 20130125
January 25, 2013
For anyone, the health care system may seem like a daunting maze of cryptic language, confusing bills, hurried doctors and medical staff, and pharmaceutical mysteries.
For some, the unknowns of health care just may be enough to stay away – that is until a health condition gets too serious to ignore.
Such people may end up in the emergency room, which many times could have been prevented.
Unnecessary emergency room visits where hospitals are required by law to accept patients without a long wait – regardless of legal status or ability to pay – add up to a financial burden passed on to all policy holders.
Yet people visit emergency rooms because they are convenient, because they assume they cannot get care elsewhere, or they avoid doctors primarily out of concerns about cost until something requires immediate attention.
Of all Coloradans who visited emergency departments in a recent one-year period, about half were either uninsured or underinsured, according to an October 2012 Colorado Health Access Survey, which asked a random sample of 10,000 Coloradans about their emergency-department use.
And those covered by Medicaid or Medicare had the highest rates of emergency visitation, trumping the notion that it’s mostly uninsured users who take advantage of the ER option.
Since Coloradans in poor health were among the most frequent emergency department users, coordination of care for such individuals may be one way of improving the overall health care system in our state, according to the study.
This nationwide, statewide policy aim to improve accessibility and coverage of health care is precisely a reason why a Grand County-based Patient Navigator Program has been in place, going on its second year of a two-year $356,000 grant from the Colorado Health Foundation and Caring for Colorado.
Some individuals face a host of health care barriers, according to Jen Fanning, executive director of the Grand County Rural Health Network.
Among them are hurdles such as lack of transportation, financial worries like high deductible health plans or no insurance at all, a feeling of isolation and helplessness after a diagnosis, or maybe a sense of being overwhelmed or a feeling of intimidation.
In the first year of the Patient Navigator Program in Grand County, there were 66 clients served. Since then, the number of clients has nearly doubled.
Presently in the county, there are three “patient navigators,” or registered nurses equipped to help referred patients break down those barriers to health care.
An example is one 55-year-old laid-off construction worker in Grand County whose, according to Fanning, debilitating hyper tension, high blood pressure and possible arthritis went untreated and led to unpaid household bills. When social services reached him at his home in the fall of 2011, he suffered from significant swelling in the limbs to the point he was crawling to get around in his house, Fanning said, and his isolated home’s heat and water had been shut off.
Social Services contacted the Patient Navigator program through the Grand County Health Network. From there, a Navigator worked to connect the individual with programs that could help him with heating bills, water bills, access to food and medical care.
Oftentimes, “people don’t know where to go to get help,” Fanning said. “And programs are changing a lot of the time.”
The program works closely with public health and socials services, but also relieves those departments in some aspects, such as making sure patients are following through with health care directives. This in turn can help keep patients from repeat hospitalizations or ER visits, Fanning said.
“In the long run, it saves everybody money,” she said, helping to reduce overall health-care costs.
Fanning hopes that eventually the program will grow to encompass more of Grand County’s citizens. Up to now, the program, which has about 50 open cases at a given time, has been focussing on low-income individuals in need, referred to the program from Social Services, Public Health and charitable organizations. But Fanning recognizes that anyone can have problems deciding on medical choices, finding needed services or sifting through insurance information. It’s this reason she hopes the program, which is becoming a one-stop link to help programs, can someday be available to the employer-insured and anyone in need of some assistance.
The key component, Fanning said, is “patient responsibility.”
“People have to be willing to help themselves and be willing to learn,” she said. And in the end, they may be able to better navigate the health care system, manage their own care, and be their own health advocate.