AccessHealth and HOP working together to care for more

For two years, Spartanburg resident Kenneth Higgins didn’t want to get out of bed. He had no job. Some days he felt like dying. With no family doctor, he often turned to the Spartanburg Regional Health System’s Emergency Department for help. In 2013, the South Carolina General Assembly passed a proviso to give the state’s healthcare providers a platform and funding to develop local partnerships to help those who are uninsured, chronically ill and over-utilizing hospital emergency departments. The Healthy Outcomes Program (HOP) was born.

Like AccessHealth SC, HOP is community based and seeks to achieve three things: provide better care and care coordination for the uninsured at-risk population, lower healthcare costs, and develop effective, replicable systems of care. HOP is a huge process improvement effort undertaken by 46 plans across the state.

Longtime AccessHealth networks in Spartanburg and Georgetown counties quickly embraced HOP. Spartanburg Regional Healthcare System and Mary Black Health System contributed $1 million to fund HOP in their community. The motivation was simple: the SC Department of Health and Human Services (DHHS) estimated that the uninsured in Spartanburg County are responsible for $21 million in nonreimbursed services received at local emergency departments (EDs). Carey Rothschild, director of AccessHealth Spartanburg, said the investment is well worth it, but changing people’s behavior won’t be easy. “Many low income people have never been to a primary care doctor; they have always used the emergency departments. They are scared to change.”

In Spartanburg, six HOP case managers were hired, each responsible for 80 clients. Case managers visit each person at home and attend their first doctor and/or mental health visits (if needed) with them. HOP case managers also connect clients with alcohol and drug abuse counseling, therapy, and help them secure needed prescriptions. But that’s just a start.

“We address the larger problems such as housing, transportation, education, food banks, food stamps, and job assistance. We help those who qualify for Medicaid complete their paperwork. People need education and hand-holding; it’s the only way to break the cycle of poverty and poor health,” explained Rothschild.

In Georgetown County, 1,485 residents qualify for HOP. Linda Bonesteel, director of Georgetown Community Care Network, agreed that her community has also had to look at larger, systemic change. In addition to AccessHealth and HOP, Georgetown County has collaborative partnerships addressing human services, early learning and after school care, and transportation.

“We conducted an inventory of existing resources to determine what services were available, where there was duplication and where there were gaps. Although we are looking at significant system changes, HOP is very person centered as in ‘how do we help this patient get to the doctor’ and ‘how do we help that person with food and housing,’” said Bonesteel. AccessHealth SC. “This is a work in progress, but we’re operating with one strategy-- to help people who need help the most. It’s a priority for all of us,” she added.

In December, Kenneth enrolled in the Spartanburg Healthy Outcomes Program (HOP). He now has a primary care doctor at ReGenesis Health Center, receives medications through Welvista, attends counseling sessions, and has a job again. HOP has changed his outlook on life. “I now have energy and want to live,” Kevin said.

05-18-2015 12:37 (EDT)