A South Carolina program was designed to help more than 8,000 uninsured, chronically ill residents, but health providers statewide are struggling to reach the patients.
Tony Keck, director of the S.C. Department of Health and Human Services, said the Healthy Outcomes Program, which was launched in October, was designed as a way to help hospitals across the state reach and serve some of the most under-served patients while lowering the state's health care costs.
Forty-six plans were submitted by South Carolina Medicaid-designated hospitals targeting 8,511 patients.
HHS allocated more than $474 million for the program in October, and the money was distributed to hospitals and safety net providers across the state.
As of Friday, only 25 percent — or 2,087 of the 8,511 targeted patients — have enrolled.
Keck said the number is low, but not unexpected.
"The health care system really doesn't know how to find people who need health care," Keck said. "I think it has been an incredible learning process. ... The low number is a big indicator of how difficult it is to actually engage with this group of patients who are really in serious need."
In Spartanburg, Mary Black Health System and Spartanburg Regional Healthcare System are working with safety net providers and nonprofits to reach 487 patients. Overall, the targeted patients have generated more than $20 million in hospital costs in the past year, according to an estimate by Renee Romberger, vice president of Community Health Policy and Strategy at Spartanburg Regional Healthcare System.
As of Friday, 332 of the 487 patients (58 percent) were enrolled.
AccessHealth Spartanburg assisted patients who were contacted about the program and decided to enroll. The nonprofit links lower income patients to affordable health care options. Patients sign up for the program and are given an evaluation and needs assessment.
Patients enrolled in the program then are referred to ReGenesis Health Care and primary care physicians. They also are referred to the Spartanburg Alcohol and Drug Abuse Commission or Spartanburg Area Mental Health for behavioral health problems.
Mary Black and Spartanburg Regional Healthcare have committed more than $1 million to the Healthy Outcomes Program thus far, but Carey Rothschild, executive director of AccessHealth Spartanburg, said Spartanburg is experiencing the same challenges other areas across the state are facing.
"A few patients have refused to enroll," she said. "Many of the people we are working to enroll are simply hard to contact."
Keck said all counties have faced the same challenges when it comes to connecting with the target patients.
"Barriers arise just when trying to send out phone calls to patients," Keck said. "There is no phone number. You have a phone number, but it's wrong. You have the right phone number, but as soon as you say you are with the hospital, they hang up because they think you are trying to collect for a bill."
Keck said there are also barriers when it comes to convincing patients to enroll in the program or scheduling appointments.
Rothschild agreed, adding that some patients they try to reach don't seem to want their help. Others don't trust the program.
"We say we are going to help them for free, and people think it's too good to be true. They wonder what the catch is," she said.
Keck said some health systems are doing a better job with the program than others. Williamsburg Regional Hospital and Clarendon Health System have each enrolled 100 percent of their targeted patients, but their target numbers were fewer than 100. Charleston County hospitals and partners had a target number of more than a 1,000 and have only reached 13 percent thus far.
Melanie Matney, director of AccessHealth South Carolina, which provides technical assistance for all 10 AccessHealth programs in the state, said people shouldn't look at the numbers.
"Quantity is very different from quality" she said. "Just because we have not reached the 8,500 patients, doesn't mean there isn't a lot of great work going on out there."
Matney, as well as Rothschild and Romberger, support the Healthy Outcomes Program despite its barriers.
"I think this program is hard, but we are learning a lot," Romberger said. "It's opening our eyes to the toughest of the tough issues. These issues exist whether we want to talk about it; and as long as we ignore them, our health care system is not going to improve. It's probably the hardest work we have done to date, but I think in three years we will see it as our most significant accomplishment."