Those findings prompted Spectrum officials to design the clinic to identify, accurately diagnose and develop a care plan for the people who used the ED more than 10 times in a year. After initiating the program in late 2011, the program—in a matter of weeks—steered more than 140 patients from the ED into coordinated care and saved about $300,000.
"I would love to say this was borne out of altruism," Waller says of the clinic, "but it was borne out of frustration at the beginning, to be honest. There was just a feeling that there is a better way to do this."
Waller trained in emergency medicine at Thomas Jefferson University Hospital in Philadelphia. When he moved on to Spectrum, he was seeing the same types of patients who needed help, who needed proper follow-up care, but weren't getting it. Too many patients were "blown off as mentally deranged," he says. "At the end of the day, they had to live in that situation." Naturally, they kept returning to the ED.
By focusing on these patients, Spectrum has channeled them to cheaper care programs and away from the ED, with hundreds of thousands of dollars saved, and with increased follow-up planning and coordination with primary care physicians, Waller says.
Each new patient undergoes a series of evaluations that includes a comprehensive exam by a physician, a behavioral health evaluation by a mental health professional, an addiction assessment, and intervention by a social work case manager. A care manual is then provided for each patient seen for a three- to six-month period to monitor his or her progress.
"A case manager can make sure they have housing, heat, a pathway toward getting a job," Waller says. Spectrum has partnered with Grand Rapids Community College to help people who may not have finished college, or who seek to be in a training program.
"A high percentage of patients, once stabilized, don't require this intensity of care. We want to make sure we have an accurate diagnosis and mental health assessment, and an accurate assessment of their social situation," Waller says.
It's at that point they could have a successful "handoff" to a primary care physician.
So, good outcomes rely heavily on physician involvement. Sometimes, the doctor comes on board a little late, but the Spectrum program shows that primary care is a key to reducing negative impacts on the ED, and eventually improving patient care.