Methodist Hospital upgrades health care in 38109

April 03--With health problems that began troubling Amber Williams at birth, the 20-year-old estimates that in one recent year she landed in the hospital more than 200 times.

"Every time I go to the hospital, normally it's by ambulance," Williams said. "You get there faster, you get through the process faster, because if I go in the waiting room, I'll sit, my blood sugar is going up, I don't have insulin, I'm dehydrated and I'm throwing up."

Williams lives in South Memphis in ZIP code 38109, where a "hot spot" map found that Methodist Le Bonheur Healthcare spent more charity care dollars than in any other Memphis ZIP code.

Now a Methodist Le Bonheur campaign to upgrade health care in 38109 has reached out and touched hundreds in South Memphis, including Williams.

Today, she's reduced her need to rush to Methodist University Hospital to about twice a month. And she succeeded in graduating with G.W. Carver High School's Class of 2014.

For Methodist, Williams is one of 90 patients in 38109 who went to hospital emergency rooms a dozen times or more a year. In 2014, their average monthly emergency room visits dropped by 25 percent, while average hospitals stays and cost per patient plummeted by 45 percent.

"If it works in 38109, we're picking up things that we can spread throughout the rest of the community -- and there are some things that are working down there," said Gary Shorb, Methodist's chief executive.

"Our big question is how do we replicate that and how do we pay for that replication?" Shorb asked.

What's working is a "community health navigator" -- a bureaucracy-busting woman named Joy Sharp -- who helps patients with needs extending well beyond health care. At the same time, Sharp is leading broader efforts to promote wellness among residents of the Riverview Kansas area of South Memphis.

She sees lack of education about insurance plans and health care, as well as ways of doing things passed through generations, as major challenges.

"It's not just health care; it's behavior and it's things I've seen my mother or grandmother do," said Sharp, 38, a LeMoyne-Owen College computer science graduate who found her mission in life in health care.

In addition, in 38109 Methodist tapped its Congregational Health Network, where "congregational navigators" help more than 560 church congregations with health care issues and "wraparound" services for members who are in or leaving hospitals.

"Joy is actually the way to connect people to churches who are not members of the church," said Bobby Baker, director of Faith Community Partnerships for Methodist. "She connects them to the hospital, to health care, she connects them to churches for wraparound services, social support and those kinds of things."

A grant from the charitable arm of a health insurer, Cigna Corp., focused Methodist's attention on 38109 by a project that mapped where the Memphis-based hospital system's charity care is concentrated.

In the summer of 2012, Baker said he took Shorb on a tour of the city's largest ZIP code, from a devastated urban landscape along Kansas to Boxtown, Voodoo Village and rural areas near the Mississippi border that still used outhouses, Baker said. Along the way in an area where Methodist spent $11 million in charity care, he said, they made stops to talk with pastors at churches in the network.

"We wanted him to understand we have relationships within these communities and that the things that are going to change utilization patterns of people who are coming out of these communities is having a relationship, having somebody to guide them, to connect with them, somebody they trust, somebody to call," Baker said. "To me it's real simple."

Shorb was convinced, for both faith-based and dollars-and-cents reasons.

"We are a ministry and as part of that ministry we try to care for everybody throughout the greater area, it's intentional, you've got a hospital in every quadrant of the city," Shorb said. "We do what we can to improve health status in addition to take care of those who are sick or in poor health status."

Financially, the hospital system is on the hook for charity care for uninsured patients who have no means. Last year, 5,000 of 64,000 patients discharged, or nearly 8 percent, were charity care, he said

<p>"So it's also our responsibility to try to bring them to health and try to improve their overall quality of life."

Like the hot spot map that drew Methodist's attention, harnessing data to improve quality, results and lowering costs is the wave of the future for hospitals, doctors, insurers and employers.

Shorb, for example, said Cigna found that of 220,000 people it covers in the Memphis-area market, it spends $310 million a year on 2,000 patients with chronic kidney disease.

"Data is playing a key role in telling us where our priorities need to be and where we can make the biggest impact," he said.

A $100,000Cigna grant announced in January 2013 helps support the 38109 effort. Micro grants for churches that may need, for example, to pay for prescriptions, Sharp said. Methodist pays her salary, and Shorb said the health system last week approved a second community health navigator whom Sharp will train.

For Sharp, interactions that come through monthly "Wellness Wednesday" health events, which include follow-up calls about health issues, or phone calls and alerts about patients at any time of day or night dominate her mission.

Methodist employees who raised money to buy three uniforms and backpacks of 150 children -- a surefire way of getting families' attention -- is an example of things going right. Discovering a woman locked in her assisted living apartment and suffering massive strokes after not returning to a doctor for follow-up care is an example of things gone wrong.

Duplicating Sharp's instincts will be a challenge, Shorb acknowledged. She knew, for example, to offer a man who had been laid off and had tears in his eyes help signing up for food stamps and unemployment before broaching the subject of health care for his diabetes, she said.

And in an area where gangs have their turf, she said she's warmly accepted by a gang member known as Big Dog. He won't be stuck by a needle himself, but tells others to "come and get what Ms. Joy got."

For Williams, Sharp has acted as problem solver while also serving as coach for her hospital, billing and school issues.

"I could call on her and she'd get it done," Williams said.

She said she's had stomach problems since birth, was diagnosed with diabetes at age 10 and has high blood pressure. As a teenager she was diagnosed with gastroparesis, a condition where the stomach muscles don't work properly and food sits for hours, leading to vomiting, nausea, blood sugar and nutrition problems.

A gastric pacemaker and a feeding tube implanted in her abdomen at Vanderbilt University Medical Center have helped her bounce back from 78 pounds to 120, Williams said.

TennCare, government coverage for low-income residents, has paid for her care. She still faces challenges, such as prescriptions she can't afford and primary care physicians who change with each visit, but Williams said she's more involved in figuring out what works for her care.

She's setting a goal of going to college, studying international accounting business and minoring in law, or becoming a registered nurse as a fall back.

And, "I want to stay out of the hospital; I want to be able to do stuff on my own," Williams said.

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