DURHAM — In 2012, 25 people accounted for 423 calls to Durham County Emergency Medical Services and 326 EMS transports to emergency rooms at Duke and Durham Regional hospitals.
Over the year, the cost to serve those 25 people totaled more than $275,000 – for EMS alone.
“That’s a pretty significant impact on the system,” said Brandon Mitchell, special operations coordinator with Durham County EMS.
“The fact of the matter is, if we add up everything that all of our health and human services and all our nonprofits ... are spending, we’re often spending four or five times ... on the same individuals but not getting the outcomes that they deserve and not getting the outcomes we want for them,” said Michelle Lyn, community health director at Duke Medical Center.
Mitchell and Lyn were among about 50 local medical, social service, law enforcement and administrative personnel who met last week to talk about “Familiar Faces” – people who, for a variety of interconnected reasons, put a high and recurrent burden on public services including emergency rooms, 911 responders and jails.
“Those folks ... deserve our help,” County Manager Mike Ruffin said. “We’ve got to figure a better way ... to give them what they need, keep the cost down and be sure we’re all talking to each other.”
Figuring out how to do all that could also create the model for future health care for everyone else.
“Thinking about our Familiar Faces, (who are some of) our most complex and vulnerable in our communities, would probably go a long way into creating a system that really works for everyone and makes sense,” Lyn said.
“Familiar Faces” is a polite term for a population previously known, among health care workers, as “frequent fliers,” often associated with homelessness.
Advocates for comprehensive homelessness-prevention projects, such as the “10-Year Plans” that Durham and hundreds of other American communities have devised, have pointed to the drain on public services represented by those who are chronically in and out of public shelters. Many have addictions and/or mental illness but get only occasional, stopgap treatments over and over again.
“Just stably housing people can be the most powerful medical, mental-health, substance abuse intervention you can imagine,” said Assistant County Manager Drew Cummings.
Familiar Faces aren’t necessarily homeless but typically live “on the edge,” said Ann Oshel of Alliance Behavioral Healthcare, the substance abuse and disability agency serving Durham, Wake, Cumberland and Johnston counties. And, as with homelessness, a large part of the problem is a lack of connection between the agencies that deal with them.
Often, Mitchell said, individuals with a health or addiction crisis arrive at an emergency room or jail because the police or emergency technicians don’t know where else to take them, and then once the crisis has passed the patient is summarily discharged.
“If they go to jail, there’s no follow-up,” Mitchell said. “If they go to the emergency room ... they’re sent back to the streets.”
One agency may be providing a service without knowing some other agency is duplicating it. Patients get doctors’ orders, but no one checks to make sure the orders are followed. Laws, technology, habit and “silo” thinking make it difficult for agencies to know what each other are doing with the same people, and those people are often typically “not the best historians of their own care,” said Durham Center Access Director Anita Daniels.
“We’re spending dollars over and over but not getting the coordinated response system we’d like,” Lyn said.
Coordination and cross-training could save money and make emergency care easier to get for those who need it by diverting those who use it because they, or those who transport them, don’t know where else to go, Mitchell said.
He said a Fort Worth Community Health Paramedics program that enrolled frequent emergency callers and provided post-crisis oversight in collaboration with non-emergency services cut the number of 911 calls by 86 percent over a year, saved $1.6 million in emergency service costs and cut $7.4 million in emergency room costs.
Mitchell and others in Durham would like to emulate that program, if they can find money to get it started.
“We’ve got to do something about the costs,” Mitchell said, “and, beyond costs, in taking care of our community.”
Getting beyond costs means a different way of thinking about health care, Lyn said.
“We’re really trying to transform from ... a reactive point of view to a proactive communitywide system that really looks for ways to improve the health of the entire community,” said Lyn, a former Southern High School teacher who helped Duke set up a school clinic years ago.
“Health care reform has certainly opened the conversation,” she said. “How do we really create a model of care and a model of health that gets us where we need to be – for the money we’re spending?”