The Palmetto Project aims to put innovative ideas to work in South Carolina. It has established several initiatives to improve healthcare access and outcomes, including the South Carolina Immunization Partnership, Communicare, and AccessNET Provider Collaborative & Patient Navigator Network. These initiatives utilize partnerships, political techniques, community involvement, and care coordination to increase immunization rates, provide care to the uninsured, and improve outcomes for patients with chronic diseases. Data collection and management systems have also been implemented to facilitate coordination between providers.

1. The Palmetto ProjectThe Palmetto Project
Putting Innovative IdeasPutting Innovative Ideas
to Work in South Carolinato Work in South Carolina
Steve Skardon, Executive Director

3. South Carolina Immunization Partnership
Communicare
AccessNET Provider Collaborative &
Patient Navigator Network

4. South Carolina Immunization Partnership
February 1993 – May 1994
Objective
Make S.C a national leader in childhood immunization
Partners
S.C. Department of Health & Human Services
Palmetto Project
Alliance for South Carolina’s Children
Blue Cross Blue Shield of SC
S.C. Press Association
Rotary & Lions Clubs

5. South Carolina Immunization Partnership
(continued)
Methods
 Political campaign techniques identify, educate, & motivate parents
 Community partnerships among business and civic leaders create
local strategies in 13 public health districts
 Broadcast and print media partners in each health district
Outcomes
 Increased immunization rates statewide from 53% to 90%
 Ranked by CDC as 1st
in the nation in 1994

6. Communicare
1993 – present
Objective
Improve access and coordination of health care services for the
uninsured and underinsured
Partners
S.C. Medical Association
S.C. Hospital Association
S.C. Pharmacy Association
Six National Pharmaceutical Companies
Smith Kline Beecham Labs

7. Communicare (continued)
Methods
Care coordinator at statewide toll-free call center arranges for…
 free visit for any uninsured caller to one of 2,000 providers
 free pharmaceuticals from formulary of six participating drug companies,
 overnight stays at one of 30 participating hospitals
Outcomes
 53% of 8,000 clients provided medical home
 Central fill pharmacy provides 1000 free prescriptions daily at
an estimated value of more than $70 million annually (Welvista)
 Faith-based Initiative in African American health reduces disparity
in cardiovascular mortality among males by 50%. (Heart & Soul)

8. AccessNET Provider Collaborative & Patient
Navigator Network
2005 – present
Objective
Improve health care outcomes and reduce cost of care for the uninsured
with chronic disease through enhanced provider coordination and patient-
centered navigation
Partners
Medical University of South Carolina (Women’s Health Initiative)
Medical University of South Carolina (Children’s Hospital)
Two Federally Qualified Community Health Centers
Three Local Free Clinics
Charleston Dorchester Mental Health Association
SC Department of Health & Environmental Control
SC Office of Research & Statistics

9. AccessNET
(continued)
Methods
Providers standardize records into single data management system
(AIMS), implement procedures for patient referral & medical follow up, &
refer patients to health education and disease management programs
Navigators assess needs of new patients, address barriers to care, develop
plan for care including referral to primary & specialty care and pharmacy
assistance,
Outreach specialists implement health education and disease prevention
programming in at-risk communities, conduct ongoing screening,screening,
monitoring, life style modification, $ disease self-management for navigatedmonitoring, life style modification, $ disease self-management for navigated
patientspatients

10. AccessNET
(continued)
Outcomes
 100% of 2,000 clients provided medical home and access to patient navigation
services
 AIMS system becomes statewide platform for statewide medical records locator
and health information exchange for 4.4 million South Carolinians
 Cost of care for navigated patients declines by 27%
 A 66 percent reduction in emergency room utilization by navigated patients with
diabetes
 An 83 percent reduction in ER utilization by navigated patients with cardiovascular
disease

11. Lessons Learned
 Clearly perceived need & limited objective
 Opportunity
 Plan
 Needs assessment of every collaborating partner
 Management of Collaborative: Democratic versus
direction from lead partner?
 Signs of early success

12. Y’all com beck, y’hare?Y’all com beck, y’hare?

13. “To every person there comes in life that special
moment when one is tapped on the shoulder
and offered the chance to do one very special
thing. What a tragedy if that moment finds you
unprepared or unqualified for the work which
would be your finest hour.”
“
Winston Churchill

14. Where are we headed?
(and who’s doing the driving?)

15. Regional Networks of Care
We can’t solve problems by using the same kind of
thinking we used when we created them.”
Albert Einstein

16. Regional Networks of CareRegional Networks of Care
PopulationPopulation
703,505703,505
Nearly 45% of
population is uninsured
or does not have
sufficient coverage
to meet
its needs.

