Episode Transcript
[00:00:00] Speaker A: Foreign.
[00:00:07] Speaker B: Hey, hey, hey. This is Philip Clark, back with you for another episode of Just say Something podcast.
Before we get started today, I want you to be sure to like share and subscribe and tell all your friends and your co workers about our podcast. They're available wherever they find their favorite podcast. And this is, I think year two or more of us doing this once a week on Tuesday. So there's a lot of previous podcasts out there to listen to. So today we have a first.
We have Ms. Susie Foley from Greenville Free Medical Clinic. Susie, welcome.
[00:00:50] Speaker A: Glad to be here. Thank you.
[00:00:52] Speaker B: And we've, we've known each other, we've, we've been around a year or two.
I know I've been here since 92 and so tell us a little bit about. Our paths have always crossed, but we're in the same path this time. So tell our listeners a little bit about Susie, but about Greenville Free Medical Clinic.
[00:01:17] Speaker A: Sure. And our orbits are circling closer and closer as there's some projects pending that I think will be working even more more closely on.
I have been the director of the Greenville Free medical clinic since 1999. The organization has existed since 1987 and was formed at that time in order to provide an alternative to the emergency room for uninsured individuals. It was seen at that time and there were clinics popping up all over the country that there needed to be a place for non emergency issues like strep throat or sore elbow or blood pressure medicine refill, you know, things that really are not best appropriately addressed in an emergency room setting.
Now over the almost 40 years since then, health care has changed, but it hasn't, if that makes sense.
[00:02:13] Speaker B: Yes, understood.
[00:02:14] Speaker A: The same issues are facing the uninsured. If anything, it is probably even more directly impacting families and individuals health. I think we saw it here very dramatically over time as the workplace changed. You know, whereas a generation or two generations ago, individuals who may have a high school education and maybe some more and maybe not even that were able to work in the mills and the mills took care of them and there was a different working environment.
When the mills started closing, the workforce started changing. There really was an evolution towards self employed small business contract labor, part time jobs, sometimes two or three part time jobs where individuals were not provided health care coverage. So along comes the Affordable Care act, which I think most people would have assumed was going to better address access for the uninsured to be able to have health care.
In reality it has probably ended up being more health insurance reform rather than health care reform because those Needs still exist for individuals, particularly in South Carolina, which did not expand Medicaid as part of the aca.
So a lot of the individuals that the general public assumed would be most helped by the ACA were probably those that are still being left behind.
That's who we generally are reaching out to and providing care for. And how we do it as a nonprofit and a charitable clinic is generally through volunteers.
[00:04:00] Speaker B: Right.
[00:04:01] Speaker A: Our physicians and our dentist are all volunteers.
We have a core staff, of course, to make sure that there's continuity of care and that we have nurses and dental assistants and pharmacy to provide those wraparound services and a lot of the supportive care that's needed.
[00:04:20] Speaker B: Right.
[00:04:20] Speaker A: But for the most part, the actual care is provided by volunteers.
Partners are terrific.
Other nonprofits and social service organizations certainly. But two of our greatest partners are the two hospital systems in the Greenville county area, Prisma and Bon Secour, who, honestly, they, they look at it as pay me now or pay me later,
[00:04:49] Speaker B: pay me a lot more later.
[00:04:50] Speaker A: That's right.
That's generally how it works.
[00:04:53] Speaker B: Right.
[00:04:54] Speaker A: An individual is either likely to be in the emergency room for something that's not an emergency, or if we're talking real health care money, we're talking about avoidable inpatient stays for conditions that could be avoided if they had access to primary care and regular services.
[00:05:14] Speaker B: Right.
[00:05:15] Speaker A: You know, a $5 blood pressure medication that prevents a stroke seems like a no brainer. But you know, that's not always the way that health care, and particularly governments being involved in any way in health care operates.
[00:05:31] Speaker B: Yeah, it goes back to that old saying, I'm with the government, I'm here to help. Yeah, not so much. Not so much. So what's the age that you're able to see people from the community?
[00:05:42] Speaker A: Our patients are generally 18 to 64.
Those are the working adults who generally do not qualify for any other type of governmental coverage.
But they may be in a workforce that doesn't provide them health insurance. The government, through Medicaid and Medicare, and sometimes a combination of both, do provide fairly well for children. The SJIP programs make sure that children have access to healthcare as well as through Medicare and seniors disability through Medicaid and or Medicare for those who are not able to work, is generally available for someone that is warranted and unable to work. But if you can work or do work in the state of South Carolina, you are likely and don't have health insurance from your employer. You are likely not able to be covered by Medicaid or Medicare and will consequently either have to use those inappropriate resources or not go at all.
