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Tri-County Project Care
Project Care
Source: Post and Courier, July 22, 2002
Written by: Wevonneda Minis

Barbara Tracy knows what it means to suffer in silence. The 30-year-old Edisto Indian has had diabetes for 13 years but was able to afford testing supplies and medicine to control the disease only when she was pregnant and on Medicaid.

Tracy's diabetes diagnosis came during the first of her three pregnancies. She knew that gestational diabetes, or high glucose levels during pregnancy, was not uncommon. Although she had been told that she was a borderline diabetic after a urine test in middle school, she hoped the disease would go away once her baby was born.

However, when her Medicaid coverage stopped three months after the birth of her baby, the diabetes remained. She has since worked at McDonald's and other low-wage jobs that don't provide enough money to pay for her medical care.

When she wasn't pregnant, testing supplies, syringes, insulin and pills to help her manage the diabetes took a back seat to everyday necessities such as food and shelter.

Tri-County Project Care, a three-year pilot program started by the Charleston County Medical Society, has found a way to cover the cost of primary care and medicines to treat people such as Tracy, says Dr. Casey Fitts, its medical director.

Fitts says professionals in the local health care system were being hurt by not having a regular system of providing primary care to the poor and uninsured. Finally, things got so bad that all of the providers in the community joined to come up with a way to serve some of the more than 100,000 uninsured residents of the three-county area.

Patients without insurance or money to pay a doctor often go to the emergency room for medical attention, Fitts says.

Instead of visiting a doctor, Tracy's diabetes sent her to the emergency room 12 times during a two-year period in the ear-ly '90s. She recalls riding in the car, unable to breathe while feeling like her chest was being crushed.

Yet rushing to the emergency room does not improve chronic conditions. Nor is it the place to seek preventive medicine. That is the job of internal medicine specialists and family physicians, he says.

Patients accepted into the program are eligible for a wide array of medical services from its many participating doctors and facilities.

Local health care professionals are particularly interested in tackling the chronic conditions - diabetes, high cholesterol and hypertension - that cause Lowcountry residents so much misery.

The Medical Society of South Carolina, majority owner of CareAlliance, has committed $2.5 million for each of the pilot program's three years, Fitts says. Others providing major support include MUSC, CareAlliance, Trident Health System and East Cooper Regional Medical Center, which jointly have committed $2 million in cash and services for each of the three years; the Duke Endowment, which has committed a total of $750,000, through CareAlliance, over three years; and Charleston County, which gave $210,000 last year, and this year and has promised the same amount for future years.

The county medical society started the little-known program in January planning to serve 1,500 patients by the end of this year and 5,000 by the end of 2004. To date, just over 400 uninsured, usually working, poor adults, are participating. Program officials want to enroll at least 200 more patients each month through December.

Tracy was accepted into Tri-County Project Care in February while seeking treatment for tremendously painful headaches at the Enterprise Clinic (a joint venture between Franklin C. Fetter, MUSC and the cities of Charleston and North Charleston) in North Charleston. She had tried the emergency room twice in two days before going to the clinic.

On the first trip to the ER, staff members helped her. But on the second visit, they refused even though her blood pressure was 160/117. The emergency room staff advised her to find a primary-care physician to help her control her blood pressure, diabetes and other health problems.

With the help of Bernadette Pinkney, nurse and clinical manager at the Enterprise Clinic, Tracy has been able to lower her blood pressure to 140/93 and her blood-sugar level, which ranged from 250 to more than 300 for years, to near 50. She says she's eager to make more progress.

Pinkney warns that taking medicine for chronic illnesses on an intermittent basis can put a strain on the heart and other organs. Tracy, who used to do that, is now on regular medication. The program covers the cost of all but about $20 of the nearly $350 in medication and supplies Tracy needs monthly.

Mary Grooms of Ridgeville, a patient of Dr. David Castellone of Summerville, says knowing she's going to have the medicines she needs has been a tremendous relief. "I don't have all that worry and aggravation about where I'm going to get my medications from," says Grooms, who was surprised when she qualified for assistance from Tri-County Project Care about a month ago.

Grooms, 44, who suffers from hypertension, diabetes and depression, needed from $170 to $190 each month to fill prescriptions to manage her conditions. She takes care of her mother, who has had a stroke and is paralyzed.

Grooms' stepfather was helping to pay for her medical expenses, but she never really told him everything that she needed. At one point, she went without filling a prescription for six months because she figured the less her needs were met, the more her mother's could be.

"I was putting mama's health over mine. Mama is mama. You don't have but one mama. I figured that more could be done for her," she says.

Now, it feels good to have her needs met as well.

Residents of Berkeley, Charleston and Dorchester counties who are 19 through 64 years old, have an income within 125 percent to 200 percent of the federal poverty level and no health insurance can participate in the program. Each person has to pay a small fee for each service offered by the program.

Most of the people already in the program work full-time but make too much to be eligible for a government health program such as Medicaid, Fitts says.

"We know we can't take care of everybody so we wanted to start with people who have no access to (primary) health care first.

"This is a pilot program that might be expanded into a community-based insurance program," says Fitts. The program administrators will have to see what impact it has on the community before asking those involved what the next phase should be.

Administrators will have to determine how much it costs per person annually to provide primary care, whether it leads to a decrease in using the emergency room as a substitute for primary care and if those in the program have shorter hospital stays than those who are uninsured. It also will consider whether there is improved productivity at businesses that employ low-wage earners with no insurance.

"The impact should be extraordinary," Fitts says. "An ounce of prevention is worth a pound of cure.

"The hope is to save a significant portion of the people who end up with complications, … decrease the number of amputees, those who die or are bedridden from heart attacks or who end up on kidney dialysis. We should be able to cut down on a lot of human suffering and misery."

Castellone of Palmetto Primary Care says unless patients are seeing a primary-care physician, they may not know they need to control cholesterol, diabetes and hypertension or get early treatment for cancer.

He says Tri-County Project Care enables him to prescribe the newest, safest and most effective medications to his patients.

Medical practitioners say that with patient education and the wide array of tests available through Tri-County Project Care, even illnesses that cannot be prevented will have a much less serious impact on those who get them.

Castellone says that people don't want to feel like charity cases. Those who cannot pay usually do not tell their doctors. They just stop scheduling appointments, skip them or fail to get prescriptions filled. Tri-County Project Care can help to eliminate those worries.

"The program empowers people to take care of their health," he says.