The MetroHealth hotline offerscheck-in and same-day delivery of groceries and other basicsupplies through the a program launched last year with the goal offinding and addressing the causes of health disparities in thecommunity. (Photo: Shutterstock)

|

At-Home Care Designed For COVID Likely Here To Stay At ClevelandHospital CLEVELAND, Ohio — In late March, Andrea Laquatra began tofeel sick. At first, it was an overwhelming fatigue, and the32-year-old Cleveland mother of two tried to push through it.

|

A fever, headaches and body aches soon followed. Then shenoticed she'd lost her senses of taste and smell.

|

By March 23, Laquatra could no longer deny the nagging fearshe'd had since first falling ill: She might have COVID-19, thedisease caused by the novel coronavirus, which by then had beendetected in every state. That day, 351 new cases, 83hospitalizations and three deaths were reported in Ohio.

|

The phone call Laquatra made next, to a COVID-19 hotline staffedby the area's public health system, MetroHealth, likely helpedcontain the spread of her illness to only her husband, Tony.

|

MetroHealth's hotline connected the Laquatras to nurses anddoctors who assessed their symptoms and checked in daily while theywere ill. MetroHealth also took care of all the family's immediateneeds — including home delivery of prescriptions, groceries,toiletries and diapers for their 2-year-old — so they could safelystay home until they felt better.

|

MetroHealth has offered the hotline and home assistance free toany Ohioan since mid-March. It said the hotline, which has fieldedmore than 11,000 calls, has saved the hospital system from beingoverwhelmed by a surge of COVID patients. It has also paved the wayfor a new model of health care delivery, one that brings care wherepatients are — at home.

|

It's a model they believe must — and will — last beyond thecurrent crisis, saving money for its health care system andaddressing the myriad social needs that keep patients from gettingand staying healthy.

|

The hotline

It's a Tuesday in mid-May and Dr. DavidMargolius is in his office on MetroHealth's main campus inCleveland's Brooklyn Centre neighborhood, keeping an eye on ascreen displaying a list of calls to the hotline.

|

It's late afternoon, and about 63 people have called that day.Ten have been referred for testing. Nearly all of the callers havesymptoms of COVID-19 and have been counseled toself-quarantine.

|

Margolius calls a young woman who works as a protection officerat a juvenile detention center, and shares his half of theconversation with a reporter via video call. A nurse flagged thedetention officer's hotline call for follow-up with a doctorbecause one of the woman's colleagues had tested positive for thecoronavirus that day. While she doesn't have any clear symptoms(just a scratchy throat), she's worried about getting sick andexposing others. After hearing that she's wearing a mask andmaintaining social distance at work, Margolius assures her she'sprobably fine.

|

"You're on top of it," he tells her. "If things change and youdevelop symptoms, we're here if you need us."

|

Dr. Noha Dardir, a family medicine specialist who has fieldedabout 780 hotline calls, said patients were terrified, but they hadfew options early on because most of the primary care offices atMetroHealth were closed.

|

"If we're telling them to call their doctor and not go straightto the emergency room, we had to be there to take those calls. Andit had to be 24/7," she said. "I felt obligated to mypatients."

|

MetroHealth was prepared for a surge of 1,000 patients, but atthe pandemic's peak in early May, only 13 COVID-positive patientswere in intensive care. Only 82 people have been hospitalized withCOVID-19 at MetroHealth since the crisis began.

|

The hotline's peak came much earlier, on March 17, when nearly700 people called. In the hotline's first three days, staffersadvised 200 people to quarantine themselves.

|

"We just couldn't keep up," said Dr. Nabil Chehade,MetroHealth's senior vice president for population health. "At onepoint, we had to have 12 physicians working to answer thesecalls."

|

Cuyahoga County Health Commissioner Terry Allan, who hasworked closely with hospitals to trace and contain COVID cases,believes the public hospital's quick work in advising quarantinesfor those with symptoms — even mild ones — helped to contain theoutbreak.

|

"We joked early on that if you had a paper cut, we'd tell you tostay home for two weeks," Allan said. "But that helps to reducepeople from potentially being part of the chain oftransmission."

