Three state projects are giving Maine’s biggest medical users more help, and it’s already paying off in a host of ways

Posted April 13, 2014, at 6:14 a.m.
Tammy Wilson looks out a window in the office at the Travel Inn in Lewiston recently where she lives and works as the manager.
Russ Dillingham | Sun Journal
Tammy Wilson looks out a window in the office at the Travel Inn in Lewiston recently where she lives and works as the manager.

Last year, Tammy Wilson visited the emergency room 38 times.

She knew she went there a lot — too much — but she didn’t know what else to do for her debilitating migraines. In the past she’d seen her primary care doctor and a neurologist, tried over-the-counter drugs and prescriptions. The ER offered the only solution she knew would work, and work fast: an intravenous medication that beat back the agonizing headache enough for her to keep her on her feet as a single mother and the on-site manager for two Travel Inn motels.

“Some days [the ER trip] was two times a day because my migraines were so severe,” she said. “I would try to take care of it at home, but the only thing that worked was going in and getting an IV.”

Then the state took notice.

Wilson is insured through MaineCare, the state-run Medicaid program for the poor, disabled and elderly. The Maine Department of Health and Human Services, which oversees MaineCare, was not happy paying for 38 expensive ER visits for one person in one year.

But in its effort to save money, the department didn’t cut back Wilson’s services.

It gave her more.

Wilson got her own care manager, a state-paid nurse who coordinated Wilson’s care, checked with her after appointments to make sure she was benefiting from them and encouraged her to make herself and her health more of a priority as she dealt with the daily stresses of work and parenthood. Wilson’s primary care doctor saw her more often, working to get her migraines and her blood sugar, which exacerbated the headaches, under control. She got new prescriptions to try.

It all worked.

Wilson, who averaged nearly one ER trip a week last year, has been to the local emergency room only twice in the past four months. One was for a migraine; one was for a possible broken bone after a fall on the ice.

The change has saved the state big ER bills. And Wilson is both happier and healthier.

It sounds counterintuitive: To save money on health care the state should spend more money on health care.

But that’s exactly what Maine is doing.

Spending more on case managers and nurses. More on medications. More on visits to the doctor’s office.

And not just that. Housing, too. Child care and job training. Transportation. Things that seem to have no impact on a person’s health but actually do.

“We’re not connecting the dots [as a nation],” said Dr. Jeffrey Brenner, a national leader in the effort to change how the country’s neediest — and most expensive — patients get health care. He is working with Maine.

Experts are pleased by early data that show spending more for comprehensive care now may save money down the road and improve people’s quality of life. They are so pleased with the data that Maine is moving forward with not one but three major programs.

One deals with high emergency room use like Wilson’s.

Another gives MaineCare patients a “medical home” that coordinates their health care.

And the third — the newest and potentially most far-reaching — looks at the needs and goals of an entire high-cost family and works to meet them. Better housing? Odd-hours child care? Someone to remind them about prescriptions and medical appointments? All that and more.

“These are truly the people who are most dependent upon DHHS to do the right thing for them or at least make the right opportunities available to them,” said Kevin Flanigan, medical director for MaineCare Services.

That third pilot program, Partners in Health and Wellness, is based in Lewiston. Two families are already enrolled.

To view the rest of the story, go to http://www.sunjournal.com/news/lewiston-auburn-oxford-hills-river-valley-franklin-maine/2014/04/12/spending-more-save-more-its-working/1515674#

 

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