Many of the nearly 40,000 people in the 29203 ZIP code are uninsured and can’t afford well-care visits to a family physician.
They don’t go to see doctors until they are badly hurt or extremely sick, and then they often end up in hospital emergency rooms, where the cost to treat them is much higher than in a doctor’s office.
Obviously, something isn’t right, and the typical fixes aren’t working. So why not try something different?
That’s the genesis of the Healthy Columbia Campaign. The innovative collaborative includes some of the state’s major players in health care – the original planners included S.C. Hospital Association, BlueCross BlueShield of South Carolina, the Department of Health and Environmental Control, the Eau Claire Cooperative Health Center and Palmetto Health. Those groups are more facilitators than leaders. The effort will follow a course charted by the people of 29203.
“Health care is done more for people and to people instead of with them,” said Terri Jowers, one of the community organizers for Healthy Columbia. “This could be a paradigm shift, changing responsibility on both sides.”
The concept is both simple and broad. The people suggest methods for improving their access to care, for example a nurse practitioner coming to a community center once or twice a week to help people with chronic problems for free or for a reduced price. Health care leaders then help arrange the service, which actually saves them money compared to unreimbursed hospital visits by those with chronic illnesses.
The nurse practitioner in the community center is just one suggestion that grew out of Healthy Columbia’s eight months of meetings with people in 29203 to gather ideas. The process was started by South Carolina Organizing for Health, an initiative funded by the Fannie E. Rippel Foundation, a New Jersey-based organization that encourages health innovation.
Some of the others ideas included:
• Health care guides, non-professionals with enough training to help neighbors through the health care maze and often hard-to-understand instructions.
• Transportation pools that link people who need rides to doctors’ offices with neighbors who can provide them.
• Health coaches who go into homes and provide guidance on storing medications and tips on routine maintenance tasks such as testing blood sugar.
The Columbia effort and a similar one in a town in New Hampshire were to be test projects, but the New Hampshire effort never got off the ground. Now 29203 is alone in breaking new ground.
“We are the experiment, which I think is neat for South Carolina and Columbia,” said Dr. Laura Long, vice president of clinical quality and health management at BlueCross BlueShield.
The 29203 area is a good test subject, organizers believe. The per capita income, unemployment rate and demographics put 29203 on the low end of the health spectrum – poor African-Americans generally are less healthy and have less access to health care. The percent of the residents without health insurance almost certainly is higher than the statewide figure of 13.7 percent.
But 29203 also has traditionally strong neighborhood associations and church groups. The organizers staged 45 house meetings attended by 750 people. More than 150 people came to a large assembly to discuss strategy. Hundreds of volunteers already have been trained for chores such as connecting people with already available services.
The second stage of the process begins Saturday with a community event 10 a.m.-2 p.m. at Eau Claire High School.
Donna Mack is one of the community volunteers. She found out about the campaign through her work with the Keenan High School parent-teacher association and immediately saw the potential in the concept.
“It engages people to make the decisions,” Mack said. “They ask themselves ‘What can I do to make myself healthier and my city healthier?’”
If people commit to a Saturday morning exercise program, one of the health care providers or a local group will pledge to get it organized. If people commit to trying to fix their diets, healthy cooking classes could be offered at local churches or schools.
“It has to be a two-way street,” Jowers said. “The community must make a commitment to change their behavior.”
The first projects likely will be small ones, acting as seeds for larger projects that would be paid for with savings captured by health care organizations or individual companies that see their insurance costs drop if their employees are healthier.
One of the keys is quantifying results and being patient. The earliest signs of progress could be seen within a year as people simply feel healthier, but the true signs of success might not be seen for two or three years, Long said.
Reductions in emergency room visits and hospitalizations for chronic disease could be the first breakthroughs. Reductions in the long-term complications from chronic disease will be slower, maybe up to five-10 years.