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Dome - Homing in on an International Patient

Dome October 2013 VOL 64
Issue No. 8

Homing in on an International Patient

Date: October 1, 2013

Even as outpatients, many international patients, like Ali Al-Ajmi, center, have complex medical needs. Now experts from Johns Hopkins Medicine International and Johns Hopkins Home Care Group collaborate, case by case, to fulfill those requirements.
Even as outpatients, many international patients, like Ali Al-Ajmi, center, have complex medical needs. Now experts from Johns Hopkins Medicine International and Johns Hopkins Home Care Group collaborate, case by case, to fulfill those requirements.

Ali Al-Ajmi recalls gazing out the window of an apartment on President Street while a nurse from Johns Hopkins Home Care Group drew blood to see if he was fit enough for more chemotherapy. Exhausted from months of surgeries and cancer treatments, the 21-year-old was glad to be spared the wait, and possible infections, that such testing might bring at the outpatient center. Most of all, however, he longed for his “real” home, 6,500 miles away in Saudi Arabia.

Al-Ajmi is one of the first patients to benefit from a partnership formed between Johns Hopkins Medicine International and Johns Hopkins Home Care Group that coordinates care for foreign patients preceding their hospital admission or following discharge. Implemented two years ago, the arrangement has made the prospect of enduring illness far from home easier for patients and their loved ones.

Like many patients from the Middle East, Al-Ajmi traveled to Baltimore with his family. His parents and two siblings remained with him during an 18-month stay that began in 2011. Now, the family has returned to Baltimore for his final treatment. And once again, Home Care’s pharmacy and nursing staff are working closely with Al-Ajmi’s oncologists in an integrated system of care while international care coordinator Ermeen Marcos connects the patient and his family with any resources they need during their visit.

Al-Ajmi says his encounters with faculty and staff, especially his favorite doctor, oncologist Ilene Browner, have encouraged him to emphasize the positive: “Everyone is always smiling and telling you to have a good day,” he points out.

“Everyone is watching everything,” his mother adds, pleased that the complexity of her son’s treatment is closely monitored through a centralized records system that also helps coordinate other aspects of his care.

The arrangement between International and Home Care provides a “great example” of the integrated system of health care delivery that Johns Hopkins Medicine hopes to achieve in its five-year strategic plan, according to Jonathan Lewin, senior vice president of integrated healthcare delivery for Johns Hopkins Medicine.

“Improving one service by building on the strengths of another results in a combination that is greater than the sum of its parts,” he says. “Ultimately, when done right, integration benefits our patients, helps our providers, and improves efficiency within our system.”

Finding a Way

In 2011, chief operating officers Burak Malatyali of International and Mary Myers of Home Care realized that a partnership could improve the quality and safety of international patients’ treatment as well as direct new business to the Johns Hopkins family.

The next step was to make Home Care become the provider of choice for those embassies charged with approving and paying for the home health services of some of Johns Hopkins’ international patients.

Although they were competing against long-established business relationships, the Johns Hopkins leaders managed to convince their potential clients that Home Care could provide a continuum of vital services, such as checking medications against patients’ medical records, which outside vendors could not duplicate.

In just two years, the number of international patients using Home Care’s services has more than tripled, and downstream revenues to Johns Hopkins Medicine have almost quintupled—surpassing $3.3 million in FY13, according to Malatyali.

In hindsight, joining forces seems natural. “From the outside, from the patient’s and the payer’s perspective, we are all Johns Hopkins,” says Malatyali. “And, financially, we truly are the same thing. So let’s do what’s best for the patient and for Johns Hopkins Medicine.”

Part of the arrangement required hiring new staff and redesigning floor plans. In order to ease communication between divisions, Home Care created a position for a “relationship manager” to sit between the embassy relations and hospital discharge planning teams at JHI’s patient services offices in the 550 Building.

An administrator with the ice-breaking name of Johns Hopkins is the first to fill the role. As the business manager for the outpatient pharmacy, Hopkins had already handled the medication needs of a large group of international visitors. Now, he arranges Home Care solutions for International patients, their families and companions, some of whom find reassurance in his name alone.

Hopkins describes much of his work in terms of choreography. When an international patient is discharged from the hospital for home care, for example, a successful transition depends on skilled synchronization. International’s care management nurses should coordinate with clinical staff while the embassy relations team is obtaining authorization for what’s needed next. At the same time, Hopkins is arranging to have services and supplies ready as soon as the authorization comes and the discharge is complete.

“If we wait for each part to be finished before the next begins, it’s going to take much longer,” he explains. “Patients’ clocks start when their doctors approve them for discharge. To enhance customer service, we have to make things happen according to their clocks.”

A software system keeps everyone on the same page about patient location as well as about medical needs and their fulfillment. There’s also a special number for international care coordinators to access Home Care services.

Another Form of Support

Improving care for foreign patients has led to further innovation. Last year, Johns Hopkins Home Care Group created Johns Hopkins Home Support to help those international patients needing assistance with personal care services that range from skilled private duty nursing to cooking and companionship. These services are also available to local patients and their families.

Myers and Malatyali hope their partnership will continue to inspire other ideas and opportunities.

“This happened because we didn’t restrict ourselves to ‘the way things are done now,’” Myers says.  “Let’s not focus on roadblocks. Let’s sit down and think about what we want—what is best for patients and what’s best for Johns Hopkins Medicine. Then let’s figure out how to make it happen.”

To learn more, visit or call +1-410-502-7683.

—Cymantha Governs