[00:06:50] Speaker B: Yeah. And unfortunately a lot of people choose not to go at all.
[00:06:53] Speaker A: And that's not a good choice. You know, sometimes you can wait it out. You know, it isn't an emergency, but sometimes waiting doesn't really solve the problem
[00:07:03] Speaker B: and sometimes waiting can turn it into an emergency later down the road.
[00:07:08] Speaker A: And that's where those avoidable admissions at the hospital occur. And then you're talking about, you know, much poorer health outcomes and much higher bills.
[00:07:17] Speaker B: Right, right. I know when Mally and Over and I were over there recently doing a tour, you really have it laid out. I know you have a more or less a resource center in the lobby.
I also realized or found out that you have community health workers. How do you involve them in what you're doing at the clinic?
[00:07:41] Speaker A: That's really been an evolution in health care over the last maybe decade or so and certainly within our clinic in the last probably five years or so.
We can treat medical and dental and health and even mental health conditions.
Clinicians, providers, healthcare professionals can treat symptoms and address those items. What they can't necessarily or are not based, best equipped to do is the patient who comes in. And you know, the first question is, how have you been doing since I saw you the last time? Well, my brother died and I'm having to deal with that, or my car broke down and I'm worried about getting to work or my child is having trouble in school and I'm having difficulty, you know, figuring out how, how to help them.
Between the behavioral health services, mental health counseling and psychiatry oversight that we at the clinic having community health workers available who can help with those social service type needs and issues.
They have many contacts and resources and ways to be able to address the barriers that are keeping our patients from having better health care.
The language, the transportation, the access to food, housing issues, child care issues. You know, there's just so much going on and when you're stuck, stuck in a position where you're dealing with the immediate crises of some of those needs, you can't think about your health long term. You aren't going to be proactive about cancer screenings. You're not going to be in a position to put health and dental needs as priority when you're dealing with a crisis day to day.
[00:09:38] Speaker B: Yeah, we see that a lot in our families.
We have six bilingual community health workers and they're such an asset.
More of us need to have those for, for the community.
So part of the tour that we had over there, you are so the medical piece, dental vision and pharmacy and behavioral and behavioral health.
So for the pharmacy. So can anybody just walk in with
[00:10:11] Speaker A: a prescription and no, you know, we're not a free cvs. We are a free clinic.
[00:10:15] Speaker B: Okay.
[00:10:16] Speaker A: And our intent is really to be a medical home for those uninsured patients. The way that we have those medications in our pharmacy and we dispense about 30,000 prescriptions a year to our patients at no charge if they are eligible.
They are ordered by our physicians and our providers.
If they establish their care at Greenville Free Medical Clinic, they are able to access the many different services.
But part of coordinating that medical home is having access to the information, having it coordinated through, you know, an organization that's, that's best able to have those multidisciplinary needs met and discussions about what needs to be the next step by many different aspects. I can promise you my physician and my dentist and my pharmacist personally are never discussing my health one on one.
[00:11:14] Speaker B: Right.
[00:11:15] Speaker A: There's probably an authorization or some sort of, you know, insurance related communication, but it's not going to be what does this patient need, what is best for their health condition and how are we going to be able to coordinate care in order to move forward.
It's amazing to see how fragmented healthcare really is in the real world with vision being a lot of times very separate from medical care, from dental being very disconnected, even from mental health. And we are fond of saying in our place that the body has many parts and the brain is one of those parts and the eyes are those parts and teeth are part of those, those parts. So addressing all those different needs as part of comprehensive health.
[00:12:08] Speaker B: Yeah, that does that, that does make a big impact in the community. I know a lot of the families that we serve and continue to serve and to grow and hope to, to be referring to.
One of our first questions is do you have a medical home?
And if that answer is no, then well, we have somewhere where you can go to get that help, to get the care that you need and that you deserve.
[00:12:37] Speaker A: And we'd all like free health care.
Ours is targeted to those who don't have access any other way. They do have to be uninsured, which means no Medicaid eligibility, no Medicare yet, no employer provided coverage, no VA health benefits, no participation in the healthcare exchange or the marketplace programs. Those that really don't have any other access to care, they also have to meet lower income guidelines because higher income that are electing to just take their chances, well, they just take their chances.
Lower income have those options.
They go without. They go without.
They also do have to live in Greenville County. And you know, as much as we'd like to be able to say we are here to help people, you know, if you need our help, come to us. We do have to have verification of actual eligibility and current eligibility.
