Priority Care program provides health care advocates

Carol Harrison/For the Times-Standard

Posted: 12/29/2013 02:33:58 AM PST

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Shortly after making her second trip to the hospital emergency room in two months, Debbie Oswald was told to see one of the North Coast's two gastroenterologists.

'I called. They told me it would be two months,' she recalled. 'So I called Jane. She got me in two days later.'

Jane Spini is a registered nurse and the case manager for Oswald, who was one of 460 Humboldt County residents to participate in Priority Care over the last two years. Priority Care provides people with chronic ailments free access to coordinated care through a personalized health care team.

It is funded by insurance companies and run out of the Humboldt Del Norte Foundation for Medical Care and Independent Practice Association.

'Getting me in probably saved me -- and the insurance company -- three more trips to the ER,' Oswald said. 'Jane is my lifeline, my health care guardian angel. She runs interference for me and gets things done a private person can't.'

Case managers accompany clients to appointments as far away as San Francisco, answer questions, take notes during meetings and direct clients to websites, reading material, research or support settings that can help with client goals.

'(Priority Care) is a way to talk things over and come up with the best solutions for how to handle it before it gets out of hand,' said 72-year-old Heidi Pettersen. 'That benefits me and the insurance company.'

'I call it just being an advocate,' Spini said. 'From my point of view, we all want to save on medical spending, but my goal is to help people stay as healthy as possible and enjoy their lives as much as possible.'

The IPA, a local physician group, launched Priority Care after seeing significant reductions in hospital admissions, health care costs and missed workdays in an Intensive Outpatient Care Program pilot study from 2009-2011.

CalPERS, PG&E and Blue Lake Rancheria employers brought their covered personnel into the program in 2011, and Blue Shield's health maintenance organization members came on board in 2013.

Anthem Blue Cross signed on for the coming year, prompting the Priority Care team to expand to three nurses, two wellness coaches and two medical assistants to handle what could be as many as 700 new enrollees. Invites went out in November.

'In our current health care system across America, you often need a little extra support,' said Rosemary Den Ouden, chief operating officer for HDN Foundation. 'To have someone local that can come into your home, talk to you about your concerns and help you navigate the system is huge. Who wouldn't want your own nurse, essentially, to be on call?'

As it turns out, the foundation has seen less than half of its selected invitees participate in Priority Care.

'At first I thought it was a trick,' said Arcata's Phyllis Willner, a long-time vocational nurse in mental health who retired in 2012.

'As soon as I found out I didn't have to call (the case manager) before I called my doctor, I embraced it. They've never discouraged me from going to the doctor or having surgery, and they've encouraged me to explore alternatives.'

Willner has re-shaped herself in less than two years. Yoga helped her drop 30 pounds and a cigarette habit.

'Priority Care is a way of helping people feel more secure in the treatment they are getting and less alone,' she said. 'It's a unique opportunity to focus on yourself, to learn what you can do from someone who is helpful and a problem solver.'

'I was a little skeptical,' admitted Jo Wattle, an automotive technician who manages the motor pool for Humboldt County. She joined Priority Care last year. 'I figured if an insurance company was rolling it out, how good could it be for me? They probably wanted to know more about me so they could have a reason to say no.'

'People are naturally suspicious about anything to do with health insurance,' Spini said. 'Some think this will change their health insurance coverage or their relationship with their primary provider. It doesn't do either. It's a voluntary insurance benefit their employer is offering at no charge.'

Wattle tossed two Priority Care letters explaining the program, but RN A'na Verdi allayed her fears after visiting Wattle and her husband, Tom, in their home.

'It's been wonderful so far,' Wattle said. 'We have a case manager who knows us and knows our history. She's an intermediary, someone to talk to and not a voice on the phone or letter in the mailbox. It's someone local, and I don't have to give a whole history every time I call. I realize now that the insurance company has someone who has both our interests in mind.'

What cinched it for Wattle was a hospital visit by two case managers in the aftermath of her 52-year-old husband's heart attack. He was due to have a stent put in that day, but was worried about costs and co-pays.

'Where else do you find people who will come to the hospital to put someone's fear to rest?' she said. 'It's beyond the moon; sort of Blue Shield -- Eureka style.'

Self-perception may be another reason for non-participation.

'They don't perceive themselves as a person who has a chronic illness and needs extra help in that area,' said Lisa Nedlan, clinical services director. 'We try to talk to them about how they feel, what they want to do and where they see themselves five years from now. The idea is to catch those people before they go to the hospital. That's where we can address their needs and really make a difference.'

Eureka's Bob Myers, 97, turned down his initial invite to join, but saved Spini's business card.

'I can't remember anything 10 minutes ago, so when I had to go to the doctor I called her,' he said. 'She went with me to the meeting, took notes, and made sure I got all my questions answered.'

And when he became ill -- stomach poisoning or a mix-up with his 13 medications and cold medicine, depending on who is telling the story -- she came to his home for three hours.

'She made two house calls and got him back on track with medications,' said his daughter, Fran Truhill. She and her sister met Spini in September when they visited for Myers' birthday.

'I'm 300 miles away in Union City, my sister's 2,000 miles away in Albuquerque. We can't be there,' she said. 'But we're thrilled he has a medical advocate. It's peace of mind to us that he has her.'

Oswald doesn't know where she'd be without the aptly-named Foundation.

'I consider them to be the foundation of my health care now,' she said. 'They even hooked me up with a trainer to get me more information, and there's no fee. Nothing. It's awesome.'

For more information, call Priority Care at 442-0478.

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The Humboldt Del Norte Independent Practice Association and Foundation for Medical Care commissioned Carol Harrison to write this article.