Kathy Hebert Kathy Hebert's vision for making Louisiana residents healthier never should have worked. A lone cardiologist laboring in a tiny hospital in the poorest U.S. state, where one in five people have no health insurance, Hebert could have accepted the status quo. But instead she piloted an award-winning disease management program to help patients recuperating from heart failure that has been expanded to include eight hospitals and has dramatically improved patient care. Now, Hebert serves as the Louisiana State University (LSU) Services Division State Task Force Director for Heart Failure and deftly harnesses health care resources for patients sometimes so poor they cannot afford bus fare to doctor's appointments. "I grew up in Louisiana and feel very committed to helping its most vulnerable residents," said Hebert. "The hard work is worth it when you see what a difference that diligence and quality of care can make in patients' lives." Hebert completed the Summer Program in Clinical Effectiveness at HSPH. Designed for clinicians, the popular program is held jointly by HSPH, Brigham and Women's Hospital, Massachusetts General Hospital, and Harvard Medical School and teaches the quantitative and analytic skills needed for clinical research and health care administration. She chose to apply those credits to pursue an MPH degree at the School and is expected to graduate this year. (http://www.hsph.harvard.edu/clineff/) For Hebert, who has a master's in medical management from the Tulane School of Public Health and an MD from the LSU School of Medicine, the MPH coursework at HSPH was an ideal opportunity to train formally in skills she was learning on the job. Her experience here has culminated in the creation of a state-wide database for Louisiana's safety net hospitals used to help plan health management strategies for thousands of heart failure patients. "There is no toll-free number you can call when your job takes you into health policy after medical school," Hebert quipped. Ten state public hospitals in Louisiana provide care for more than one million indigent residents, she explained. Approximately 70 percent of those patients are considered charity cases and receive free care; 23 percent receive Medicaid; and seven percent receive Medicare. The mean income of the group is $11,800 per year. In 1995, Hebert designed and implemented a post-heart-failure disease management program piloted at the 145-bed Chabert Medical Center in Houma, LA. Multifaceted, the program capitalized on opportunities for low-income patients to receive free drugs from pharmaceutical companies, reached out to patients with no transportation by using shuttles, employed inventive measures using drawings and plain conversation to explain health material to illiterate patients, and guaranteed patients they would wait no more than 10 minutes to receive IV diuretic therapy to help prevent future heart failure so that they could quickly get back to jobs that did not pay sick time. In the first year, the medical center experienced a 72 percent decrease in hospital admissions, with a resulting cost savings of $500,000, said Hebert. In addition, she documented use of evidence-based medication, including ace-inhibitors and beta blockers, at rates higher than the state's average. Because of her efforts, Hebert was tapped in 2000 to lead the heart failure prevention program in the LSU medical services division, allowing her to supervise a disease management program for the state's public hospital system. In the ensuing years, Hebert and a team of health care professionals have tracked its success, reporting increased patient compliance and quality of care, coupled with $27 million in savings over three years. In September, Hebert will begin a Robert Wood Johnson Fellowship in Washington, D.C. to learn how to craft health policy that will allow more Americans to carry health insurance. Next spring, she will be featured on PBS in a four-part series on chronic disease in America. But Louisiana remains on her mind, and she plans to return there after her fellowship. Her presence is more pressing than ever. Last year, the budget for the state's public hospital system was slashed by $90 million, she said. "I feel compelled and called to obtain the skill and experience from this fellowship, so that it may be used to contribute to improving health care for Louisiana's most valuable resource, its people," said Hebert. Harvard Public Health NOW is published biweekly by the Office of Communications Harvard School of Public Health 665 Huntington Ave., SPH 1-1312 Boston, Massachusetts 02115 617-432-6052 Editor and Layout: Christina Roache Contributing Writers: Carol Cruzan Morton Photos Credits: Suzanne Camarata, Kent Dayton, Richard Feldman, Christina Roache, Audrey Smith Archived Issues || HSPH Home Copyright, 2007,  President and Fellows of Harvard College