An Urgent Need

Health Guardians reroute frequent ER patients to primary care

Dana Toval, 45, got her first job at age 15 and she kept on working in retail, state government, and hospitals. Then she got sick. “From the tip of my head to the soles of my feet, it affected every part, every aspect of my body, every fiber of my being,” Toval remembers. “I couldn’t work; I couldn’t even move.” Unemployed since the end of 2012, she lived off her savings, but ended up practically homeless.

Without health insurance, when her lupus flared and made her unable to breathe, Toval visited the emergency room. “Twice in the hospital I had to be on oxygen the entire time,” she says. Interim LSU Hospital contacted Health Guardians, a program of Catholic Charities of the Archdiocese of New Orleans that helps frequent emergency room visitors move to more consistent, cost effective healthcare, sparing ER resources. Patients with three or more ER visits or two hospital admissions in six months are eligible.

Dr. Elmore Rigamer, medical director for Catholic Charities, helped develop Health Guardians in 2012. “We have an especially big problem here in New Orleans where we have a high rate of uninsured people and their only way of getting access to care very often is going to the emergency room,” Rigamer says. “Sometimes they go because they need to but most often they go because they have no other place to go, and they can be assured of being seen and they can get some medicine.”

A 2011 Centers for Disease Control survey of adults 18 to 64 showed nearly 80 percent said their top reason for visiting the emergency room was lack of access to other providers. ER overuse nationwide carries an estimated price tag of $38 billion a year, according to a New England Healthcare Institute 2010 report. The Louisiana Department of Health & Hospitals says Louisiana ranks third in ER use per capita, and leads the nation in preventable hospital admissions and costs.

Rigamer says the ER is not the best place for patients to get care. He says they need to see a primary care doctor regularly, be educated about their disease, and learn how to manage it. Health Guardians arranges the care and accompanies clients to the doctor. The extra steps the program takes make it unique in Louisiana, and similar to only a handful of organizations in the nation. “Our goal is to ask them what brings you to the emergency room and whatever in their mind causes them to go … we address,” Rigamer says. He adds it’s not only medical reasons. Sometimes they can’t get off work during clinic hours, or lack transportation or housing.

Toval views Ben Wortham as her guardian angel. He is one of Health Guardians’ patient navigators and social workers helping Toval and about 140 patients a year. He set up Toval in free

temporary housing while others on the team paid for medications and helped provide food and transportation. Once the Guardians help Toval secure disability benefits, Wortham will find permanent housing she can afford. She’ll have free drugs and health insurance.

“Her graduating from this program will mean she’ll be self-sufficient moving forward,” says Wortham. “And she’ll always be able to call us and re-enroll if she starts going to the emergency room for anything, but the idea is we were able to set you up to be successful, and that’s hopefully going to happen.” What separates Health Guardians is it is completely client centered. “Nothing’s off the table in terms of what their goals are,” Wortham says.

A study done by LSU Interim Hospital tracked 55 patients six months before and six months after their encounter with Health Guardians. Nearly 73 percent decreased their visits to the ER and admissions to the hospital at a savings of $16,725 per client. The program projects it may expand to as many as 250 patients a year as it partners with Federally Qualified Health Centers around New Orleans.

For people who have overused the ER, Wortham says Health Guardians hopes to be the answer. “We try to be that one-stop shop for people who need a little help in navigating.” Toval is feeling healthier now, with no returns to the ER or hospital. She gives Health Guardians the credit. “It’s taken a big load off of me with the stress that kept me sick,” she says. “Me being here has been a true uplift in my life; it has really caused me to want to do more for the next person.”