Saving Health Care Costs With House Calls

Nov 22, 2013

Credit 401(K) 2012 via flickr /

Want to cure what probably ails you?  Join Brenda Williams and her early morning walking squad as they lap the Morris H. Blum senior apartments building in Annapolis. They like to tease the stay-at-homes, like the maintenance man dropping a rope down from a third floor balcony.

“Don’t do it.  He’s going to hang himself.  Don’t do it,” Williams called out as her buddies guffawed. “I said don’t do it, it ain’t worth it.  Oh, don’t tell me you’re going to climb down on that.”

“That was good,” said one of her companions. “We startled him, too. He looked like: huh?”

Williams’ hearty band of a dozen or so, mostly female, senior athletes are perhaps the most visible—and certainly most fun--symbol of a new venture aimed at upending a practice that effectively denies health care to the elderly poor until it’s very expensive and likely too late.

Victoria Bayless, president and CEO of the Anne Arundel Medical Center, said the idea sprang from the discovery that even though there are only about 184 residents of the Morris Blum building, ambulances were called to that address 220 times from November 2011 to Nov. 2012.  In six months alone, 73 Morris Blum residents made 175 trips to the emergency room, resulting in 38 admissions.

“There were an enormous amount of 911 calls being made from this address and people were calling in if they had chest pains or shortness of breath, or any conditions, their first choice or option--but what they might have thought was their only choice--was to call 911,” she said.

Thus, often for just lack of a regular doctor, such patients ran up huge emergency room bills that had to be absorbed by the hospital and premiums paid by those with insurance.

So, as of this fall the residents of Morris Blum and up to 3,000 of their uninsured or under-insured neighbors have another option: a primary care doctor right in the building, 40 hours a week. Plus, she makes house calls.

The clinic is financed in part by an $800,000 state grant for health enterprise zones designed to provide medical care for low-income communities that would otherwise do without—except for emergency rooms that take all comers. Five such ventures have been created in Maryland this year at a total grant cost of $4 million.

In Annapolis, the public housing authority provided space for the clinic, which AAMC is operating. The hospital also kicked in $185,000 in additional start-up costs. AAMC’s investment comes as Maryland is seeking federal approval to change the way hospitals are paid:  away from a fee-for-service model to one based on patient outcomes.

Maryland Health Secretary Joshua Sharfstein says it’s a smart move. “I think they see the future of health care and realize that what’s going to matter in the future is not just the number of admissions they have or the number of surgeries but the health of people in their community,” Sharfstein said.

Dr. Claudia Arumala is more than a convenience for those with minor aches and pains. She is an advocate for preventive measures, such as low fat diets and regular exercise, which can work wonders on common ailments of age: diabetes, high blood pressure, arthritis and obesity.

Brenda Williams, 58, started her walking group before Arumula arrived in early fall.  But since then, the doctor has been weighing her weekly. “She told me she would have me 20 pounds lighter by Christmas, but I’m 20 pounds lighter before Thanksgiving,” Williams said. “And it’s all due to walking and watching what I eat.”

Linda White, walking her laps with a bum knee and a cane, said it was   Williams who inspired her quest to try to get rid of the cane--plus an extra 50 pounds. “I used to make excuses and then I would look out of my balcony and see Brenda and all the girls and guys walking around,” White recalled.” “So it got me motivated.”

Now she’s with the crowd making catcalls. Definitely more fun.