After determining that 5% of patients were utilizing 50% of total patient costs, the finance and nursing departments at Daniel Freeman Hospitals created an outreach service to help those patients more effectively manage their own care.
Through the Professional Nursing Case Management Program, 136 patients have received continuous support from specialized nurses who go into the communities surrounding the two Daniel Freeman hospitals in Inglewood and Marina del Rey, Calif.
"The program is really about enhancing their capacity to help themselves," said Marian Haskins, one of two professional nursing case managers at the hospitals.
Most participants in the program were patients with stays of longer than three weeks. Such outliers account for $3.5 million in annual costs, said Maude Ham, who helped implement the program as a senior financial analyst at Daniel Freeman. She has since moved to a new post at another health system.
The hospital takes a pro-active stance in identifying and helping patients at risk for longer stays, Ms. Ham said. The Professional Nursing Case Management Program aims to manage clinical problems before they become outliers.
"We don't make money for the hospital," said Mickie Tynan, a professional nursing case manager and the program's director. Instead, the case managers promote savings.
Most participants are elderly, poor African-American patients with a low literacy level. Many live alone, Ms. Tynan said. Patients must actively participate in improving their health to receive services.
The day-to-day routine of a case manager involves making home visits and helping patients "make connections" to enhance their quality of life, according to Ms. Haskins. "It's that partnership that makes the difference."
She added that the interaction often helps elevate patients' spirits and self-esteem. Staff members helped one patient find a new dog when hers died. They helped another join a church.
On the clinical side, Ms. Tynan said she has been able to admit patients who otherwise would have allowed their condition to deteriorate, resulting a much longer hospital stay. In one case, she noticed during weekly at-home visits that a patient had gained 15 pounds in fluids. The problem was taken care of in a two-day hospital stay. But, Ms. Tynan said, it could have developed into a three-week stay if she hadn't intervened.
Daniel Freeman funds the program with savings realized through case interventions. Its start-up costs were $120,000, Ms. Ham said.
The program is recruiting two more case managers, Ms. Haskins said.