As told by HealthComp Case Manager, Georgia, BSN, RN, CCM
Overview
One of our members, a woman with Crohn’s disease, was missing her medical appointments. We asked her why and she shared this was because she could not drive and her husband had to miss work to take her to her appointments – an hour’s drive each way. At times he could not leave work so they would have to miss her appointments. Other times, he would have to take vacation days to drive her.
Challenge
Without proper treatment and with missed appointments, this woman experienced an increase in symptoms. Although Crohn’s disease is incurable, its symptoms can be managed with lifestyle changes and medications – hopefully leading to a patient’s long-term remission and inflammation healing. But for Crohn’s disease patients like her, symptoms can worsen if left untreated, leading to someone having further digestive damage and even possibly needing surgery. So, we needed to get her help quickly to help improve her health outcomes.
We started looking into available rideshare and community resources this woman could take advantage of. When we researched her location compared to government offerings, her area had limited options. Rideshare was quickly eliminated as a practical solution. She would have had to pay for it herself – on top of infusions and out-out pocket deductible, and co-pays, which could get pricey fast. Other free options still meant it would be two-hours round-trip for travel to her appointments.
“We listen to members to find out what their true needs are and what stumbling blocks keep them from adhering to treatment.”
Solution
We started looking into if the patient was interested in having treatment performed at another point of care – like in her home. We looked into if the doctor would order this medication to be given at home, as well as a provider that could offer this service. In short, we managed many moving parts.
Sometimes in situations like these, doctors feel a candidate should not receive care at home. In other cases, a doctor supports this, but the patient is uncomfortable having someone come into their home in this way. Or sometimes, there’s no available agency or provider, depending on the medication and corresponding protocols that need to be administered. So, we addressed issues such as these when deciding.
In the end, we found a home health organization that had the right medication protocol and allowed at-home infusions. Everyone from the doctor to the patient agreed that home was the best point of care in this circumstance. It was a priority for the woman that her husband didn’t have to transport her. We were able to secure a Preferred Provider Organization (PPO)-level discount on home health care – great savings-wise for her and the group employer.
“Case managers develop a rapport with members after a while. Members come to see us as friends or family members.”
Impact
The patient never missed another treatment after she was directed to the right point of care that suited her lifestyle. Her symptoms and lab work improved, and she’s since been discharged from case management and is doing well. Her husband has also missed fewer workdays because of her home health care.
Since then, we remain in direct contact with her as a support system, to make sure she’s still active, feels good, and that she has the right insurance coverage. By helping her have her infusion venue switched over to home health, we increased her compliance, resulting in good disease control. We also helped her avoid hospital admissions, resulting in nearly $18,000 in employer savings. Additionally, in-home infusion versus outpatient infusion at a clinic saved the employer nearly $130,000 annually.
“At the end of the day, her husband could stay at work and she could stay at home; she got her medicine and her symptoms improved.”
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