“How one hospital reduced uninsured Emergency Department
visits by nearly 70 percent.”

September 18, 2019

Among America’s greatest achievements is its form of government.  When the U.S. Constitution was crafted, it was the first such document of its kind.  Nowhere in the world did there exist, in a single document, a framework for structuring government and empowering citizenry—a supreme law of the land.  Today, nearly every nation on Earth has ratified its own constitution.  What America provided the world was a new model for governing.  It was seen at the time as revolutionary.

It is indeed possible for a single country, a single company or a single individual to bring forth a new idea that captures the imagination and produces a new paradigm throughout the larger community.  Isolated innovation that eventually leads to national or global change can occur when you least expect it.  It may be that one hospital in Memphis has managed to do that very thing.

Laying Out the Problem

One of the greatest drags on the American healthcare system is the large number of patients who enter our emergency rooms (ERs) without insurance.  Many times, these individuals end up in the inpatient setting where they may remain for days.  Depending on the state in which your facility is located, “uncompensated care”—the current euphemism for this issue—can range from over one percent to over six percent of your total operating costs, based on an analysis of Medicaid and CHIP Payment and Access Commission (MACPAC) data, as well as a U.S. Census Bureau review of uninsured rates in the individual states.

While it is true that the Affordable Care Act contributed to a 35-percent reduction in the national uninsured rate between 2013 and 2015 (according to MACPAC’s 2018 report to Congress), uncompensated care continues to be a significant burden to the nation’s hospitals.  According to a Medical Expenditure Panel Survey, five percent of patients—known as super-utilizers—are responsible for 50 percent of the nation’s healthcare costs.  Many of these are uninsured, have chronic conditions, and make multiple trips to the ER per year.

For some of these super-utilizers, illness may not be the only trigger for a trip to the hospital.  There are often other factors at play.  Take, for example, one patient in Memphis, Tennessee who entered the ER 53 times between September 2018 and June 2019.  He was not only hoping to find help for his diabetes-related issues, but he was also seeking out a “social connection.”  Many of these uninsured ER patients are lonely or homeless and enter those sliding-glass doors for something other than a check-up or an X-ray.

A Concept is Born

Memphis, the cradle of rock and home of the blues, has a poverty rate of 24.6 percent.  Add to that fact that Tennessee is one of the 14 states that opted out of the Medicaid expansion provision under the Affordable Care Act.  It doesn’t take a soulful rendition of Heartbreak Hotel by “the King” or a mournful note on Lucille—the guitar of Memphis’ other King—B.B.—to realize that a large segment of this city’s population is in crisis.  Many simply do not have the financial wherewithal to pay for proper food, housing or healthcare; and some of these individuals repeatedly seek care, and sometimes belonging, in the city’s hospitals.

The leaders of one of these hospitals—Regional One Health Medical Center—realized that if they could help craft solutions for some of the socioeconomic conditions faced by these returning patients, the patients just might end up healthier, happier and ultimately less dependent upon ER services.  So, the visionaries of Region One came up with a comprehensive strategy—a pioneering program they call “ONE Health.”

The Program Particulars

The various stakeholders of the hospital came together and developed the parameters of the ONE Health program.  After deliberations, they cobbled together a basic outline, process and set of priorities to which they would adhere.  In brief, the program included the following elements and emphases:

1. Identify Repeat Users.  Those tasked with implementing the new program began by identifying all self-pay and uninsured patients who made use of the hospital’s ER services 10 or more times in a two-year period, or alternatively were admitted to the hospital four or more times during that same timeframe.
2. Sign ‘Em Up.  Once identified, these individuals become eligible for the ONE Health program.  A nurse or social worker contacts them and explains that ONE Health is there to help with a variety of services they might need, such as food, housing, transportation and much more.  If interested, the patient is placed into the program.
3. Assess the Need.  New program participants are assisted by ONE Health staff with filling out an assessment form, which is based on the Arizona Self-Sufficiency Matrix.  The assessment focuses on 18 areas of social determinants and seeks to identify the patient’s greatest areas of need.
4. Hardcore Caring.  Based on the assessment, the ONE Health staff devises a comprehensive strategy that includes connecting the patient to clinical care providers, as well as agencies that can meet their fundamental needs.  Program team members will check on the patient at least weekly—a true testament to committed caring.  When certain metrics have been met, monitoring is appropriately reduced.  Program managers also hold regular conferences with healthcare providers and applicable community partners on each patient case, discussing and evaluating the patient’s progress.  To date, Regional One has enlisted the buy-in of about 250 community agencies.
5. Nurses Rule!  Decision-makers at Regional One decided to put real money behind the new program.  They also determined that RNs would be the best candidates to take the lead.  Nurses have a wide array of skills, including higher education, coordination of care, working with people of all backgrounds, and filling out clinical paper work.  This skill set, along with their reasonable salary package (as opposed to that of a doctor or high-paid administrator) made them a good choice to oversee the new effort.

The Benefits of Benevolence

At this point, ONE Health’s staff includes only two nurses, two social workers, and a data analyst. The program’s cost in its initial year was about $250,000 in salary and benefits and another $26,000 in expenses and supplies.  However, these costs pale in comparison to the money saved in reducing recidivism among uninsured patients.

Due in large part to the new program, uninsured ER visits at Regional ONE were reduced by 68.8 percent in its first 15 months.  In addition, uninsured inpatient admissions declined by an even more impressive 75.4 percent, with lengths of stay falling by 78.6 percent.  This led to an estimated $7.5 million in cost-savings for the medical center.  This proves that humanitarianism doesn’t have to hurt.  By helping others—by truly meeting the needs of people where it counts—one hospital in Memphis is buttressing their own bottom line.

Making the Model Mainstream

We at MiraMed Global Services salute the innovators at Regional One Health Medical Center.  We believe this is a model that should be adopted at other facilities across the country.  Each town is different in its demographics, and each hospital will need to tweak the program to fit its own circumstances.  Nevertheless, this program has the potential to make a real difference in people’s lives, as well as a real difference in America’s effort to contain healthcare costs.

From Beale Street where they belt out the blues to the walls of Graceland where “the King” once reigned, Memphis is once again producing a revolutionary sound.  It is the sound of monumental success—a song that should be taken on the road.

If you would like our help in implementing a similar program at your facility, please do not hesitate to contact us at info@miramedgs.com.  MiraMed cares about your success.