Diagnoses:

Crohn's Disease

Summary:

This female participant has a history of multiple episodes of abdominal pain, diarrhea, and rectal bleeding. She also has a history of hypothyroidism and morbid obesity. She was scheduled for bariatric surgery when her symptoms intensified. She underwent diagnostic testing and was subsequently diagnosed with Crohn’s disease. The participant was started on medication for her condition, but experienced a flare in her abdominal symptoms, which can often be a side effect of the prescribed medication. The participant had an episode of severe abdominal pain in January 2014 and was admitted to the hospital. At the time, she was diagnosed as having acute pancreatitis and gallstones. She underwent surgery to remove her gallbladder.

The MRC Nurse Consultant was able to facilitate an earlier discharge than originally planned, as well as a laparoscopic surgery instead of an open procedure. The MRC Nurse Consultant maintained contact with the participant while in Oregon, Alaska, and her temporary move to Japan. The MRC Nurse Consultant determined that the participant had Indian Health Benefits, and was able to facilitate the participant being evaluated by a gastroenterologist in Anchorage, Alaska at no cost to the plan. The participant was started on a specialty injectable medication, and her disease process has remained in remission. The MRC Nurse Consultant has thoroughly researched means for the participant to receive her specialty medication while in Japan, and also facilitated the participant being seen by a gastroenterologist in Japan for possible transfer of care. The participant has at times been very stressed with the need to ship the medication, and on multiple occasions, against medical advice, has stated she may stop taking the medication if she cannot receive it in Japan. The MRC Nurse Consultant has been successful in explaining the possible consequences, including probable flares of her Crohn’s disease and potential hospitalization.

Cost Savings:

The participant was hospitalized for acute pancreatitis along with continuing Crohn’s flare. Due to the MRC Nurse Consultant’s involvement, including education relating to her diagnosis and medications, the participant and her mother felt capable and comfortable discharging home after three days, two days earlier than planned. The MRC Nurse Consultant’s interventions and assurance to the participant that the MRC Nurse Consultant was available at any time, lead to the successful early discharge from the hospital.

Estimated Cost of Hospitalization (2 Day LOS): $ 4,000

The MRC Nurse Consultant questioned the need for an open cholecystectomy, as originally proposed by the participant’s surgeon. After reviewing with the provider, a laparoscopic cholecystectomy was deemed medically necessary. Due to the MRC Nurse Consultant’s intervention, the cost of an open surgery was avoided.

• Open Cholecystectomy: $ 19,447

• Laparoscopic Cholecystectomy: $ 6,793

Cost Savings: $ 12,654

The MRC Nurse Consultant determined that the participant had Indian Health Benefits and as a result, the participant’s two gastroenterology visits, as well as air and ground transportation, were covered by the participant’s SEARHC benefits.

Specialty Provider Visits (x2), including travel and transportation: $ 2,188

The MRC Nurse Consultant facilitated the participant being able to receive her medication while temporarily in Japan. After learning that the participant planned to discontinue the use of Humira, the MRC Nurse Consultant successfully explained to the participant the importance of continuing to take the medication, thus preventing hospitalization for the flare of Crohn’s symptoms.

Hospitalization (4-5 Day LOS) for Crohn's Disease: $ 44,606

The MRC Nurse Consultant was able to contact the Humira manufacturer and verified correct handling/shipping means of the medication to determine that three doses of medication received by the participant in Japan, were still safe to utilize even, though the temperature had been exceeded. Thus, unnecessary disposal and additional medication was not required.

Humira (x3 Doses): $ 3,864

Total Cost Savings: $ 67,312