‘ I call ourselves a GPS system’
By Claire Hughes, Times Union | Published Friday, July 26, 2013
Navigators help patients through the maze of medical, social services Schenectady – Lewis Benware had to choose which crisis to address: his failing health or need for a home. He could take the bus in one direction and apply for housing assistance, to escape an overbearing roommate. Or he could cross the street and head to Ellis Hospital, to see a doctor about the pressure on his chest.
The 52-year-old chose the hospital, where he received treatment for congestive heart failure – and a navigator.
“Navigators” are nurses and social workers charged with guiding patients through an often convoluted maze of medical and social services, to prevent illnesses from becoming emergencies. Three navigators are part of Care Central, a collaboration among Ellis Medicine, the Visiting Nurse Service of Schenectady and Saratoga Counties, and Hometown Health, a community health center.
The idea of using “navigators” or “coordinators” to help patients through the medical system is taking hold nationally, as industry officials look for ways to make care more effective and efficient, said Jean Moore, director of the Center for Health Workforce Studies at the University at Albany School of Public Health. CHWS has embarked on a study of this new type of worker, including their roles and qualifications.
“Care coordination really is at the core of providing better care,” Moore said. “There is a great sense that health care in this country is very fragmented.”
Before his admission to Ellis, Benware was overwhelmed by a recent job loss and the death of his mother. His hopes of creating a new life by moving to Schenectady turned to despair when jobs didn’t pan out. He stopped caring, and let his prescriptions for high blood pressure and depression run out. He became homeless while in the hospital, after his roommate threw his belongings on the street.
“That’s when Faithann appeared, in a cloud of pixie dust,” Benware said of navigator Faithann Amond.
Amond listened to Benware’s concerns, including his fear of wearing a portable defibrillator. She helped him with using it and after Benware’s July 5 discharge, accompanied him to the Department of Social Services for a three-hour wait to apply for housing assistance.
A nurse, she continues to advise him on managing his heart ailment and depression.“I call ourselves a GPS system,” Amond said.
Amond and navigators Margaret Rogers- Meagher and Nicole Baptiste are called in to the emergency room or a medical office when a patient, say, needs help following up with a doctor’s instructions or lacks public health insurance he is eligible for. Or patients seek the navigators out at offices on Ellis’ Nott and McClellan street campuses. They might inquire about food stamps, and Rogers-Meagher will ask, “By the way, do you have a primary care doctor?”
Care Central coordinates services with community organizations and operates a free shuttle bus that stops twice a day at the YMCA, YWCA, Salvation Army and Bethesda House.
“The agencies who used to be in silos came to understand we need to work together,” Rogers-Meagher said.
The navigator idea grew out of the 2008 merger of Ellis, St. Clare’s and Bellevue hospitals, said James W. Connolly, Ellis Medicine’s chief executive. When combining the institutions, administrators discovered too many patients arrived at emergency rooms for problems that should have been treated weeks or months before in doctor’s offices, with better results and at less cost. To encourage patients to seek treatment earlier, Ellis administrators created a hub-and-spoke system of primary care and related services, operating from a base at Ellis Family Health Center.
“That’s when we realized, if you build it, people won’t come,” Connolly said. “We realized we needed to have navigators to guide people through the system.” Navigators’ reach gradually extended into the community, he said.
The navigator program costs $1.4 million a year to run, and operates at a loss of about $400,000, said Tim Berger, chief operating officer for the Visiting Nurse Service. Medicaid, the government program for low-income patients, is the only insurer that will pay for navigator services, Connolly said.
Ellis administrators believe the program will ultimately save money in unnecessary emergency room admissions, while building up the health system’s primary care practices. They are collecting data on navigators’ progress with the hope of convincing more insurers of its value, Connolly said.
Without a navigator, Benware said he would have been crushed by the weight the issues confronting him this month. “I probably would’ve dropped out of the health care scene,” he said.