Stepping up for Lowcountry health care

An unprecedented collaboration is afoot here in the Lowcountry. Dozens of organizations are working together to provide efficient, effective care to low-income uninsured people by placing them in "medical homes" that provide access to donated medical care.

And while that in and of itself would be a tremendous accomplishment, the ripple effects from this effort have the capability of transforming our entire community toward better health and prosperity.

Why? Because 150,000 people in the tri-county area, more than 20 percent of the population, lack health insurance. Twenty percent is a staggering number of our friends and neighbors working hard but unable to afford health insurance. The uninsured are postponing routine and preventive care and bringing their acute care to the emergency room.

The effects are unnecessary suffering, being sick more frequently and for longer periods of time and a 10 percent to 15 percent increased mortality rate. They also earn 10 percent to 30 percent less and have decreased educational achievement because of their poorer health status. The effect to the insured population and to local businesses is the cost-shifting of this care to them, which is estimated to be 35 percent to 40 percent of the health care premium. Two examples:

--A 40-year-old working mother without health insurance has asthma. She has not been formally evaluated and cannot afford medications. She has terrifying attacks, taking her to the emergency room and sometimes resulting in hospitalizations. The cost of her care is absorbed by the hospital and her physicians. She also misses more work which deprives her of income and her employer of her productivity.

By providing her with a medical home to properly assess her condition, and providing her with the necessary medications, she is able to be healthier, happier, more productive and earn more money. She also decreases the drain on local resources that she never wanted to or intended to be. And, by being healthier, she is able to be a more effective mother for her children.

--A 34-year-old male head of household has recurring attacks of abdominal pain. Without insurance he delays care until he has an emergency. He finally goes to the ER with a bad case of gallstone pancreatitis. During what turned into a one-year stay, he endures 20-plus operations and ends up with difficult to manage diabetes, end-stage kidney disease requiring dialysis treatments and an unpayable bill of over $1 million. For less than $10,000, he could have been seen earlier, had his gallbladder removed and continued to work for the next 30 years as a tax-paying citizen supporting his family. Now he is unable to work, and he and his family are dependent upon disability payments for the remainder of his life.

Make no mistake -- creating an integrated network of care is a massive undertaking. Tens of millions of dollars are at issue. Fortunately for us, our entire medical community along with philanthropic organizations have mobilized to tackle this problem. Facilitated by the Trident United Way, our local effort is about providing the right care, at the right time, in the right setting by developing networks of care for the low-income uninsured of our community.

Our collaboration has already attracted the attention of AccessHealthSC, a program of the South Carolina Hospital Association funded through the Duke Endowment. We were selected earlier this year to receive a technical assistance grant to conduct a community health system profile and develop a strategic plan for action. As a result of this plan of action, we have now been awarded a three-year, $750,000 grant from the Duke Endowment to begin implementation.

This is not about health insurance reform. Nothing we do will affect how anyone with insurance will receive their health care or how they will be insured. It is about health care reform, organizing our delivery system and educating our community toward more efficient and productive utilization.

While this is a daunting task, it is also an incredible opportunity for us to establish ourselves as leaders in health care reform while also attracting investment and high paying jobs to our community.

I am a general surgeon and did my training in Mississippi. They had a saying there that I have carried with me. When facing a difficult problem that might be considered a hill or an obstacle to moving forward, someone would always say, "That ain't no hill for a stepper!"

I am convinced that we are a community of steppers and look forward to the great things that we will be able to accomplish by working together.

Casey Fitts, M.D., FACS, a general surgeon with Surgical Associates of Charleston, is vice president of Charleston County Medical Society and medical director of TriCounty Project Care. He serves as physician coordinator for Tricounty AccessHealthSC.