17. Regional Networks of Care
Continuum of Care
Provider collaborative reduces administrative duplication
& streamlines access to primary, diagnostic, & specialty care
Access & Care Coordination
New navigator network increases access & care coordination
Education & Prevention
149 Heart & Soul sites provide outreach & ongoing health
education
Data Collection & Management
Providers create single data management system

18. Regional Networks of Care
Medical Outcomes & Patient Centered Care

19. Medical Outcomes & Patient Centered Care
Outcomes research seeks to understand the end results
of particular health care practices and interventions.
These include effects that people experience and care
about, such as change in the ability to function. For
individuals with chronic conditions, end results include
quality of life as well as mortality. By linking the care
people get to the outcomes they experience, outcomes
research has become the key to developing better ways
to monitor and improve the quality of care.
Agency for Healthcare Research and Quality

20. Medical Outcomes & Patient Centered Care
Patient centered care is that which is based on a
partnership among practitioners, patients, & their families
to ensure that decisions respect patient wants, needs,
and preferences and that patients have the required
education & support to make decisions and participate in
their own care.
Institute of Medicine

21. Regional Networks of Care
Medical Outcomes & Patient Centered Care
Data Management & Electronic Records

22. Disabilities &
Special Needs
Vocational
Rehabilitation Law Enforcement
Health Department
Education
Outpatient
Surgeries
State Employee
Health Services
Emergency Room
Visits
Hospitalizations
Environmental
Conditions
Home Health Care
Medicaid Services
Social Services
Public Safety
Mental Health
Juvenile Justice
Free Clinic Visits
Alcohol & Drug
Services
Child Care
Community Health
Centers
Medicare
Disease Registries
Elder Services &
Assessments
SC
Integrated
Data
System
Probation, Pardon
& Parole
Corrections*
Legal/Safety
Services
Social Services
Claims Systems
All Payer Health
Care Databases
Behavioral Health
Health
Department
Education
Other State
Support Agencies
Disease
Registries
LEGEND

23. Data Management & Electronic RecordsData Management & Electronic Records
 Web-based database system designed and implemented by the SCWeb-based database system designed and implemented by the SC
Office of Research and Statistics (ORS),Office of Research and Statistics (ORS),
 System integrations and coordination utilizes the state’s HIPAASystem integrations and coordination utilizes the state’s HIPAA
compliant secure Data Warehouse and Client Information System.compliant secure Data Warehouse and Client Information System.
 Accessible to all collaborative members for information storage andAccessible to all collaborative members for information storage and
retrieval, referral of clients, and meeting reporting requirements.retrieval, referral of clients, and meeting reporting requirements.
 PNs use the AIMS individual client records as basic clientPNs use the AIMS individual client records as basic client
information---scheduled appointments, language, pharmacy andinformation---scheduled appointments, language, pharmacy and
transportation needs are viewed up to date, in real time.transportation needs are viewed up to date, in real time.
 Database allows for maintaining information about the client; trackingDatabase allows for maintaining information about the client; tracking
and maintaining client appointments, assessments, and referrals;and maintaining client appointments, assessments, and referrals;
recording information about community outreach activities and healthrecording information about community outreach activities and health
education.education.

24. Regional Networks of Care
Medical Outcomes & Patient Centered Care
Data Management & Electronic Records
Communications

25. Communications
Last year 98,000 patients died as a result of medical
errors.
According to the American Hospital Association, the
leading cause of those errors was inadequate
communication among providers.
o

26. Communications
 Evidence-based practices are specific clinical guidelines
that help bridge the gaps between what researchers find
to be effective treatment and what is implemented at the
practice level. Their use is growing in all areas of health
care in an effort to reduce errors and improve health.
 According to the Institute of Medicine, only 50%-60% of
medical treatments are evidence-based.

27. Regional Networks of Care
Medical Outcomes & Patient Centered Care
Data Management & Electronic Records
Communications

32. New Programming under PNDP
New H&S
Health
Education &
Prevention Sites
New Health
Collaborative
Service Delivery
Sites

33. Health Conditions TargetedHealth Conditions Targeted
 DiabetesDiabetes
SC is 2SC is 2ndnd
in the nationin the nation
 Hypertension/CVDHypertension/CVD
SC is 3SC is 3rdrd
in the nation for high blood pressurein the nation for high blood pressure
 StrokeStroke
SC is 2SC is 2ndnd
highest in the nation for stroke mortalityhighest in the nation for stroke mortality
 ObesityObesity
SC is 3SC is 3rdrd
in the nation for obesityin the nation for obesity

34. Disparities in Cardiovascular DiseaseDisparities in Cardiovascular Disease
 African Americans had a higher prevalence rateAfrican Americans had a higher prevalence rate
(15.4%) than Caucasians (8.4%).(15.4%) than Caucasians (8.4%).
 African Americans were more likely to report aAfrican Americans were more likely to report a
diagnosis of high blood pressure (36.4%) thandiagnosis of high blood pressure (36.4%) than
Caucasians (29.5%).Caucasians (29.5%).
 African American men in SC are likely to die fromAfrican American men in SC are likely to die from
CVD 10 years before white men. Most will notCVD 10 years before white men. Most will not
reach 65reach 65..

