South Carolina's hospitals collectively submitted 46 plans for improving the lives of chronically ill, uninsured
residents who frequently use their emergency rooms. The plans involve partnering with nonprofits, such as area free clinics and centers that provide services for a sliding fee. Here are three examples:
The Regional Medical Center of Orangeburg has formed the Tri-County Healthy Outcomes Partnership of Orangeburg, Calhoun and Bamberg counties. A part-time coordinator has been hired to help place the 158 target patients in a "medical home" for primary care. The hospital hopes college students can help find them. While hospital records may include addresses and telephone numbers, many of them likely won't be current, if the patient didn't give the correct information, said Brenda Williams, the hospital's vice president of strategy and compliance. The pilot is focusing on illnesses including asthma, high blood pressure and diabetes. Williams said the hospital has identified more than 400 patients who have visited its ER at least four times over the past year with those ailments.
Fairfield Memorial Hospital has chosen to focus on diabetes. It is among 13 small, rural hospitals given the minimum target of 50 patients. Its application notes that diabetes-related hospital costs in South Carolina have risen 37% in the past five years. Over the past year, 95 uninsured patients with diabetes accounted for 193 visits to its ER. The county has a Diabetes Education Center recognized by the American Diabetes Association, where a registered dietitian and a registered nurse provide classes on managing the disease to patients referred by a doctor. The classes' cost, up to $800 over eight hours, and location in Winnsboro put them out of reach for poor residents who lack transportation. The pilot will take that education on the road, holding group classes in two health clinics in the county's western, rural areas once a week, said Mac Russell, a registered dietitian and director of the center.
Palmetto Richland and Palmetto Baptist have partnered with health providers in Richland County. The two hospitals must jointly reach 662 patients. Their plans involve expanding on pilot projects and changing how those patients are reached. Previously, patients were referred for case management. "We haven't proactively gone out and reached out to them and said, 'Based on your history, you could really benefit from these services,'" said Anna Kay, business director at Palmetto Health Quality Collaborative. A program started two years ago connects patients to a team of nurses, social workers, doctors and pharmacists to meet needs, including taxi vouchers and gas cards for transportation. Another program was started last year specifically for frequent ER visitors with multiple chronic diseases. The ACCESS clinic, short for Ambulatory Care Center for Evaluation and Stabilization, provides those patients intensive help managing their issues for a short term before they're connected to a local provider. Beyond providing near-immediate benefits for the patients, the programs have freed up ER capacity for patients with truly urgent conditions, Kay said. Expanding those programs will require hiring care coordinators.