GREENVILLE, SC – Greenville Health System (GHS) received national recognition for its work to improve health care to some of its most vulnerable patients through an innovative outreach program that increases access to care in the neighborhoods where patients need it the most.
America’s Essential Hospitals, which represents more than 325 hospitals committed to caring for the vulnerable and keeping communities healthy, awarded GHS a 2018 Gage Award for its work with population health. The award recognizes activities that improve delivery, access or value for specific populations in the recipient’s community and, as a result, have improved health outcomes.
“Essential hospitals are pioneers in a challenging health care landscape,” said America’s Essential Hospitals President and CEO Bruce Siegel, MD, MPH. “Our Gage Award winners show how taking risks with inventive projects not only can improve quality of care within hospitals, but also expand care beyond a hospital’s walls.”
“GHS is honored to receive the Essential Hospitals Gage Award in Population Health,” said GHS President Spence Taylor, MD. “Through its focus on our most vulnerable patients, our ‘Neighborhood Partnerships to Improve the Health of Communities’ program is critical to fulfilling GHS’ commitment to serve all patients regardless of income. We hope to expand this work in our communities and look forward to sharing our program with others.”
GHS’ patient-centered medical neighborhood model is a critical component in improving the health of patients, said Jennifer Snow, director of accountable communities for GHS. “Health systems can’t wait on patients to become sick and need hospital care anymore. We have to be innovative in taking care to these patients before they ever need to enter the four walls of the hospital.”
GHS launched its patient-centered medical neighborhoods model in 2015 to increase access to care in vulnerable neighborhoods. Initially piloted in five neighborhoods in Greenville County, it’s now expanded into Laurens, Pickens and Oconee counties.
In each neighborhood targeted by the model, GHS deploys teams of care transition coordinators, community health workers, social workers, community paramedics and mobile health clinic staff. The community health workers visit residents in their homes to connect them to community resources and help resolve health barriers. Meanwhile, the community paramedics conduct in-depth home screenings that include measuring vitals, collecting lab samples, delivering medicines and helping ensure that medicines are taken appropriately. The staff also helps arrange transportation to medical visits, which typically include physician offices, community clinics or GHS’ popular Mobile Health Clinic, which is essentially a medical practice on wheels.
From February 2015 to December 2017, community paramedics conducted 1,960 total home visits, with the one-on-one care resulting in better health, decreased hospital admissions, about 25 percent fewer emergency department visits and a nearly 50 percent reduction in in the use of emergency medical services.
Community health workers, meanwhile, saw more than 300 patients between January 2016 and December 2017, with the interventions also resulting in improved patient outcomes. GHS Mobile Health Clinic staff saw 1,590 patients between February 2016 and February 2018, referring more than 1,500 uninsured patients to community health programs.
“Our patient-centered medical neighborhood model is an example of how you can develop an interdisciplinary approach to population health,” said Snow.
“Our care team works together to improve the health of our patients and each intervention is critical to our outcomes. The community health workers and community paramedics work together to address both the clinical and non-clinical needs of the patients, while the mobile health clinic provides access in the neighborhoods when the patients don’t have a medical home or cannot get an appointment to see a provider,” she said.