S.C. Launches "Healthy Outcomes" for Some Uninsured

Thousands of unhealthy South Carolinians without insurance could soon get a phone call or a knock on their door.

Under the state’s “healthy outcomes initiative” launching Oct. 1, hospitals will be reaching out to their most frequent emergency room visitors and collaborating with area nonprofits to help solve their health issues rather than waiting for them to walk into the ER again and again.

The goal is to figure out how to help South Carolina’s most vulnerable residents live healthier while lowering the state’s health care costs. That involves evaluating patients’ medical and social needs, coordinating with existing safety net programs offering free- or low-cost care, and checking back to ensure patients are following doctors’ advice.

“If we can get them successfully in a medical home to provide them routine care, we can avoid very costly ER services,” said Brenda Williams, a vice president of Orangeburg’s hospital, which is partnering with health clinics throughout Orangeburg, Bamberg and Calhoun counties.

The state’s Medicaid agency gave each of the roughly 60 hospitals in South Carolina a target number of uninsured patients to help over the next year, ranging from 50 at some small, rural hospitals, to 750 each at the state’s two biggest hospitals in Greenville and Charleston.

In all, the hospitals are expected to find health care solutions for at least 8,511 people.

Critics of the state’s opposition to the federal health care overhaul note that’s a far cry from the hundreds of thousands of additional poor residents that could have been added to the state’s Medicaid rolls by expanding eligibility – something the Republican leadership refused to do after the U.S. Supreme Court’s ruling made it an option rather than a mandate. Legislators approved the “healthy outcomes” initiative as part of the 2013-14 state budget, though Democratic legislators blasted it as not doing nearly enough.

Director Tony Keck views the initiative as a critical first step.

“There are some who continue to believe that the path to good health is simply to give a Medicaid card. We’re saying the path to good health is prevention, aggressive screening, finding people at risk, understanding their barriers and putting together comprehensive plans,” he said. “This does it in way that focuses on results first. Let’s focus on the 8,500 sickest and most needy, because if we can’t do it for 8,500, how do we do it for 350,000?”

Technically, the program is voluntary. But the price for saying no was steep.

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