Fort Worth Hospital program provides low-cost care for uninsured
In September 2021, shortly after Larry Gonzales was diagnosed with type 2 diabetes, he asked his son to pick up medication an ER doctor had prescribed for him.
The doctor had written a prescription for insulin and asked Gonzales to start taking the drug to manage his diabetes. Gonzales, 50, knew very little about the chronic condition he had just been diagnosed with, let alone the medication he had been prescribed.
When his son came home, he had insulin pens for his father as well as a $1,400 charge for medication.
Gonzales does not have health insurance and has therefore been charged the list price for the drug, essential and life-saving for people with certain types of diabetes.
“I spent almost $6,000 the first month out of the hospital,” said Gonzales, a building contractor who lives in Denton County.
But Gonzales found a lifeline through a Texas Health Resources hospital system program. At nine of its hospitals, the North Texas Health System offers a program designed for people like Gonzales, who have a serious chronic illness but don’t have health insurance to access regularly to a primary care physician.
The initiative, the Education and Healthy Lifestyles Program, offers health care at low cost anyone aged 18 and over who is uninsured and who suffers from diabetes, hypertension, hypercholesterolemia or congestive heart failure. For $10 a month, patients receive a monthly exam by a nurse or other healthcare provider, education on how to manage their illness, and help navigating the complex healthcare system. to find affordable prescriptions.
Through the program, Gonzales learned to manage his diabetes by changing his diet and exercising more, and found cheaper insulin that usually costs him around $20 a month, he said.
The program was designed to help some of the sickest patients manage their chronic conditions in a state where about one in five adults lack health insurance. Chronic diseases are among the costliest in the US healthcare system, both for patients and for hospitals. According to some estimates, diabetes is the most expensive chronic disease in the country when direct costs, such as hospital stays, are combined with indirect costs, such as when someone with diabetes has to take time off work for treatment. Diabetes can also be a difficult disease to manage. A study that screened nearly 2,000 diabetic patients found that the majority failed to achieve the four most important goals for diabetes patients to prevent complications: improving blood sugar, lowering blood pressure, improving cholesterol, and not smoking.
Gonzales had made progress in all of these areas. His hemoglobin A1c went down from about 13% to 5%, his blood pressure went down, as did his cholesterol level. When he was first diagnosed with diabetes, he had to inject insulin twice a day. Now he only needs a daily dose taken in pill form, he said.
Tiffany Benson, the nurse who helped Gonzales lower his blood sugar and find affordable insulin, said her goal was to keep her patients safe. Benson leads the Texas Health Harris Methodist Hospital Alliance’s HELP program and said she works to provide patients with enough regular care so they don’t end up in the emergency room.
For many of his patients, they haven’t seen a doctor for preventive care in years. By checking their blood sugar, blood pressure and other metrics monthly, Benson can see if his patients are healthier or worse.
“I don’t let them fall off the radar, because that’s exactly when they end up in the ER,” she said.
The emergency room is often where supervising nurse Alma Diaz sees patients who have had serious illnesses and have sometimes gone years without treatment. Without regular care, a disease like diabetes can turn into a life-threatening condition like diabetic ketoacidosis or DKA. Diaz spends much of her time visiting uninsured patients in the hospital and telling them about the program, so they can hopefully join and avoid future hospitalizations.
Gonzales, the entrepreneur, said he never had health insurance as an adult. Although he was always employed, his contract jobs never offered health insurance as a benefit. That’s the norm for Benson’s patients.
“All of my patients have jobs,” she said, and some even juggle multiple jobs. “But they just don’t have a job that provides them with medical insurance.”
In Texas, Republican leaders have opposed expanding Medicaid so that more adults can benefit from the program, which provides health insurance to people with disabilities or low incomes. People can buy health insurance plans themselves, but not everyone knows how to enroll, and the cost of some plans can still be high.
The HELP program remains a relatively small initiative in the massive Texas Health Resources system, but Benson said she hopes to add more patients. Across all sites, the program treated 1,475 patients in 2021, according to data provided by the health system. Benson meets with her patients at least once a month and usually meets with them for a full hour, answering questions and discussing strategies for staying healthy, she said.
Not all patients are able to manage their illnesses as quickly as Gonzales did, she said, but she tracks metrics such as blood pressure, cholesterol and blood sugar to monitor patients’ progress. Across all HELP clinics, 61.8% of diabetes patients at the clinics had their blood sugar levels controlled and well over half of the patients with hypertension had their blood pressure controlled, according to Texas Health.
The first clinic opened in 2012, at the hospital’s Azle site. The program was originally supported by a federal government health care funding source, but is now fully funded by the health care system. Because of this change, some hospitals may change the name or focus of their clinics in the future, Caryn Paulos, senior director of Texas Health Community Health Improvement, said in a statement.
For Gonzales, the program was the difference between not being able to afford medical care and finding a way to manage a lifelong illness.
The program “saved me a lot of time financially and taught me a lot of information,” Gonzales said. “That’s crazy.”
How to find out more about the program:
The HELP program currently operates in nine different locations in the Texas Health Resources hospital system. The program is open to any uninsured adult over the age of 18 who has a chronic condition that the clinic can treat. To learn more and see program locations, visit bit.ly/THRhelp.