35. Palmetto Project
What does it take to provide health care to theWhat does it take to provide health care to the
nearly 45% of South Carolinians withoutnearly 45% of South Carolinians without
private health insurance?private health insurance?
 Continuum of CareContinuum of Care
 Access & Care CoordinationAccess & Care Coordination
 Health Education & Disease PreventionHealth Education & Disease Prevention
 Data Collection & ManagementData Collection & Management

36. Target CountiesTarget Counties
PopulationPopulation
703,505703,505
Nearly 45% of
population
are uninsured or
do not have
sufficient
coverage
to meet
their needs.

37. Disparities in StrokeDisparities in Stroke
 Mortality from stroke among African Americans isMortality from stroke among African Americans is
24% higher than the national average.24% higher than the national average.
 African Americans are 40 percent more likely to dieAfrican Americans are 40 percent more likely to die
from stroke than Caucasians.from stroke than Caucasians.
 Identifiable and treatable risk factors for CVD andIdentifiable and treatable risk factors for CVD and
stroke nearly twice those of whitesstroke nearly twice those of whites
 One in three African Americans has high blood pressureOne in three African Americans has high blood pressure
 One in two is overweightOne in two is overweight
 Two in three are physically inactive.Two in three are physically inactive.

38. Disparities in Diabetes
IIn 2005, estimated 280,000 state residents had beenn 2005, estimated 280,000 state residents had been
diagnosed with diabetes, and another 140,000 havediagnosed with diabetes, and another 140,000 have
diabetes but do not know itdiabetes but do not know it
 African Americans had a higher prevalence rate forAfrican Americans had a higher prevalence rate for
diabetes (15.4%) than Caucasians (8.4%).diabetes (15.4%) than Caucasians (8.4%).
 Mortality rates for diabetes were three times higherMortality rates for diabetes were three times higher
for non-whites as for whitfor non-whites as for whiteses
 ER visits for diabetes were almost seven timesER visits for diabetes were almost seven times
higher among African Americans than amonghigher among African Americans than among
whites.whites.
 In Dorchester County, diabetes resulted in more thanIn Dorchester County, diabetes resulted in more than
three times as many ER visits for blacks than whites.three times as many ER visits for blacks than whites.

39. How Patients are IdentifiedHow Patients are Identified
Referrals by collaborative partnersReferrals by collaborative partners
Outreach & screeningOutreach & screening
CommunityCommunity
Target Capacity under PNDPTarget Capacity under PNDP
3,000 navigated clients by August 20103,000 navigated clients by August 2010

40. What are the interventions?What are the interventions?
 Outreach to health disparities populationsOutreach to health disparities populations
 Prevention and early detectionPrevention and early detection
 Education, screening, monitoring, life style modificationEducation, screening, monitoring, life style modification
 Referral to primary careReferral to primary care
 Referral for diagnostic and specialty careReferral for diagnostic and specialty care
 Medication assistanceMedication assistance
 Reduction of BarriersReduction of Barriers
 Self-management goal settingSelf-management goal setting
 Facilitate involvement with communityFacilitate involvement with community
organizationsorganizations
 Coordinate with relevant insurance/other coverageCoordinate with relevant insurance/other coverage

41. PNDP Navigated PatientsPNDP Navigated Patients
PN Actions by Patient ConditionPN Actions by Patient Condition
 Diabetes = 53Diabetes = 53
 Ophthalmology scheduling = 21Ophthalmology scheduling = 21
 Foot care scheduling = 4Foot care scheduling = 4
 Hypertension = 186Hypertension = 186
 Cardiology scheduling = 22Cardiology scheduling = 22
 Cancer screening and treatment referrals = 41Cancer screening and treatment referrals = 41
 Women’s services/OB/GYN scheduling = 90Women’s services/OB/GYN scheduling = 90
 Pediatrics = 266Pediatrics = 266
 Dental or oral health scheduling = 10Dental or oral health scheduling = 10
 Mental health referrals = 11Mental health referrals = 11
 Other specialty care scheduling = 148Other specialty care scheduling = 148
Arthritis (8) Neurology (12) Pulmonology (6)Arthritis (8) Neurology (12) Pulmonology (6)
GI (78)GI (78) Orthopedic (10) ENT (14)Orthopedic (10) ENT (14)
Dermatology (20)Dermatology (20)
Non-Disease SpecificNon-Disease Specific
PN ActivitiesPN Activities
 Health coverageHealth coverage
assistance = 28assistance = 28
 Medication/PAPMedication/PAP
assistance = 68assistance = 68
(ECCO PAP = 298)(ECCO PAP = 298)

