Fort Worth hospital program offers low-cost care to uninsured

In September 2021, shortly after Larry Gonzales had been diagnosed with Type 2 diabetes, he asked his son to pick up the medication that an ER doctor had prescribed for him.

The doctor had written a prescription for insulin, and instructed Gonzales to start taking the medication to manage his diabetes. Gonzales, 50, knew very little about the chronic disease he’d just been diagnosed with, and even less about the medication he’d been prescribed.

When his son returned home, he had insulin pens for his dad as well as a charge of $1,400 for the medication.

Gonzales doesn’t have health insurance, and so was charged the list price for the medication, which is essential and life-saving for people with certain types of diabetes.

“I spent almost $6,000, the first month coming out of the hospital,” said Gonzales, a construction contractor who lives in Denton County.

But Gonzales found a lifeline through a program from the Texas Health Resources hospital system. At nine of its hospitals, the North Texas health system offers a program designed for people like Gonzales, who have a serious, chronic health condition, but don’t have health insurance that could get them regular access to a primary care doctor.

The initiative, the Healthy Education Lifestyles Program, offers low-cost health care to anyone 18 and older who is uninsured and has diabetes, hypertension, high cholesterol or congestive heart failure. For $10 a month, patients get a monthly check-up from a nurse or other health care provider, education on how to manage their disease, and help navigating the complex health system to find prescriptions that are affordable.

Through the program, Gonzales learned how to manage his diabetes by changing his diet and exercising more, and found a cheaper insulin that usually costs him about $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 out of every five adults lacks health insurance. Chronic diseases are some of the most expensive in the U.S. health care system for both patients and hospitals. By some estimates, diabetes is the most expensive chronic disease in the country when the direct costs, like hospital stays, are combined with indirect costs, like when someone with diabetes has to miss work to seek medical care. Diabetes can also be a difficult disease to manage. One study that examined almost 2,000 diabetic patients found that the majority of them had not achieved the four most important targets for diabetic patients to prevent complications: improving blood sugar levels, lowering their blood pressure, improving their cholesterol, and not smoking.

Gonzales had made improvement in all of these areas. His hemoglobin A1c levels have decreased from about 13% down to 5%, his blood pressure has lowered and so has his cholesterol. When he was first diagnosed with diabetes, he needed to inject himself with insulin twice a day. Now, he needs only one dose daily taken by a pill, he said.

Tiffany Benson, the nurse who helped Gonzales lower his blood sugar levels and find an affordable insulin, said her goal is to keep her patients safe. Benson runs the HELP program at the Texas Health Harris Methodist Hospital Alliance and said she works to provide patients with enough regular care that they don’t end up in the emergency room.

For many of her 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 her patients are getting healthier or if their condition is worsening.

“I don’t let them fall off the radar, because that’s exactly when they end up back in the ER,” she said.

The emergency room is often where nurse supervisor Alma Diaz will meet patients who have had a serious disease and sometimes gone years without treatment. Without regular care, a disease like diabetes can develop into a life-threatening condition like diabetic ketoacidosis, or DKA. Diaz spends much of her time visiting with uninsured patients in the hospital and talking to them about the program, so they can hopefully join and prevent future hospitalizations.

Gonzales, the contractor, said he has never had health insurance as an adult. Although he’s always been employed, his contract jobs have never offered health insurance as a benefit. That’s standard for Benson’s patients.

“All of my patients have jobs,” she said, and some even juggle multiple. “But they just don’t have a job that offers them medical insurance.”

In Texas, Republican leaders have opposed expanding Medicaid so that more adults would qualify for the program, which provides health insurance for people with disabilities or who are low income. People can purchase health insurance plans on their own, but not everyone is aware of how to sign up, and the cost of some plans can still be expensive.

The HELP program remains a relatively small initiative across the massive Texas Health Resources system, but Benson said she hopes to add more patients. Across all locations, 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 diseases as quickly as Gonzales, she said, but she tracks metrics like blood pressure, cholesterol, and blood sugar to track patients’ progress. Across all of the HELP clinics, 61.8% of the clinics’ diabetic patients had controlled their blood sugar levels, and well over half of patients with hypertension had controlled their blood pressure, according to Texas Health.

The first clinic opened in 2012, at the hospital’s Azle location. The program was originally supported by a health care funding source from the federal government, but is now funded by the health system in full. Because of this change, some hospitals might 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 has meant the difference between being unable to afford medical care, and finding a way to manage a lifelong disease.

The program “saved me big time financially and taught me a lot of information,” Gonzales said. “It’s freaking crazy.”

How to learn more about the program:

The HELP program currently operates at nine different locations of the Texas Health Resources hospital system. The program is open to any adult 18 and older, who is uninsured, and who has a chronic condition that the clinic can treat. To learn more and see program locations, visit bit.ly/THRhelp.

Ciara McCarthy covers health and wellness as part of the Star-Telegram’s Crossroads Lab. The position is funded with assistance from the Morris Foundation. She came to Fort Worth after three years in Victoria, Texas, where she worked at the Victoria Advocate. Ciara is focused on equipping people and communities with information they need to make decisions about their lives and well-being. Please reach out with your questions about public health or the health care system. Email cmccarthy@star-telegram.com or call or text 817-203-4391.