Kevin Coin didn’t expect a cancer diagnosis. Who does, really? The brawny, long-time welder and heavy construction worker weighed over 200 pounds when he got the news in 2022: throat cancer.
Now in stage 4, the disease has taken its toll on Coin’s body, as cancer does. His weight dropped to 133, he says with a hint of dismay in his voice.
But Coin is back up to a sturdier 143 now and “I’m on the climb up,” he said. The Seabrook resident is still battling the ravages of the disease and treatments, but he’s feeling better mentally and physically thanks to his support system—his wife, his brother and Vicki Cappa, a nurse care manager who is part of UTMB’s Community Health Program.
Cappa is there to help with the myriad concerns Coin and his wife, Dezeree, struggled with once he was home from the hospital.
She helps with things like setting up Coin with primary care after his surgery and treatments, dealing with pharmaceutical companies, liaising with doctors and addressing issues with his feeding tube—the "big" things. But she's there for the important day-to-day things, as well, like ensuring Coin is eating for better nutrition and keeping a positive attitude—things he needs, as well as things he needs to do, to live as comfortably and productively as possible as he fights for his life.
Having Cappa at his side has helped Coin through what he considers the toughest part of dealing with cancer—the uncertainty.
“The not knowing, that’s the hardest part, for sure,” he said. “But if you have good people around you, it makes a difference.
“Like her,” he said, pointing to Cappa, then quickly waving his arm in his wife’s direction. “Well, of course, her too,” he added quickly with a laugh.
“I’ve had my moments, trust me, but nothing real severe as far as mental thoughts,” Coin said. “I know I can’t lay down, that’s for sure. The more I fight, the better I feel. Now I’m fighting boredom; I want to go back to work.
“They gave me the drive to go on,” he said, again with an arm sweep across the room that included Dezeree and Cappa.
Cappa’s influence in Coin’s life can range from a gentle nudge to a pretty substantial push—like when she strongly encouraged him to quit smoking. It was tough, but he did it. So did his wife.
Cappa is there not just for Coin, but for his family—a welcome twist that isn’t lost on Dezeree.
“Anything we need, she’s there for us,” Dezeree said. “She calls to check on him and to make sure I’m OK. Nobody ever asked that before because I’m ‘just the wife.’ But she makes sure I’m OK too.
“If we need rides, stuff like that, she can hook up anything for us,” she said. “She’s on the ball with making sure we’re OK.”
A safety net for the vulnerable
The UTMB Community Health Program was initiated in 2007 as a pilot program to redirect high-risk, unfunded patients from overcrowded emergency rooms to a more appropriate care setting within the community.
The pilot showed the benefits of these services early on—as well as the continuing need—so UTMB developed an integrated disease and care management program designed to help the most vulnerable patients in Galveston and Brazoria counties.
“Initially, the program aimed to assist patients with chronic diseases, primarily diabetes, congestive heart failure and hypertension,” explained Craig Kovacevich, associate vice president, Alternative Care Models Optimization. “More recently, we’ve expanded our scope to include uninsured patients with complex medical conditions, such as cancer.”
CHP works collaboratively with St. Vincent’s House Clinic, Grace Clinic, community health centers and county indigent programs to connect UTMB’s underserved patients to available services and resources. Referrals come from inpatient care management, community and faith-based clinics, reports and other data sources.
“The Community Health Program aligns with UTMB’s goals to advance health equity and access to care for UTMB’s unfunded and underserved patient population,” said Latonia Shultis, Nurse Manager, Community and Population Health. “Additionally, the program has proven to reduce healthcare costs by providing care management services and interventions which facilitate access to care, funding resources, and improved health outcomes for our unfunded patients.”
The team collaborates closely with the patient and provider to develop a patient-centered plan of care, monitor patient progress and secure any available resources to facilitate a successful outcome. Services include establishing primary care, disease management education, medication assistance, care coordination, assistance with funding applications, referrals to social service organizations, goal setting and monitoring to improve self-management.
Helping those who seek to help themselves
Cappa explained that, push as she might, there’s only so much she or anyone can do for someone who doesn’t want help—or doesn’t want to do the work they have to do to feel better. But most, like Coin, do.
“He wanted to get better. He would say that he would do anything, whatever, and I threw a lot at him at first—applications and forms and ‘you gotta do this, you gotta do this.’” Cappa said. “And they were right on it all the time. [Coin and his wife] were the persons who did everything—we just gave them the tools.
“If you give a person the tools and they choose not to do anything with them, well then, you know, that's OK. That’s what they choose to do,” she said. “Our job is to let them know what the risk could be if they didn't. But in his case, he did everything right.”
Cappa also credits strong teamwork within the CHP team.
“The specific interventions of the community health worker and social worker contribute to the successful outcomes of our patients," she said. "In Mr. Coin’s case, these interventions included assistance with SNAP benefits, handicap sticker, medications, durable medical equipment, trach supplies and nutritional supplements.
