House calls, not ER visits

Community health workers make free stops at patients’ homes to encourage preventative care

Maybe all that’s needed to cure out-of-control health care costs are house calls, early intervention and compassion.

That’s the idea behind Connexions, a two-month-old program based at Good Shepherd Medical Center that uses community health workers to improve lives while cutting the cost of future care.

Boardman resident Lisa Rose opened her front door Monday to find two community health workers on her porch. Heather Metcalfe and Catie Brenaman had stopped by to check on Rose, who was diagnosed with multiple sclerosis in March. The two community health workers initiated small talk, petted the dog, then started asking questions about Rose’s condition.

“When was your last fall?” Brenaman asked.

“Friday,” said Rose, who had parked her walker and eased into an overstuffed chair. She wore a purple sweatshirt emblazoned with the word “Whatever…” and stroked the fur of Mia, who had jumped onto her lap.

Brenaman, who has a public health background, and Metcalfe, a nurse, aim to improve health and keep people from needing expensive emergency room care by visiting people in their homes, helping their clients set health goals and carry them out. The service is free to anyone in Umatilla and Morrow counties. Referrals come from agencies, concerned friends and family members and individuals themselves.

At Rose’s apartment on Monday, the trio discussed doctor’s visits, medications, physical therapy, a faulty shower chair, transportation, smoking cessation, insurance, stress and the ultra-dim lighting in Rose’s apartment that might contribute to falls. Brenaman and Metcalfe often connect clients with services and communicate with providers on their behalf (after the proper release of information documents are signed). They make calls, assist in filling out applications for various social services, pick up prescriptions and whatever else they believe could help. In a rolling tote, the community health workers carry client files, exam gloves, a blood pressure cuff, scales, glucose monitor, advance directives, a computer and other tools of the trade.

New clients often initially react with suspicion, then with gratitude.

“The first visit can be a little tearful from the stress of it all,” Brenaman said. “You can see the relief, the smiles.”

Metcalfe and Brenaman are joined by two other community health workers, Leidi Rodriguez and Maritza Madrigal. Both have medical backgrounds and are fluent in Spanish. The program is catching on so quickly, the workers may have to find a way to clone themselves.

At first, referrals trickled in, Brenaman said, but now are up to more than 10 each day.

At a formal launch this week of the program, Brenaman, Metcalfe and others associated with the program spoke to about 65 people from various agencies and the public who had gathered for lunch in a hospital conference room about Connexions. Juli Gregory, Good Shepherd’s Director of Education Services, said the need for this personal and proactive service is great.

“People keep falling through the cracks,” Gregory said. “This is a team approach. Hopefully, it will decrease inappropriate use of the ER and the doctor’s office. Some people use the ER as their doctor. Some don’t go to the doctor at all.”

Good Shepherd Educator Kathy Thomas shared some heady statistics.

“The use of community health workers has reduced health care spending by $4 billion (in the U.S.) and saved over 15,000 lives,” Thomas said. “This data helped define our program.”

The program is one of 23 funded by Transformation Grants awarded by the Eastern Oregon Coordinated Care Organization using $1.6 million in funds provided by the State of Oregon Transformation Center. The EOCCO, which serves 12 Eastern Oregon counties, examined 36 proposals, looking for innovation and ideas that could be transferred to larger populations.

The EOCCO awarded three grants in Umatilla County. Good Shepherd received $91,290. The Yakima Valley Farm Workers was awarded $100,000 to embed a behavioral health clinician at the Mirasol Family Health Center in Hermiston. Lifeways received $88,118 to place community health workers inside St. Anthony and Good Shepherd to focus on people with behavior health issues who end up at the emergency room in crisis.

A Morrow County project uses a care team to improve prenatal care, promote well-child checkups and encourage screening for children and pregnant women.

The grants pay for a year of service. Kevin Campbell, the CEO of the EOCCO, said he is cautiously optimistic the funding will continue.

“There’s a lot of pretty innovative stuff here,” he said. “This is an incubator for creative ideas. I expect a good return on the investment.”

Lisa Rose said Connexions is a blessing after a frightening diagnosis.

“It’s scary,” she said. “They help me figure out what to do and where to go.”

For more information about Connexions, call 541-667-3504 or go to [email protected].

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Contact Kathy Aney at [email protected] or call 541-966-0810

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