Opening the door to health care
Date: December 16, 2011
By the time the laid-off public servant arrived at Howard County General Hospital’s emergency department last summer, her lung disease had progressed to a dangerous degree. With her disability benefits exhausted and her savings drained, she had nowhere else to turn.
Fortunately, the woman had come to the right place. After an admitting registrar signed her in to the ED, she was greeted by a case manager and introduced to the benefits of the Access to Care Program. A partnership between Howard County General Hospital and Chase Brexton Health Services, the program makes primary and specialty care available to uninsured and underinsured patients such as the young woman. “We’re looking at someone with no benefits, and who couldn’t afford to pay a specialist up front,” says Katrina Balovlenkov, a former Access to Care Program case manager and now a social worker with Howard County General.
Now enrolled in the Access to Care Program, the woman sees a primary care provider at Chase Brexton and receives treatment from a pulmonologist at no cost. With the case manager’s support, the woman has also been approved for enrollment in the Maryland Primary Adult Care program, an inexpensive health service for low-income residents.
The patient is among the growing number of patients arriving at Howard County General’s ED who hail from the nation’s swelling ranks of the working poor. When the Access to Care Program was launched in February, Nicholas Nutting, assistant administrator of emergency services, did not expect to encounter so many county residents struggling to make ends meet on meager or non-existent incomes.
But as the program got off the ground, Nutting saw up close the toll exacted by the grim state of the national economy. “If you factor in the cost of living in Howard County, these unemployed or underemployed residents are starting to feel the pinch and sometimes have to make the difficult choice to let go of their health insurance,” Nutting says.
Bridging the care gap
As a Federally Qualified Health Center that can receive enhanced Medicare and Medicaid reimbursement and other benefits, Chase Brexton brings a host of resources to the partnership with Howard County General, including the services of three case managers. Financed by a grant from the Maryland Community Health Resources Commission, the program also acts as a buffer against costly trips to the hospital’s ED.
The Access to Care Program is one of several initiatives within the Johns Hopkins Health System that address health care disparities. In East Baltimore, The Access Partnership provides free specialty-care access to uninsured patients who live in the neighborhoods around The Johns Hopkins Hospital and the Johns Hopkins Bayview Medical Center. At Suburban Hospital, the MobileMed/NIH Heart Clinic provides diagnostic exams and treatment for patients who are uninsured, homeless, and unemployed or among the working poor.
In Howard County General’s ED, an Access to Care Program case manager is on site 40 hours a week to meet and debrief prospective participants. “Since Howard County General is the only hospital in the county, the ED is an excellent place to reach people,” Balovlenkov says.
Since February, the case management team has met with more than 700 patients. Face-to-face contact has made all the difference, Nutting says. Once they “engage, person to person, they’re much more likely to follow through.” About 15 percent of the patients who have met with case managers have become active patients with Chase Brexton.
All insurance information for participating patients is withheld from clinicians, Nutting says. “We care for all patients presenting to our ED, without regard for the individual’s insurance status or ability to pay.”
—Stephanie Shapiro and Sharon Sopp