The way that our hospitals support us, the way that our grants and funding are structured, the way that our volunteers have expectations, and probably most of all, the way that our pharmaceutical partners expect that patients who receive care and particularly their services do qualify and meet those income eligibility, residency eligibility, and no coverage eligibility.
[00:14:05] Speaker B: So if someone's listening to this and they're outside of Greenville county, is there a network?
[00:14:11] Speaker A: There is a network.
All of our adjacent counties do have free clinics.
Some are called free clinic, like Greenville Free Medical Clinic, Anderson Free Clinic.
But in Spartburg county, The name is St. Luke's Free Medical Clinic. In Lawrence county it's Good shepherd and I think it's Good Samaritan in Pickens County. But each, each of the counties do have some sort of charitable health care organization, have a little bit different requirements, they may have a little bit different services.
You know, we are, we are fortunate here in Greenville that the health resources are plentiful and available to us now. They are not necessarily plentiful for the uninsured except through us.
[00:14:59] Speaker B: Right.
[00:15:00] Speaker A: But there are specialists. There are, you know, many of the providers that sometimes smaller and more rural counties have a harder time.
[00:15:09] Speaker B: Right.
[00:15:10] Speaker A: Being able to be as comprehensive.
[00:15:12] Speaker B: Right.
[00:15:13] Speaker A: But, but we're fortunate in Greenville and, and Greenville is generous. You know, philanthropy supports charitable efforts.
Remarkably in this county, volunteers step forward. I was at a our national conference recently and in speaking with communities across the country, some of them big cities, you know, real cities, like I say, you know, that have the same kinds of structure of volunteer driven charitable care and they have a harder time sometimes recruiting physicians and recruiting dentists to give their time. And there's a generosity and a volunteerism and a giving back that is really kind of unique in this community.
[00:16:00] Speaker B: Yeah, we are very fortunate that there are so many givers. And again, it's not always money. We love time as well.
So if someone would like to find out more information about what you provide, what do they need to do?
[00:16:16] Speaker A: Well, we do have a website that does have the specifics of what you need to bring and how it does work.
And our website is greenville freeclinic.org it's long enough without the medical. It's just Greenville Free Clinic.
The specifics are on there. We do have many sites across the county. Our main site is in downtown Greenville, not too far from St. Francis Downtown Hospital.
That used to be a fairly impoverished near the Mill Villages area. Now it's not quite. It's so close, so close to downtown. It's not as impoverished as it used to be, but that's where our main site is.
We also have satellite sites.
One is in Greer at the Neighborhood Impact Center. One is at the Northwest Crescent center not too far from Cherrydale in the San Souci area. And one that's at the center for Community Services down in the Golden Strip Simpsonville area.
We are hoping to open another satellite soon in the 29605 zip code area down in partnership with Upstate Circle of Friends and hope to have a location to meet that area. You know, transportation is probably almost as major of a barrier for patients as cost.
[00:17:46] Speaker B: Right.
[00:17:46] Speaker A: And access to care.
[00:17:48] Speaker B: Yeah.
[00:17:48] Speaker A: So actually having services closer to where they are and in multi service centers where they are able to if not get one stop shop at least have multi services.
[00:18:02] Speaker B: Absolutely.
[00:18:03] Speaker A: One area.
[00:18:04] Speaker B: Yeah. And that's something that we're looking at as we continue to grow and expand of, of having more partners located in the same space as we are knowing that the needs of the families are greater than any one organization can provide. But collectively we can. And so that's at the end of the day, it's what's best for the people that we're serving.
And that's been my mantra for a while and continues to be my mantra.
[00:18:33] Speaker A: And that's really our focus too. We are patient focused. You know, it's not insurance driven, it's not cost driven. You don't have to have this before you can do that. You don't have reauthorizations. You know, it's a, it's kind of a unique concept in healthcare to, to look at it say what does the patient need? That's what our next.
[00:18:57] Speaker B: So if there's one thing that looking at what the depth and the breadth and the reach that you have, what's that one surprising statistic that maybe people don't realize about either your clinic or about the health care in our community, what's the that one nugget that when you tell people that they're like oh my goodness, I didn't realize that.
[00:19:25] Speaker A: Yeah. Well there's a couple.
One is I think because of the volunteers and the partnerships with other organizations and the donated pharmaceuticals from so many different sources that $1 to run the clinic, to have the doors open and have somebody answering the Phones and paper in the copier and, you know, all those kinds of hard things we have to have. You just have to have $1 to run the clinic. Actually ends up providing almost $10 worth of care to the patient.
And that's pretty good bang for the buck. That's a, That's a return on investment.
You know, when. When. Particularly when you think, you know, how expensive health care is.
