After her brother's fourth epileptic seizure in one day, Shelly Dozier called an ambulance and headed for the hospital.
"We were out of moves," the Portsmouth, Va., woman said. "When you go to an emergency room, you're already full of stress. The doctors and nurses there could tell we were in a panic. And then they told us, 'We have this great program.'"
In walked Vanessa Dunlap, one of two "life coaches" at Bon Secours Maryview Medical Center in Portsmouth. Dunlap arranged for the brother, Troy Dozier, 32, to see a neurologist through the hospital's affiliated free clinic. He is back on affordable antiseizure medication and has a new medical home at the clinic.
The Bon Secours life coach program will be the subject of an Innovation Forum session at the Catholic Health Assembly, June 3-5, in Philadelphia presented by Pamela A. Phillips and Jeff Doucette. Phillips is senior vice president for mission at Bon Secours Maryview and its sister hospital, Bon Secours DePaul Medical Center in Norfolk, Va. Doucette is vice president of emergency services for the Bon Secours Hampton Roads Health System, the parent of both hospitals.
Each of the two hospitals has two life coaches, known formally as medical life coach navigators. They work with their emergency department staffs to help guide toward a medical home patients, who are uninsured and medically underserved, or who regularly use emergency rooms for nonemergency issues.
Troy Dozier once had access to affordable medication, but he lost it when a neurologist stopped seeing him, his sister said. Troy works at a hot dog stand and has no medical insurance. Shelly Dozier, 25, said she tried to find another neurologist willing to take her brother on as a charity patient, but had no luck. So when he began having seizures again, they had to head for a hospital.
"With the state of our economy, there are lots of people like my brother," she said. "It is so reassuring to meet someone like Vanessa, who has the time to understand our struggle. She helped us to realize we are not alone."
Ongoing care
Phillips said hospital administrators developed the program during a Bon Secours Health System Ministry Leadership Formation session, with help from the University of Notre Dame business school.
Uninsured patients who frequent emergency rooms for nonemergency or chronic conditions cost hospital systems a lot of money. Phillips said the life coach program at Bon Secours DePaul Medical Center saved the hospital about $150,000 in cost avoidance in 2010. She said only 12 of the 1,000 patients seen by the hospital's two life coaches returned to the emergency department for the same complaint that year, and 90 percent of them followed through with the coaches' arrangements for primary care.
Bon Secours began the life coach program in March 2008 at its Norfolk hospital. Phillips said the hospital works with Park Place Medical Center, a federally funded clinic one mile from the hospital, which serves as a medical home for low-income patients. The two life coaches, both licensed practical nurses, help arrange the appointments and other services at Park Place.
Bon Secours Hampton Roads, the division of Marriottsville, Md.-based Bon Secours Health System that serves the Norfolk and Portsmouth areas, expanded the program to its hospital in Portsmouth in 2010.
Life coach Dunlap of Portsmouth's Bon Secours Maryview is a pharmacy technician by training. She has experience in getting prescription medicines at little or no cost for indigent people. Her fellow coach in the emergency room is a certified nursing assistant. Both women help set up ongoing care for their patients at Maryview Foundation Health Care Center, a free clinic located on the Maryview hospital grounds.
Contrasting models
Maryview's life coaches are employees of Catholic Charities of Eastern Virginia.
Said Phillips, "We love working with Catholic Charities because it has so many resources and integration in the community. Patients who lack primary care often have a lot of other social issues. If you can't pay your electric bill, you don't pay attention to your health."
Lynne Zultanky, a hospital spokeswoman, said the original program at Bon Secours DePaul also began with life coaches who worked for a Norfolk social service agency. The Norfolk hospital hired the two coaches in 2010 after there were major program changes at the social agency. She said Bon Secours Hampton Roads is monitoring the two structures — coaches paid by the hospital or an outside agency — to evaluate which model works best.
Persistent prodding
At both hospitals, the life coaches work overlapping shifts and cover the emergency departments from 8 a.m. to 8 p.m., Monday through Friday. Dunlap said she begins her work day at Bon Secours Maryview by checking the electronic medical records of overnight emergency visits. If any patient meets the criteria for life coach services — low-income, lack of insurance and no regular source of primary care — she calls that person to provide information and offer assistance.
She also works directly with patients who arrive at the emergency department during her shift.
Dunlap said she can arrange appointments at the hospital's free clinic or with the Care-A-Van, a mobile clinic operated by Bon Secours Hampton Roads for the Norfolk-Portsmouth area. Phillips said a key to success for the program is to continue encouraging patients to take advantage of the assistance. Dunlap said she's happy to give them a push when necessary.
"I tell them I'm going to remind them about appointments," Dunlap said. "I told one patient I was going to call back and make sure he saw the doctor. When I called again, he said he'd gone. I told him I was glad. And he said, 'I went because I didn't want to have to tell you that I didn't go.'"
Phillips praises Dunlap's compassion and persistence. "She is willing to go that extra mile," Phillips said. "You need someone like her — someone with heart."
Dunlap said her motivation is simple: "I have good news to tell people."