"One of the most important interventions was helping Mr. Coin establish UTMB casebook, which provided access to a UTMB specialist for treatment of his cancer," she said.
You could call islander Berta Pompa a CHP success story. She was enrolled in the program while she was hospitalized in January. She had had a series of ministrokes over time, as well as high blood pressure and diabetes. At the time of enrollment, her A1C was high at 11.7, which indicates poor control of diabetes and increased risk for complications.
As of July, it’s down to a more favorable 6, lowering her risk for complications from diabetes.
After her hospitalization, the CHP team established ongoing care and occupational therapy for Pompa at St. Vincent’s. Other interventions included education about a low-sodium diabetic diet, medication assistance through the Kroger’s RX Savings Program and provision of the necessary medical equipment, including a glucometer, rollator and shower chair. The team also helped Pompa obtain SNAP benefits and financial assistance for her medical bills and ongoing care.
The help was especially useful because Pompa only speaks Spanish, which can make it difficult to navigate the health care system and establish needed services.
Through her daughter, Julia Garza, Pompa talked about the impact CHP has had.
“They helped me to stay motivated and would check on me regularly,” she said. “They made sure I was always on track, and I knew they would be coming to see me and would be looking at my numbers.
“They helped my family and me with all the information they provided because it helped me stay on track, and my health has improved,” she added. “They provided great service and motivated me to keep going and to do better. I continue to monitor my readings and am continuing to do better every day.”
The CHP program utilizes a multidisciplinary approach designed to help the patient improve their health outcomes and self-management skills. The patient works with a dedicated CHP team that consists of an RN care manager, a social worker and a community health worker.
It’s a safety net for patients who might not otherwise have the benefit of a continuum of care once they leave the hospital and find themselves afloat in a sea of decisions to be made, forms to complete and worries overt what to do next.
Like Pompa, Coin expresses gratitude for the program and said he would encourage anyone who is eligible to take advantage of it.
“It’s a good thing. I’ve never been a quitter anyway; I’ve always fought my whole life,” Coin said. “But for something like this, you gotta have good support. With good support, I mean, you can’t help but win. That’s kind of the way I see it.”
COMMUNITY HEALTH PROGRAM TEAM
Leadership
- Craig Kovacevich, associate vice president, Alternative Care Models Optimization
- Andrew Herndon, director, Community and Population Health
- Toni Shultis, nurse manager, Community and Population Health
- Cheryl Herod, business operations manager, Community and Population Health
- Jessica Hughes, administrative manager, Community and Population Health
Nurse Care Managers
- Stacy Avina
- Vicki Cappa
- Paula Judy
- Laura McKenna
- Mary Simon
Community Health Workers
- Elizabeth Bobadilla
- Alma Colwell
- Sandra Soliz
- Irene Vidana
Social Workers
- Robert Lemire
- Sarah Linde
- Latasha Mitchell
- Jocelyn Salinas
- Katherine Smith
Insights from the inside
Sarah Linde: “The Community Health Program fills a much-needed gap for those that do not qualify for government-sponsored health care (or even private health care) and those that are eligible but don’t know how to access. We educate patients on maintaining their health as well as how to access the care they need using the resources available to them. We provide tools that they can use for the rest of their lives and build relationships with their community so that in the future, if they find themselves in a crisis situation, they are better equipped to handle it in their own.
As part of the program, I am able to experience changes within my patients with them. I have the opportunity to witness the impact made on each and every patient and in many cases, they are drastic changes. I am proud on a daily basis to have the opportunity to work with the patients and help them obtain their goals! This is the most fulfilling program I have had the privilege of working with and the patients are the beneficiaries of my dedication to the mission.”
Latasha Mitchell: “I enjoy being a part of the CHP program because an essential factor of being an effective social worker is working with our patients in their environment and building on the resources in their environment. CHP provides that bridge of the clinical and environmental gap.”
Jocelyn Salinas: “The CHP reaches out to the meet people where they are and provides a holistic viewpoint of patient care needs. The team supports and provides education to help navigate a complex system. By serving within the community, we are able to assist patients who often need assistance with accessing resources that can support other social needs. No man is an island, and acting as a bridge builder to connect various systems to support a patient’s needs is critical to sustainable change.
“I enjoy being part of the program because I am able to give back to my community by advocating for the well-being of patients' health care and social needs. I love building relationship with my patients by meeting them where they are and advocating for better access to resources that support a better quality of life.”
Katherine Smith: “I recently transferred from working as an inpatient social worker for over 22 years at UTMB with the focus on quick, safe, smooth and sustained discharge planning to Community & Population Health. Working with the outpatient CHP enables
me to assist people on a more long-term basis, which is so rewarding. Our patient population is challenging. However, I have found that our patients are truly humble, appreciative and grateful for the follow up and for the time provided to them to
assist in navigating resources in the community and to help with their financial security."