Providers team up on care for uninsured

Carolina Health Net has enrolled 800

When Feliciana Gachuzo's son, Ricardo, cut his head and had to go the emergency room three years ago, he had to wait several hours before he could be seen.

Now Ricardo, 6, is being evaluated for possible attention deficit disorder -- something Gachuzo, who is originally from Mexico, had never heard of. She said she worried about getting the evaluation at first, believing that seeing a doctor would be difficult and costly. But this time, Gachuzo isn't having any trouble getting an appointment.

Gachuzo and her son are two of 800 patients enrolled in Carolina Health Net, a new attempt by Piedmont Health Services, UNC Health Care and the UNC School of Medicine to cut rising emergency room costs and streamline specialty care for uninsured patients.

"It's about getting the right care at the right place at the right time," said Brian Toomey, CEO at Piedmont. The nonprofit agency runs six community clinics, including the one in Caswell County's Prospect Hill that Gachuzo uses.

Carolina Health Net identifies patients with frequent emergency room visits, diseases and multiple medications. It encourages them to enroll in the program, which connects them to primary care doctors at Piedmont and specialists at UNC. Patients such as Ricardo go to their local clinics for routine and follow-up care, and see UNC specialists with more ease when they need to.

"We can start [treatment] here at UNC, but then we need somebody to hand it off to," said Warren Newton, chairman of the department of family medicine. "We can talk to a person's family and get him launched into the program so that he has a regular doctor to talk to and help manage his disease, whatever it may be."

Emergency room visits continue to rise. At UNC Hospitals, the emergency room sees more than 62,000 patient visits per year, and the annual cost for indigent care exceeds $70 million.

Carolina Health Net covers four counties -- Alamance, Orange, Chatham, and Caswell -- that have more than 82,000 people without insurance. Nearly half of UNC's uninsured patients come from these counties.

Patients in Carolina Health Net also are encouraged to enroll in Medicaid if they are qualified.

Another issue the program hopes to resolve is missed appointments, which also raise costs, Toomey said. Too often a patient has to wait weeks or even months to see a specialist. By then, the problem may have resolved itself or become worse and required an emergency room visit. Or, work issues get in the way and a patient has to skip the appointment. In its first six months, Toomey said, Carolina Health Net has significantly reduced the no-show rate.

Cynthia Oakley and her husband have never had health insurance. Both self-employed, they enrolled in Carolina Health Net. "I use mostly the community health center, and in dire emergencies I'll go to the hospital," said Oakley, who was recently diagnosed with diabetes. "Going somewhere else isn't an option -- there's no way we could pay the bills."