There might be a way for Kootenai County Assistance to save money on indigent health care patients, according to Mike Baker.

But how feasible it is, and how much it will save, are far from being determined.

"If we can get creative and there's a willingness to do it, I think we could do something pretty cool," said Baker, CEO of Dirne Community Health Center, during a meeting with the county commissioners.

Catching the elected officials up on Dirne's recent progress, Baker relayed how the nonprofit has been focusing on educating high-utilizing patients on preventative care and health care resources.

By providing case managers who guide patients one-on-one, Baker said, Dirne aims to reduce the likelihood of those individuals facing more costly issues down the road.

"We've done pilot projects with case managers, and had success," Baker said.

He pointed to when Dirne case managers recently gave information on diet and exercise to patients at high risk for diabetes.

As a result, a lower number of those patients are facing potential amputations, he said.

"These case managers, they're the heroes of the health care system," Baker said. "They're the only group in the health care system that has time to talk to patients."

Offering that same case management to individuals who rely on county assistance for health care coverage, Baker told the commissioners, could mean "significant savings" for the program.

His exact suggestion was still in seed form: That Dirne and Kootenai County Assistance network together on repeat indigent patients.

For instance, county assistance could refer indigent, unhealthy applicants to Dirne, he said.

Dirne's case managers could provide education and guidance for those individuals, he said, ideally preventing future problems for which they would have sought additional county support.

"If any program could benefit from a little assistance, it's indigent," Baker pointed out.

The county indigent fund, part of the county assistance department, provides up to $11,000 in loans to qualifying low-income individuals to cover health care costs.

The county commissioners had to inject an extra million dollars into the indigent fund last year to avoid anticipated shortfall. This fiscal year's budget allocates more than $3 million for county assistance.

Dirne could also refer patients to the county, Baker added, as part of the collaboration.

"We do have patients who have multiple things they need, but aren't willing to get assistance," Baker said. "We're all working with the same people, but maybe don't talk as well as we need to."

Commissioner Todd Tondee said there is potential in networking with Dirne.

The commissioners have seen indigent applicants who could use the Dirne case managers' guidance to prevent future issues, he said.

"The train wreck or heart attack guy who comes in, we know he's going to be back. You can tell by his lifestyle," Tondee said. "We can ask them, 'Hey, do you want to have help with this?' And give them a Dirne card."

Commissioner Jai Nelson said it would be best to start with volunteers to refer to Dirne.

"I think it's a good discussion. I don't know if we'll get there," Nelson said. "It's better than, 'Here's this individual, this crisis could have been prevented if only this individual had gotten preventative care.'"

There could be legal snags, cautioned Chief Deputy Clerk Pat Raffee.

County assistance is not mandated by legislation to provide preventative aid, she said.

"Our role is reactive," Raffee said, adding that there are also restrictions on sharing indigent applicants' personal information.

Todd Rickard, county assistance manager, said his department already notifies applicants about Dirne services and offers literature on the health center.

"I've seen someone but once take a pamphlet," Rickard acknowledged.

Theresa Neeser, visiting Dirne for throat issues, had not considered the option of applying for county assistance.

She did not see the need, she said, as Dirne has worked so well with the Post Falls woman on negotiating co-pays and payments.

"Like today, I said, 'With Christmas, I don't have the co-pay,'" said Neeser, uninsured as she juggles two businesses. "They said, 'Don't worry about it. Just come in and get better.'"

She lauded the idea of Dirne providing case management for unhealthy individuals.

Neeser had never heard of the service, she said, adding that she would like to see it more promoted.

"Definitely more people need to be educated about diet and healthy living," she said.

Dirne relies on payments from insured patients to provide a sliding fee scale for the uninsured, Baker reminded the commissioners on Tuesday.

"There's a tremendous impact there of what we're providing to the community," Baker said. "I think we can provide more."