Health care program takes medical care to the community

As the mole on her leg began to grow and change, Gloria Kipp worried that it might be something serious.

A friend even suggested that it looked like melanoma.

But without health insurance, the Greenville woman didn’t have the money to see a doctor.

One day while driving near Long Branch Baptist Church, Kipp spied a green and white bus with the words Mobile Health Clinic emblazoned on the side.

Although the image stayed in her mind, she didn’t think she would qualify. But someone encouraged her to check it out.

“And I’m glad I did,” she told The Greenville News. “It was melanoma.”

On the bus, which is equipped like a medical office, Kipp was seen by nurse practitioner Chuck Arnold who found the mole suspicious. And after a biopsy confirmed it was the most dangerous form of skin cancer, surgery was performed two weeks ago to remove it.

“When you hear the word cancer, it hits you in the heart,” she said. “It could have been a lot worse.”The Mobile Health Clinic is part of Greenville Health System’s Neighborhood Health Partners program, which brings health care into low-income communities whose residents often lack insurance coverage and access to medical treatment. As a result, their conditions deteriorate to the point that they can wind up in the ER or hospitalized.

The program aims to keep that from happening.

Access to care

The community health program is made up of paramedics in quick-response vehicles, a social worker, lay health workers who keep tabs on the patients and their needs, and the Mobile Health Clinic, which visits neighborhoods so patients can get health care where they live.

Since it started, along with providing care to thousands of people, it's reduced ER visits and hospitalizations and saved hundreds of thousands of dollars, said Jennifer Snow, director of accountable communities for GHS.

“These patients don’t have resources. They don’t know how to use the system,” she said. “Often they have nowhere else to go but call 911 and got to the ER.

“It’s part of our population health effort here to make sure patients have access to the right level of care.”

The community paramedics, for example, launched in February of 2015. In their first year of operation, they provided care for 70 patients, 57 of whom were classified as frequent EMS users, she said.

Through the paramedics' intervention, EMS responses among those patients dropped by 71 percent and EMS costs declined by a total of $106,480, or $1,869 per patient, Snow said.

In terms of overall utilization, the paramedic program cut hospital admissions by 44 percent, readmissions by 50 percent, ER visits by 29 percent and specialty practice visits by 28 percent.

And because the program works to link patients with a medical home, the use of primary care increased by 41 percent.

All in all, the program saved $660,986, or $9,442 per patient, Snow said.

Greenville’s uninsured

The Mobile Health Clinic sees patients at a variety of locations, including the Triune Mercy Center, Long Branch Baptist Church, the Parker Fire Department and United Ministries. Since it started a year ago, it’s seen 868 patients, Snow said. And while cost figures aren’t yet available, it has led to 31 ER diversions.

Of the patients seen on the unit, 71 percent were uninsured, 11 percent had Medicaid and 7 percent had Medicare. About 7 percent were children, 38 percent were between 19 and 44, 45 percent were between 45 and 64 and 10 percent were 65 and older.

With about 70,000 uninsured people, Greenville County has the largest number of uninsured of any county in the state, Snow said. The Neighborhood Partners program works to address the socioeconomic and other barriers they have to health care.

So in addition to offering medical care, the team provides health and insurance education and checks to see that patients are taking their medications appropriately, among other functions. Sometimes it’s as simple as arranging for a cab so they can get to the doctor.

The patients are typically chronically ill — many with multiple conditions — such as diabetes, high blood pressure, high cholesterol, COPD, and mental illness, Snow said.

Some are disabled, some are not working, and some work one or more part-time or low-income jobs that don’t offer insurance, or do odd jobs around their neighborhoods, leaving them unable to afford health care, she said. And that includes medications.

So a medication assistance program was just started, too.

“It’s very expensive if you’re uninsured. And that’s sometimes why patients are not compliant,” she said. “They have to choose between the power bill, feeding a child or getting their medication.”

Caring for families

In the two years it’s been in existence, the program has grown to 30 employees, including the lay community health workers who logged 1,714 home visits in their first year.

The teams are trusted because they’ve been in the patients' communities helping them, Snow said.

Arnold, who grew up in a missionary family in Honduras, said working on the Mobile Health Clinic is a dream job.

“When I saw this job available, it looked like a mission trip every day that I actually get paid for instead of paying to be on,” he said. “The level of need is so high.”

Patients often confess that they haven’t been to a doctor in years because of lack of insurance, he said. Some are skeptical, thinking they will have to pay for their care somehow. But they’re all grateful to get the care they get, he said.

Kipp’s situation was a challenge because she needed to be seen by a specialist fast, Arnold said.

“Melanomas tend to spread quickly and once they pass a critical threshold, it’s a very bad prognosis,” he said. “So we didn’t want to wait. Time is life.”

At first, it looked like an appointment wasn’t available for three months. But Angela Lake, the unit program coordinator, hit the phones and got Kipp into one of GHS’s clinics a week later.

“It’s a big problem with folks who don’t have insurance,” she said. “And some people just don’t know how to maneuver the system.”

Future growth

Kipp, 52, moved to Greenville about a year ago to live with her daughter because of a divorce. But she hasn’t been able to find a job.

Shopping for insurance proved equally frustrating. She earned too little to qualify for Obamacare and since South Carolina didn’t expand Medicaid under the Affordable Care Act, she wasn’t eligible for that either. The cost of private market insurance removed that option.

The mole on her right calf had her worried for a couple of years. But with no insurance, she just pushed on.

“Folks that aren’t insured don’t go to the doctor. They just have to hope they get better. And many times they don’t,” said Arnold. “Then it becomes an emergency and is harder to treat, more expensive to treat, and more suffering on the part of patient.”

Along with the biopsy and surgery, Kipp, the mother of three and grandmother of five, had to have a full body skin check to rule out any other melanomas. And she has to see the doctor every three months for a year.

Last year, three quarters of the program's cost came from grants while GHS picked up the rest, Snow said. And she hopes to expand it to vulnerable populations in Pickens, Oconee and Laurens counties over the next two years while strengthening partnerships with other agencies and providers that tackle mental health issues and food insecurity.

The paramedic program runs Monday through Saturday and the Mobile Health Clinic, which averages six to 18 patients a day, operates Monday through Thursday.

Kipp said having access to care means saving lives for people who have no insurance.

“Our insurance is not good in America and there are a lot of people out there who cannot afford it because I’m one of them,” she said. “And I’m sure there are people out there who have it a lot worse than I do.”

For more information, go to www.ghs.org/MobileHealthClinic or https://www.ghs.org/events/nhp/.