Promising Practices: South Carolina Reaches Out to Uninsured Residents Through the Healthy Outcomes Plan (HOP)

i Nov 6th No Comments by

In an effort to provide consistent medical care to thousands of underserved residents, South Carolina’s “Medicaid System” has implemented a statewide program designed to coordinate care and provide a medical home for some of its most at-risk residents.

Now in its second year, the Healthy Outcomes Plan (HOP) asked every hospital in the state to identify a predetermined number of low-income, uninsured residents who visited the emergency department at least five times in the last year, and who suffered from a chronic condition such as diabetes, cardiovascular disease, hypertension, sickle cell or HIV/AIDS.  The size of the hospital determined the number of residents they were required to identify, with 50 being the minimum for the state’s smallest hospitals.  All of South Carolina’s hospitals are participating in the program.  The state’s three largest metropolitan hospitals had to identify at least 750 residents.  “Activity always follows the dollar,” said Graham Adams, Ph.D, CEO of the South Carolina Office of Rural Health (SCORH).  “The hospitals were incentivized to get on board or they would lose the Disproportionate Share Hospital (DSH) money they were already receiving.  Plus, the state gave additional money to every hospital involved in the program.  Our 19 rural hospitals received 100% of their DSH money.”

Dr. Adams went on to say that HOP is particularly important in the rural areas, where residents are less likely to have a medical home and often wait until they are very ill before visiting an emergency department for care.  SCORH provided technical assistance to rural hospitals in the development of the program.  “Rural providers have a close relationship with their patients and as a result were more successful in identifying and bringing new patients into the program.”  The goal for the first year of HOP was to enroll 8,500 residents.

Now in its second year, Dr. Adams said the program has been beneficial because it provides a medical home and a system of care for people who really need it.  “It gives incentives for medical providers to work together for these folks well-being.  Controlling the chronic illnesses of our residents is one of the biggest benefits so far,” he said.  “Overall, it’s been a very positive thing.”

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