[00:20:08] Speaker B: Right.
[00:20:08] Speaker A: The other thing I think is really the stereotype and, and probably misconception that somehow if it's free, it is something less than, you know, what is the value of free.
And particularly if you've seen on television or in movies or anywhere where they may depict some sort of charitable clinic, you know, a free clinic or, you know, some of the doctor shows, they go volunteer and it's. It's a rundown place and a rundown neighborhood with, you know, just barely getting by and, you know, kind of a band aid in healthcare.
The actuality is that particularly for our clinic, and we know it because we're measuring it now, patients are getting as good or frequently better care than in the healthcare system. And a lot of it is because we're coordinating care and we're taking away a lot of the barriers, for example, our blood pressure control and our diabetes control in our patients, who you would think might have a harder time maintaining good control levels, their diets, just their
[00:21:23] Speaker B: lifestyle in general is not the healthiest in the world.
[00:21:28] Speaker A: It's easy to say, eat healthy food, but healthy food is pretty expensive.
So you would think that they might be doing a little worse than the general population. But as we have been measuring in the same ways and measures that Medicaid measures and hospitals and practices and federally qualified centers measure, our patients are actually doing better in many of those measures. In some of the screening rates, our patients are getting mammograms and flu shots and cervical cancer screening more frequently than the average, sometimes commercially insured population.
You know, they are really very grateful that providers care about their health. We are taking the next steps beyond just treating what is the immediate need and looking ahead to saying you have to have access to preventive screening. You know, please don't come in. I mean, come in if you do, but please don't wait to come in until there are symptoms of sometimes worse conditions.
We can screen early and we can address many of those, but it is quality care in addition to compassionate care. And I don't think that that message is frequently relayed even to colleagues in the health system, colleagues within hospital systems, you know, somehow figure that it's just not quite as good as, as real health care.
[00:23:01] Speaker B: Well, and you know, part of that we look at what, when we're talking to parents and adults that have kids, it's, you know, at the end of the day, your child just wants someone that they can rely on, that they know that cares. Yeah, well, same for adults.
[00:23:21] Speaker A: Yes.
[00:23:22] Speaker B: If we're growing up, if we have those unhealthy habits, if we have that chaos having one place that when you walk in the door, you know, you can feel the difference that these people really care.
[00:23:38] Speaker A: Yeah. And they won't care how much, you know, until they know how much you care.
[00:23:44] Speaker B: Yeah.
[00:23:45] Speaker A: And, you know, that has been, I think, one of the strengths even more enforcing the community health work that's being done.
Because a lot of that is about trusted relationships. You know, they, they help them address the barriers and then convince them that, that these things are important. Take your medicine on a regular basis. Try to get, you know, a little bit of walking in each day, show up for your visits, do the things that your providers are recommending and when they trust and have that relationship. And sometimes it is the community, many times it is community health worker, sometimes it's the front office clerk, sometimes it's the pharmacy where they, they click and they, or the nurse or the dental assistant, that's where they, they really, you know, feel like somebody cares and then become more engaged in their own health.
It's easy a lot of times to label a patient as non compliant. You know, they haven't taken their medicine, they haven't showed up for their business, they didn't get their lab work done. You know, they're not doing their refills without looking a little deeper into why aren't they doing those things.
[00:24:59] Speaker B: Right.
[00:25:00] Speaker A: You know, just saying they're non compliant, they're not doing what I'm telling them to do. Well, why are they not doing that? And are there ways we can help improve that? And guess what? Maybe their compliance will help. So I tend to, at, at our clinic and within our staff and our volunteers emphasize and stress, you know, non compliant is not a term that we're going to use here. We will take the more positive side of that and say they are not yet engaged in their own health.
[00:25:30] Speaker B: There you go.
[00:25:31] Speaker A: And we will work toward getting them more engaged in their own health and then they'll realize why it's important to take the medicine and show up for their visits.
[00:25:39] Speaker B: Right. That sounds great. Well, Susie, I appreciate you being here with us today.
I've learned a lot. I know I'll continue to learn a lot from you, especially as our organizations continue down the same path of working together.
I appreciate everything that you've always done for our Greenville community and look forward to growing our relationship for the time to come.
[00:26:04] Speaker A: I appreciate it. And we have so many patients and the community in common that it. It makes sense for us all to be working and pulling in the same direction.
[00:26:15] Speaker B: Absolutely. Absolutely. All right, thanks again.
And thank you again, listeners, for being here with us. This is Philip Clark with Just say Something. And this has been another episode of Just say Something podcast.
So until next time, please stay safe.
