Out to further reduce avoidable emergency department visits from its highest users, Florida Hospital has expanded its Community Care program in Volusia County and expects to add more hospitals in the Orlando metro area. 

Meghan Budvarson, director of ambulatory care management for the Florida Hospitals in those counties, says that for patients enrolled in the program for a full year, Community Care has triggered a 25 percent reduction in avoidable ED visits, a 57 percent reduction in inpatient stays and a 17 percent drop in unnecessary observation.

Community Care first launched at Florida Hospital Memorial Medical Center in Daytona Beach in 2014 and expanded in September to the New Smyrna Beach location, both in Volusia. Hospitals in Flagler County were added later that year and then two more in Orlando for a total of seven hospitals, although more hospitals in Orlando are to come. The program serves uninsured patients with chronic illnesses.

Budvarson says Florida Hospital noticed a pattern of patients with numerous prescription medications repeatedly coming to the ED to manage their disease, so it developed the program to enroll them for a free, post-discharge service that sends nurses, licensed clinical social workers and registered dietitians to a patient’s home to focus on preventive care.

“In the 12 months prior to enrolling in Florida Hospital Community Care, just four patients in this high-utilizer group collectively had more than 40 encounters (either ED visits or hospital stays) with Florida Hospital, adding more than $175,000 in direct costs to the hospital,” Budvarson says. She adds that the top 5 percent of high utilizers represent nearly 50 percent of health care resources.

Todd Goodman, senior executive officer and chief financial officer of Florida Hospital and the Central Florida Division of Adventist Health System, says that because the program aims to assist “the most financially and physically vulnerable,” a thorough evaluation is performed on each community before bringing the Community Care to a hospital.

The program works closely with local organizations like the United Way, food banks and medical homes for the uninsured that help patients maintain health and receive preventive care. “They need a network of local partners that can provide services the health care system cannot, such as food [for those who face food insecurity] and housing for the homeless,” Goodman says.

Technology plays a role too. MedMinder is used in the hospitals to remind patients to take medications; it’s a pill dispenser with medical alerts that notify nurses if a patient has not taken medication.

Florida Hospital Community Care is based on a model developed by Barry Bittman, M.D., of Meadville, Pa., a college town where Bittman created a “health coach curriculum” for students to study and use when visiting patients in their homes. In addition to the team of nurses, social workers and dietitians, Florida Hospital Community Care partnered with universities such as Stetson and Bethune-Cookman to train students. Budvarson says the program follows the same process and curriculum as Bittman’s but is tailored to the culture of Florida and uses more current literature.

The program is internally funded. Budvarson stresses the program requires an interdisciplinary approach and collaborative plan of care.

“This program is not a black-and-white approach,” she says. “We are dealing with complex diseases, coupled with complex life stressors that can exacerbate the disease process. The approach needs to be from a hierarchical perspective, and basic needs (such as running water, electricity and stable housing) need to be addressed before expecting patients to be able to manage their complex diseases on their own.”