|

As of early June, about 300 of Cuyahoga County's 1.3 millionresidents had died of COVID-19. While the county, Ohio's secondmost populous, has had a high proportion of the cases in the state,it has fared much better than hard-hit counties with similardemographics in other parts of the country.

|

Nine weeks in, call volume has slowed. Now, about 100 peoplecall daily and about three-quarters talk to a doctor. Still,MetroHealth's hotline remains available round-the-clock, andMargolius said it's clearly still needed. The county recently sawits highest rate of infections since the pandemic started, likelydue to the partial reopening of Ohio's economy, which began inmid-May.

|

"This is obviously so far from over," Margolius said.

|

A new model

When MetroHealth's doctors told Andrea Laquatra to quarantine athome in late March, she and her husband weren't sure how they'dmanage. They were already low on diapers and wipes, and had beengrocery shopping for Tony Laquatra's parents.

|

"We always take care of my mom and dad. We couldn't do nothingfor them because we didn't want to get them sick," Tony Laquatrasaid.

|

Many others the hospital told to quarantine were in the sameboat. So the MetroHealth team added a social worker check-in andsame-day delivery of groceries and other basic supplies through thehospital's Institute for H.O.P.E. (health, opportunity,partnership, empowerment), launched last year with the goal offinding and addressing the causes of health disparities in thecommunity.

|

As of May 22, institute staff members had delivered food andsupplies to 620 households. In the early days of the pandemic, asthe team scrambled to respond to the influx of calls, even membersof the hospital's executive team pitched in on those deliveries. Sodid some doctors.

|

The health system also started screening for loneliness andstress and has since referred 700 people for calls from thehospital's behavioral health team, Chehade said.

|

MetroHealth also connected the Laquatras to a church group thatcould shop for his their parents.

|

"I just cried, I was so grateful," Andrea Laquatra said. Theyhave since recovered, and because they were never tested, are amongthe hundreds of probable COVID cases in the county.

|

The pandemic proved to be the perfect opportunity forMetroHealth to deliver on a long-discussed but only partlyimplemented plan to treat patients at home while addressing thebasic social needs that sometimes prevent them from stayinghealthy, Chehade said.

|

"We were forced to really transform our care overnight," hesaid.

|

No going back?

The health system has vowed not to return to business as usualwhen the pandemic eases.

|

"This is an inflection point in the delivery of health care, andit would be a tragedy if we didn't learn from it," said Dr. BrookWatts, MetroHealth's vice president and chief quality officer. "Thehealth care system will try to go back because there were a lot ofincentives for the system to deliver care the way we did. We're notgoing to go back. I'm not going back."

|

For now, MetroHealth is paying for this new model of carethrough donations, its own funds and payment from Medicare andMedicaid, which have expanded reimbursement for telehealth inresponse to the pandemic. The health system estimates 30% to 60% ofits visits in the future will be managed through telehealth,compared with just 0.5% pre-pandemic.

|

And a new program, Hospital at Home — which deliversBluetooth-enabled equipment such as heart rate, blood pressure andblood-oxygen monitors to patients with chronic illnesses to managetheir recovery at home — could deliver hospital-quality care at 60%of the cost for half of all medical-surgical admissions.

|

It remains unclear if insurers, including the Centers forMedicaid & Medicare Services, will continue to pay for expandedhealth care delivered via telephone or video calls after thepandemic eases. If they return to pre-pandemic rules forreimbursement, it could make maintaining the current modeldifficult, or even impossible.

|

For the model to be viable and adopted widely, MetroHealth CEODr. AkramBoutros said, the nation's health care system will have toreinvest these savings, and redirect the money it wastes onunnecessary tests and procedures, repeated hospitalizations forchronic, manageable diseases and overpriced medications andhigh-tech devices.

|

"It may take some shaming of nonprofit medical institutions tobring them to this same area of focus," said Boutros. But if theydon't want to do it, he added, they should financially support thehealth systems that do.

|

KHN (Kaiser HealthNews) is a nonprofit news service covering health issues. It is aneditorially independent program of KFF (Kaiser Family Foundation),which is not affiliated with Kaiser Permanente.

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.