A bridge across Emergency Rooms that lead to better health for Aurora’s poor

AURORA | For participants of the Bridges to Care program, the difference is in the ears. Or at least the direction in which they’re pointed.

“This is the first time I’ve had someone who listens like that,” said Norma Armistead, a recent Bridges to Care graduate. “In the past, with any doctor, if you ask them something they change the subject. But my nurse practitioner now, if I have a question, she will answer it.”

Armistead, who has been living in a Colfax motel for the past five years, is one of the over 100 Bridges to Care patients who graduated from the six-month program during a ceremony at the Summit Conference and Event Center on Feb. 4. Run through the Metro Community Provider Network, Bridges to Care, or B2C, provides 60 days of free, in-home care for uninsured or Medicare/Medicaid-insured individuals who are frequent users of hospital emergency rooms.

The victim of a chronically bad back, a foot that has required multiple surgeries and sufferer of diabetes, Armistead said she was visiting the hospital about twice a week before being enrolled in the B2C program, racking up thousands of dollars in hospital bills that she was unable to pay. She said the program helped her find a primary care provider to reduce her hospital visits, which has greatly helped reduce her stress — a result grounded in her caretakers’ empathy.

“It makes it a lot easier with a lot less stress,” she said. “It made me feel like someone really cares.”

Armistead was chosen to participate in the program by hospital staff who recommend patients for the program based on hospital and emergency room visits — a practice often referred to as “hotspotting.”

“I first heard about the program when I was in the hospital and one of the coordinators came into my room and asked me if I wanted to join,” she said. “As she explained it and I’m like, ‘Yeah, that sounds good.’”

Jeff Brenner, a general practitioner based in Camden, New Jersey, initiated the hotspotting concept in his home state in the early 2000s and rolled it out on a national level two-and-a-half years ago with the help of a $14.3 million innovation grant through the Affordable Care Act.

“I was always very upset that my sickest patients always seemed to get lost in the health care system,” Brenner said after the Aurora graduation ceremony. “So, this has been a labor of love.”

Brenner said that the four states and nearly 25 sites that have participated in B2C over the past 30 months have reported statistically positive results, with Aurora leading the charge. To date, Aurora has graduated approximately 540 B2C participants, a number higher than any other community in the country, according to John Reid, vice president of fund development for MCPN.

“We’ve been great admirers of what they’ve (Aurora B2C employees) put together and brought some of the things they’ve done back to Camden,” Brenner said. “I think Aurora’s a tight-knit community where I think people know each other and have worked together for a very long time, so I see it as a very hopeful opportunity to break some new ground here.”

MCPN reported that in Aurora the average number of ER visits over six months decreased from 3.8 visits pre-B2C enrollment to 1.8 visits following graduation for uninsured patients and from 4.2 visits to 2.8 for Medicaid-insured patients. That resulted in a $22,930-per-patient savings and an overall 38 percent reduction in University of Colorado Health charges, based on data taken from the program’s first 96 graduates. Now with over five times as many program alumni, MCPN said those figures have since ballooned.

On a primary care level, approximately 89 percent of B2C participants who did not have a primary care provider upon enrollment got one, according to an MCPN report released last year.

But despite the program’s success, its future is contingent on funds that may soon run out. The $4.4 million grant MCPN has financed the Aurora program through for the past two-and-a-half years is set to expire this June, putting B2C’s vitality in question.

“Right now there is no funding model for this, and this program is going to go out of existence in six months, but I’m hopeful that the community will pull together and keep this thing going,” Brenner said.

He outlined that an inevitable funding structure should be based on a mix of income streams, and that the solution is ultimately up to the state to provide.

In an evaluation report released late last year, MCPN proposed two possible solutions to continue the program, which includes various combinations of reducing staff, cutting services currently offered through Aurora Mental Health, focusing solely on high utilizers of the ER and offering early graduation options. The more expensive alternative would require MCPN to come up with just under $800,000 annually, with the more scaled back version necessitating approximately $430,000.

Like Brenner, Reid said that a combination of the two MCPN proposals would be ideal.

“We’re leaning toward a combination of both by looking to hospitals, foundations and our state’s Healthcare Policy and Finance Division,” he said. “This is a sustainable model that has a proven track record and we know empirically it has produced results and could save the state millions of dollars, so why would it not support this?”

Aurora City Councilwoman Molly Markert, a longtime proponent of the program, said that a municipal solution and support is also possible.

“If we’re talking about city dollars, we need to find the connection to city services and that’s probably difficult,” she said. “The better thing is to have the city, the mayor, the city council, the elected officials, stand up and say, ‘we need this program in our community, may I write a letter of support for your funding application?’ Or maybe the mayor should have a meeting with the two hospitals and say, ‘hey bubba, kick in some dough here, you’re the ones that are saving.’”

Regardless of B2C’s current financial limbo, Reid said he believes a solution will be found before the grant funds expire in June.

“I’m optimistic, given the results, that yes there will be another funding structure in place,” he said. “The current way is a dinosaur and extremely costly — this is more cost effective and doesn’t bleed the system.”