In health policy circles, we are fond of saying that all health care is local. The research on variations in health care costs, delivery, and outcome bears this out. So, if that is the case, don’t solutions to many of our health care problems also need to be locally generated, locally shaped, and locally implemented? Communities across the country are experimenting with ways to become healthier from the Blue Zone communities to communities like Columbia, South Carolina, the topic of today’s guest blog by Rick Foster, MD, SVP for Quality and Patient Safety at the South Carolina Hospital Association, a key stakeholder in the “Healthy Columbia” campaign. Thanks, Rick for providing this great post on Columbia’s call to action to improve the health of its residents. Pat
by Rick Foster, MD
It is increasingly clear that the sustainability of health care in this country depends on the health of the American people, and that requires a transformational shift on the part of health care providers. Here in Columbia, South Carolina, we are in the process of making that shift, and there’s much that health care providers elsewhere can learn from this effort.
In Columbia, chronic disease and poor health have reached alarming proportions. The 29203 zip code area, on which we have focused, has high rates of diabetes, heart disease, cancer, emergency room use and hospitalization, as well as one of the highest rates of diabetes-related amputations in the United States. With more than 40,000 residents, one in three is uninsured. Those almost 15,000 uninsured residents – with limited or no access to primary care – incur millions of dollars in health care costs.
That’s why the South Carolina Hospital Association and major health care providers in the area have joined with the broader public to develop a community-wide mobilization of stakeholders to improve health and care and better manage the resources collectively available. The campaign – called “Healthy Columbia” – did not originate with the health care providers; it grew out of a shared concern by a broad group of stakeholders: individual residents, churches and other influential nonprofits, local businesses, and health care institutions (providers and insurers).
The Campaign has evolved through an unprecedented sequence of events:
- In July, 130 one-to-one meetings were held with residents of the 29203 community to explore common values and experiences;
- In August, 91 residents came to a Town Hall Assembly to talk about their vision to transform their health and health care;
- In September, 35 community leaders were recruited and equipped to help advance this effort;
- In October, 750 people in the community attended House Meetings to discuss potential campaign strategies;
- In November, nearly 200 residents of the 29203 community came together for an Issues Assembly held at a local middle school, where community members collectively decided on a campaign strategy to transform health and health care within the community;
- In January, another 100 community leaders were recruited and equipped to launch the Campaign.
This is stakeholder mobilization, which helps residents determine their own goals for better health, better care and lower costs, and turn those goals into an action strategy that a broad group of stakeholders embraces.
The process was funded by the Fannie E. Rippel Foundation, a national foundation that serves as a catalyst to identify new ways of thinking and innovative solutions to help address the complex and growing challenges of our health system. It was guided and coached by Organizing for Health, a part of the Foundation’s ReThink Health initiative.
The “ah-ha” moment came when participants recognized that the enemy was not a particular stakeholder – a health care provider or payer – but chronic disease itself. That realization enabled all major stakeholders to come together around a shared commitment, rather than pitting one group against another.
Central to the “Healthy Columbia” Campaign is a Community Covenant that emerged from those months of meetings, representing a public commitment made by all key stakeholder groups to address the failing health care system as one. By signing the Community Covenant, community members, providers, hospitals and insurers each make different commitments:
- Providers will work together with the community to produce new ways of accessing primary care, such as longer hours at doctors’ offices, better transportation services to health care facilities, and greater use of volunteer health coaches.
- 29203 community members pledge to better manage their health, taking steps to prevent disease and using primary care services rather than relying on emergency rooms for non-emergency needs.
- As non-emergency use of emergency rooms declines, hospitals and insurers agree to investing savings in the Campaign’s prevention and primary care efforts.
The long-term goal of the Campaign is not only increased access to primary care but that the cost of health care for citizens and providers will decrease. The goal is to reinvest those savings back into community efforts for health and well-being. As part of the Community Covenant, the 29203 community itself will have a voice in how the savings are reinvested by the hospitals and insurers.
The “Healthy Columbia” Campaign is still in its early stages. It was launched in March at an event at which the Community Covenant, which now has nearly 2,000 signatures, was unveiled. More than 500 members of the 29203 community attended the kickoff event, including leaders from local government and key community organizations, as well as representatives of Eau Claire Cooperative Health Centers, the South Carolina Department of Health and Environmental Control, the South Carolina Department of Health and Human Services, BlueCross BlueShield of South Carolina, Select Health, Palmetto Health, Providence Hospital, the South Carolina Hospital Association and the University of South Carolina.
The Campaign is already proving transformational, however, as it has brought together, for the first time, the major stakeholders in the 29203 area to achieve shared goals in managing the health care resources of the community. The Campaign’s effectiveness in reducing costs and reallocating resources is not yet proven, but its capacity to unite all major stakeholders – in a shared commitment to health and health care improvement – is showing promise that is very exciting for those of us involved.
The author is Senior Vice President for Quality and Patient Safety at the South Carolina Hospital Association.