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Small health team could save big money

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More than 1,000 indigent patients cost county more with multiple ER visits

REDWOOD CITY — Bowing under the burden of ballooning medical costs for the indigent, the county has launched a program to bring primary care to many of the its most desperate residents.

The new program, called the Healthier Outcomes through Multi-disciplinary Engagement, creates a four-member team that will hit the streets and local hospitals to track down more than 1,000 patients who end up in emergency rooms four or more times each year. Thepatients, many with multiple illnesses, make up just 4.8 percent of emergency room patients in the county, but account for 18 percent of emergency room visits, said Srija Srinivasan, county director of health policy. That comes to a cost of $5.9 million a year for taxpayers, Srinivasan said.

“Often they are people with quite complex health needs, including substance abuse, mental illness and homelessness,” Srinivasan said.

Aside from regularly experiencing homelessness, many of the 1,030 patients identified by the county so far also suffer from one or more chronic illness, such as asthma or diabetes, officials said.

With so many visits to the emergency room, the $388,000 HOME team aims to rein in costs by regularly checking in with patients, connecting them to free or low-cost services and providing primary care, officials said. While a typical visit to the county-run San Mateo Medical Center costs about $700 per patient on average, many of the chronic patients run bills into the thousands because they go so long without care, officials said.

The program is part of a more comprehensive approach to reducing indigent care costs, which required a $65 million subsidy from the county to the San Mateo Medical Center this fiscal year alone.

In addition to savings, the county hopes the multidisciplinary HOME team will provide “better treatment and care for the county’s most needy patients,” medical center spokesman Dave Hook said. “We also think it will reduce wait times and free up capacity in the emergency room.”

Studies of similar programs in other counties, including San Diego, have shown dramatic drops in emergency room visits, as well as trips to court, ambulance runs and jail time — saving taxpayers money, according to Frank Lalle, of the Peninsula Community Foundation.

The foundation has donated $100,000 toward the first year of the trial program, which goes before thecounty Board of Supervisors for final approval Tuesday.

“I’m really excited about this,” Lalle said. “I think we’re going to learn a lot about whether this is a cost-effective way to focus on these folks, if a more proactive approach is better and whether it reduces homelessness.”

Reaching out to such patients typically takes some time, as similar programs have required two to three years to show results, but the county plans to report back on its progress to a steering committee regularly, Srinivasan said.


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