Program Curtails Visits to Emergency Rooms

Tony Waller

Tony Waller

After navigating the brightly lit aisles of the Raytown Wal-Mart, Lance Sharples wheeled a grocery cart to the check-out line one night last week.

The clerk made quick work of the items – staples like bananas, hotdogs, frozen pizza, and white bread. “You push, man,” Sharples told his companion as they headed for the door. “It’s your food.”

That’s not something Tony Waller, 39, has heard a lot in a lifetime spent largely on the streets.

He grew up around 66th Street and Prospect Avenue, and, as a teenager, a drunk driver hit him while he was walking to catch a bus. He never regained his ability to read and write, compounding his struggles with cerebral palsy.

Waller now lives in an apartment not far from the Wal-Mart, placed through a program launched four years ago by ReDiscover, a community mental health center in Lee’s Summit. Financial backing has come largely through the Health Care Foundation of Greater Kansas City.

The program aims to stop the revolving door at hospital emergency rooms among persons with mental health and substance abuse problems. Medical experts generally consider it more cost-effective to manage chronic or preventable conditions before patients seek care in emergency rooms.

Last month, in fact, a Missouri Senate committee hailed the ReDiscover program as an example of how to reduce Medicaid costs in the state.

A program official testified before the committee that the program had saved approximately $13.7 million in medical costs during its first year and a half alone. The center has spent approximately $800,000 on the program, according to ReDiscover officials.

According to ReDiscover, the Missouri Department of Mental Health has allocated $7.5 million this year to implement the program around the state.

The bottom line, said Laura Shrader, hospital diversion director for ReDiscover, is this: “If you think people can change, they can change.”

The model
Case workers like Sharples are the central component of the ER diversion program.

Through referrals from hospital emergency rooms and inpatient psychiatric units, those front-line staff members provide assistance that goes way beyond typical case management. Small caseloads of fewer than 10 clients allow workers to spend extra time with each individual.

Armed with credit cards, Shrader said case workers don’t have to clear bureaucratic hurdles before they can provide simple assistance that can stabilize a patient’s life.

That assistance might be some clothes for someone who has nothing but a hospital gown, she said, or it could be help paying a license bureau fee so a client can start applying for benefits with a state-issued identification card.

In a current case, Shrader said, ReDiscover paid a $600 community college debt for a young schizophrenic who had dropped out when his disease emerged.

Hospital staff referred the man to ReDiscover after he came to an emergency room 17 times in nine days. Now that he has the medication he needs, Shrader said, he has re-enrolled and is doing well so far.

Referring hospitals in and around the central and eastern part of the city include Truman, Saint Luke’s and Centerpoint. Referrals have also come from north of the Missouri River, including from hospitals in North Kansas City and Liberty, program officials said.

The program started with three community mental health centers. The program has double that amount now, including one that serves rural communities east of Kansas City.

With continued funding from the Health Care Foundation and additional support from the Missouri Department of Mental Health, the number of case workers has grown from three to 14.

Some of the case managers work nights and weekends at hospitals.

‘Huge success’
At Truman Behavioral Health, Robin Morrison cited one example where a program participant has moved on to a job.

“Getting a job is a huge success for some of the people who have struggled and been homeless and who have had some pretty severe mental health issues or substance abuse issues,” said Morrison, who is director of crisis services.

Helping patients get those conditions under control, Morrison said, frees up space for other patients in the emergency room and maximizes the effectiveness of the limited supply of inpatient psychiatric beds.

She said the program has also encouraged coordination between organizations that often work in silos.

That cooperation largely comes into play, Morrison said, as case managers from the hospitals and community mental health centers work together to manage participants. It might even mean, she said, that a case worker from Truman steps in to help with a ReDiscover client.

People like Waller, the man in Raytown, oftentimes show up in emergency rooms when they are hungry or want a place to stay.

Or sometimes they need medical care they could’ve avoided if they weren’t homeless.

Waller said he once suffered a broken jaw and a busted-up nose in an assault while he slept in a bus shelter. On the streets, he said, people might even rough you up to take your shoes.

Waller said he felt safer sleeping during the day, which is why he is still restless at night in his apartment.

He still doesn’t have a complete handle on his substance abuse issues either. Just the other day, he traded his vacuum cleaner for a six-pack of beer.

Waller smiled sheepishly when Sharples told that story. “I need to stop doing that,” he said.

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