42. SC Data WarehouseSC Data Warehouse
 Builds off of existing legacy systems from state agencies and private sectorBuilds off of existing legacy systems from state agencies and private sector
 Creates a Unique ID (not related to any other number)Creates a Unique ID (not related to any other number)
 Identifiers are pulled off of the statistical data. Use only the statistical dataIdentifiers are pulled off of the statistical data. Use only the statistical data
 Data is always “owned” by originating agency. Permissions required to useData is always “owned” by originating agency. Permissions required to use
and/or linkand/or link
Using Data in the Data Warehouse Agencies & Other Entities can:Using Data in the Data Warehouse Agencies & Other Entities can:
 Evaluate their programsEvaluate their programs
 Look at OutcomesLook at Outcomes
 Understand better how their programs interact with other agency & other entityUnderstand better how their programs interact with other agency & other entity
programsprograms
 Study Health, Human Service, Education, and Law Enforcement IssuesStudy Health, Human Service, Education, and Law Enforcement Issues
 Analyze Statistical – Aggregate InformationAnalyze Statistical – Aggregate Information
 Access Analytic Data CubesAccess Analytic Data Cubes
 Partner in the Development of Customized Software ApplicationsPartner in the Development of Customized Software Applications

43. The Client Information SystemThe Client Information System
Web-based HIPAA compliant secure Client InformationWeb-based HIPAA compliant secure Client Information
System tracks SC public sector clients and services acrossSystem tracks SC public sector clients and services across
multiple agenciesmultiple agencies..
 ForFor Treatment and OperationsTreatment and Operations
 Designed to provide a 12-month rolling history of the client’s services.Designed to provide a 12-month rolling history of the client’s services.
 Includes management and summary reports.Includes management and summary reports.
 Medicaid clients served by the Dept. of Health and Human ServicesMedicaid clients served by the Dept. of Health and Human Services
operational. operational.
 Discussions with two other state agenciesDiscussions with two other state agencies
 Legal teams involvedLegal teams involved
 End product will allow the tracking of SC public sector clients acrossEnd product will allow the tracking of SC public sector clients across
multiple agencies to ensure better coordination and management.multiple agencies to ensure better coordination and management.

44. AIMSAIMS
 Web-based database system designed and implemented by the SC BudgetWeb-based database system designed and implemented by the SC Budget
and Control Board’s Office of Research and Statistics (ORS),and Control Board’s Office of Research and Statistics (ORS),
 System integrations and coordination utilizes the state’s HIPAASystem integrations and coordination utilizes the state’s HIPAA
compliant secure Data Warehouse and Client Information System.compliant secure Data Warehouse and Client Information System.
 Accessible to all collaborative members for information storage andAccessible to all collaborative members for information storage and
retrieval, referral of clients, and meeting reporting requirements.retrieval, referral of clients, and meeting reporting requirements.
 PNs use the AIMS individual client records as basic client information---PNs use the AIMS individual client records as basic client information---
scheduled appointments, language, pharmacy and transportation needsscheduled appointments, language, pharmacy and transportation needs
are viewed up to date, in real time.are viewed up to date, in real time.
 Database allows for maintaining information about the client; trackingDatabase allows for maintaining information about the client; tracking
and maintaining client appointments, assessments, and referrals;and maintaining client appointments, assessments, and referrals;
recording information about community outreach activities and healthrecording information about community outreach activities and health
education.education.

45. AccessNETAccessNET
RHIO HeadStartRHIO HeadStart
State Data Warehouse used to establish a Record Locator Service (RLS) for the
region as well as longitudinal record for over 4 million residents of the state.
Specifically, the data includes
• all Medicaid (including pharmacy and physician office visits)
• State Health Plan claims
• UB-92 inpatient, ambulatory surgery and ED claims
• In summary, a secure “bus” to connect to.
As such, this warehouse will provide a nearly comprehensive record of all
providers who have served a given patient or client since 1996
• Diagnoses
• Procedures
• Prescription History