• How Oregon health reform got 'frequent flyer' out of ER

  • Forty-year-old Jeremie Seals has had a tough life. He left home at 14 and his health isn't good.
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    As part of a pilot project, Pearlstein guides patients like Seals through the medical maze.
    Seals explained, "I have congestive heart failure. I have cardio myopathy. I have neuropathy in both my legs really bad. I have had a heart attack when I was 35 and I am, long story short. I'm terminal."
    His doctor, Christina Milano, has given him two troubling pieces of information. First, that he'll die without a heart and kidney transplant. And second, he's about as likely to get a transplant as he is to win the lottery.
    Seals said, "It's because my heart wouldn't handle the duel operation."
    Jeremie Seals: "I basically lived at the emergency department. Ever since I'd had a heart attack, anytime my chest hurt, I'd either call the ambulance or go up to the hospital. and I think it was also out of desperation to just get out of my car and off the street."
    Essentially he was what's known as a "frequent flyer." Health experts say people who use the healthcare system in this way help to explain why 80 percent of the nation's health care costs are spent on 20 percent of the population.
    And that's what brought Seals to the attention of Oregon's new coordinated care organizations — and specifically Lisa Pearlstein.
    In fact, it was at an appointment with Dr. Christine Milano in 2011, that Pearlstein first met Seals.
    She says the two of them built a rapport and he now trusts her. But it wasn't easy:
    That distrust stemmed from previous experiences. For example, Seals says doctors tried multiple times to put a fistula into his arm — it's essentially a point of access for dialysis where blood can be taken out, cleaned, then put back.
    He said, "I tell them I want them to knock me out, but they won't do it."
    Pearlstein said, "In our working together it's understanding that as the patient, he does have the right to say, 'No, I'm not going to go through with this.' But it's very hard and it takes a lot of courage to do that because you're in this powerful medical system and they're thinking, 'This time, it'll work.' That's their job to be optimistic and to believe in these techniques but sometimes the human body and the person cannot withstand that experience again."
    Pearlstein doesn't give Seals medical advice, but she has helped him build a relationship with his doctor — Christina Milano at OHSU's Richmond Clinic.
    He says he now trusts Milano, and she says he's moving in the right direction.
    Milano said, "When he has the resources available to him and when housing had stabilized for him, he is actually wanting to be adherent to the medication regiment that I had recommended for him and that his specialist have recommended for him. So essentially providing him clear information and a supportive environment I think has allowed Jeremie to improve his condition and to stabilize his condition."
    Milano and Pearlstein worked extensively with Seals for the first few months. Now he has a home, he's medically stable and he's much more on his own.
    CareOregon won't give the specific figures for how much it cost to care for Seals, and he doesn't want that information released. But in the year before Pearlstein started working with him, he visited OHSU's emergency department 15 times and had 11 patient admissions.
    Ramsey says just one in-patient admission for someone with Jeremie Seals' medical problems can easily amount to $10, $20 even $30 thousand — depending on how long they stay.
    If the state fails, it faces some big fines.
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