ACA-based program gives high-risk patients better care, saves money

October 10, 2017

Story 

Hilary Edmondson needed an advocate after the amputation of her leg, and thanks to the Health Home program, she had one. 

Five days after her surgery — with the wound-closing staples still in her leg — the hospital discharged the Spokane woman to her home because staff could not find a physical rehabilitation center to take her.

Back at her apartment, she managed on her own for one night. She was still experiencing some shock from the loss of her foot, and because her apartment was not wheelchair accessible, she had to crawl to get around. When she had trouble administering her antibiotics intravenously, she called for help and was taken back to the hospital by ambulance.

That is when her advocate, Sharon Miller, a care coordinator through the state’s Health Home program, discovered the hospital had discharged Edmondson and stepped in. Miller realized that although the hospital had checked for beds in rehabilitation facilities, it hadn’t checked with skilled nursing facilities. She worked with the hospital’s discharge team and found Edmondson a bed in a nursing facility, where she was able to receive follow-up care such as physical therapy and to learn the skills to become more independent.

Through the Health Home program, Edmondson gets more than an advocate. The program provides highly coordinated care, including comprehensive care management, health promotion, follow-up, individual and family support, and referral to community and social support services, as needed.

The program began in 2013 as part of the federal Affordable Care Act, sometimes referred to as Obamacare. By focusing comprehensive care on high-risk, high-cost patients, the program actually saves money. Health Home resulted in a preliminary gross Medicare savings of $67 million over two years, according to a new report by the federal Centers for Medicare & Medicaid Services.

Read the rest of the story on the governor’s Medium page.

Media Contact 

Tara Lee
Governor Inslee’s Communications Office
360.902.4136