Richland Care: A Healthcare Delivery System for the Uninsured

In 1998 Palmetto Health began planning of a coordinated healthcare delivery system to serve the low-income, uninsured residents of Richland County, SC. A community coalition consisting of representatives from many organizations began to identify the specific needs of the target population in order to improve health status and decrease non-emergent use of emergency department (ED) and inpatient services. Through the needs assessment, it was recognized that low-income, uninsured persons of Richland County needed access to specialty care services in order to decrease their use of non-emergent ED services and to improve their health status. They also needed assistance with navigating the complex healthcare system in order to receive needed healthcare services. The Richland Care model has been called a medical home network and consists of the following services: primary care through a medical home, pharmaceuticals, specialty care, hospital care, mental health and substance abuse services, disease management, identification of utilizers and educational materials.

Between November 2001 and January 2008, Richland Care has touched the lives of over 12,000 people, which is approximately 35% of the target population. All participants have chosen a medical home and 98.1% indicate a medical home as the usual source of care.

The impact of the Richland Care healthcare delivery system is outstanding. First, Richland Care participants report improvements in health status. Utilizing the Primary Care Assessment Tool Survey (developed by Johns Hopkins) the percentage of surveyed participants self-reporting their health status as excellent, very good or good was 55.2% in 2002. In 2006, 67.1% of surveyed participants indicated the same health status categories.

Second, utilization of inpatient and ED services has declined for Richland Care participants. Hospital utilization data were gathered from the SC Budget and Control Board and participating hospitals for two years prior to Richland Care and then through August 2006. The data showed that ED and inpatient utilization by active participants declined by 36% and 15% respectively during the post period. The total value of the missed stays is $9.7 million in hospital charges over the post period. If it is assumed that costs are 35% of charges and variable costs are 60% of total costs, the variable cost avoidance is $424,200 annually due to decreased utilization of inpatient and ED services of active participants.