SC Healthy Outcome initiative focuses on frequent ER users

10/07/2013 12:42 AM

01/02/2014 9:06 AM

With one in five South Carolinians medically uninsured, the launching of the “Healthy Outcome Plans” by hospitals throughout the state recently appears to be the proverbial drop in the bucket.

The plans, done at the request of the state legislature, are designed to help those who rely on emergency rooms for their health care. About 8,500 chronic users of emergency rooms statewide are being asked to participate in pilot program that hopefully will find them a medical home. Participation is voluntary.

The chronic users represent 1 percent of the state’s uninsured.

But if the pilot programs at various hospitals -- Piedmont Medical Center, Chester Regional Medical Center and Springs Memorial among them -- are successful, it could be a fundamental change in the way we deliver health care in South Carolina to the those often in the greatest need.

If successful, hospitals would become the hub or center of a community system that would be a true safety net, a system matching needs with resources from the non-profit and for-profit sectors. The challenge for some will be identifying what resources are lacking and developing them.

The legislature asked hospitals to devise “healthy outcome plans” that focus on the most frequent, uninsured users of their emergency rooms with chronic health problems such as diabetes, cardiovascular disease, hypertension, sickle cell, HIV and AIDS.

These patients would undergo a “social determinant” screening to find out how their quality of live is affecting their health.

The intent is to not only find these patients a medical home, but to make sure the live in an environment conducive to good health.

The outcome would be less people using the ER for primary care, something it was never intended to be.

The state, in conjunction with the hospitals, also set estimates for each hospital to meet. The estimate of those that met the standards is 196 patients for Piedmont, 72 for Springs Memorial and 50 for Chester Regional.

“South Carolina put the onus on the hospitals to work with their communities,” said Jamillah Hasan-Jones, director clinical quality improvement at Piedmont Medical Center.

The challenge excites Hasan-Jones.

She reached out to the hospital’s traditional partners such as the United Way, the North Central Family Medical Center, the York County Free Medical Clinic and Catawba Mental Health. But she and other hospital staffers have reached out to people who deal with education, housing, transportation -- all social factors that can influence one’s health.

It’s early in the process but Hasan-Jones said those working with Piedmont are beginning to look at the list of frequent ER users to determine if they are already providing them other services.

While the focus is on the 196 identified patients Hasan-Jones hopes the outlook can be expanded. Piedmont has already identified children that fit the state’s profile for help.

Page Vaughan, CEO at Chester Regional, said efforts there have already identified 15 doctors who would be willing to work with patients that chronically use the ER.

Hospitals had only a couple of months to develop their plans -- a good thing in Hasan-Jones’ opinion. The short time frame meant that “perfection paralysis” did not set in, she said.

But the time frame also makes the challenges seem ever more insurmountable.

Dental care is one of the areas covered by the Healthy Outcome initiative. Dental care for people with Medicaid is a problem in most urban areas of the state, not to mention rural areas such as Chester.

For those without insurance, dental pain often means a visit to the ER where you get a antibiotic for the infection, pills for the pain and are told to go home and visit a dentist later. The patients take the pills, the pain goes away, but return to the ER when the infection resumes. Again, it’s more pills because most emergency rooms do not have dental care.

Mental health services is another problem area even for those with insurance. Demand outstrips resources.

Nonetheless, Hasan-Jones, Vaughan and others are seeking alternatives.

Admittedly, there is a financial motive for the hospitals. Last year Chester Regional spent $8 million on charity care, with $1 million being spent on the 50 most frequent users. Piedmont’s annual charity care is $33 million and hospital officials estimate that the 196 targeted patients represent more than $2 million in care.

And finances will remain the biggest challenge as these are uninsured patients. But even that could change as these patients could likely qualify for some form of healthcare assistance.

The efforts of the participating hospitals will be evaluated in a year. One of the goals is to replicate successes throughout the state.

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