Greenville Health Assessment a reassessment of greenville’s medically underserved 3 rd Edition

1. Study Background Greenville Health Assessment a reassessment of greenville’s medically underserved 3rd Edition Contact: Russell StallExecutive Director Greenville Forward14 Manly StreetGreenville, SC 29601864.233.8443rstall@greenvilleforward.com

2. Thank you… Thank you to each organization that sponsored this study. Thank You Piedmont Health Care Foundation

3. From Our Chairman October 2008 We are extremely proud to release Greenville Health Assessment for the third time. Greenvillians have seen dramatic changes in Greenville County over the last ten years, and we are glad to be able to continue to build partnerships and collaborations. The Health Assessment Series has given Greenville leaders a better understanding of the health of our community at the local level. It has allowed us to understand not only the national and state trends on our health and access to care, but also how Greenville County has fared and how our residents are directly affected. The series has provided the opportunity to celebrate our successes and progress as well as continue to identify critical areas for improvement and collective action. It spurs our leaders to continue to move forward and continue to be attentive to the health status and access issues for all of those residing in our wonderful County. We offer our special thanks to all the many people who sponsored and participated in the studies over the last ten years and in our efforts to provide information for change for our inspired community. Thank you for reading this report, and we hope you become inspired to make a difference. Lillie Hall, ChairmanHealth and Wellness Task ForceGreenville Forward Maya Pack, ChairmanSC Business Coalition on Health Stephanie BrundageNew Horizon Family Health Services Lori CenterBon Secours St. Francis Health System Darrin GossUnited Way of Greenville Lillie HallDHEC Region 2 Hank HyattGreenville Chamber of Commerce Kristy MaherFurman University Katy SmithPiedmont Health Care Foundation Thank You

4. Health & Wellness Task Force Lillie Hall, Task Force ChairmanDHEC Region 2 Robin Scott BlackburnGreenville Medical Society Doug BrownRealtiCorp Lori CenterBon Secours St. Francis Health System Regina CookNew Horizon Family Health Services Natalie DoughertyBon Secours St. Francis Health System Marsha DowellUSC – Upstate Eleanor DunlapSE Consulting Steve EppsCorporate Benefits Phil FeisalBon Secours St. Francis Health System Suzie FoleyGreenville Free Medical Clinic Kim MahaffeyHealthy Connections Maya PackSC Business Coalition on Health Bill PierceFurman University Alicia PowersFurman University Jane Earle PresslyFAVOR – Greenville Liz SemanMeals On Wheels Andrea SmithSenior Action Katy SmithPiedmont Healthcare Foundation Cathy StoreyGreenville County Schools Mike TeacheyGreenville County Recreation District Ira WilliamsRetired Physician About Greenville Forward Greenville Forward was created in 2006 to enhance the quality of life for greater Greenville by engaging citizens in continually updating, promoting, and facilitating a community vision for 2025 and beyond. Greenville Forward is the organization that “wakes up every morning thinking about where Greenville County is going.” Prior to forming Greenville Forward, Executive Director Russell Stall was the lead consultant of the two previous Greenville Health Assessment Studies. Thank You.

5. The study is the third wave in ten years.

6. History “the most comprehensive health assessment in Greenville County’s history… The Greenville News

7. Learnings from Our Past. History 1998 2003 • Expanded Neighborhood-Based Medical and Community Health Centers for the Medically Underserved. • Dental Services for Medically Underserved Adults and Children are Created. • The South Carolina Business Coalition on Health Was Developed • Opened New Greenville Hospital System Eastside and Greer Campuses and announced the Building of the Bon Secours St. Francis Health System Millenium Campus. • FAVOR – Faces and Voices of Recovery • Activate Upstate Kicks-Off and Encourages Active Lifestyles. • Greenville City Creates a Plan for Greenways and Trails, an d Development of the Swamp Rabbit Trail and a County-wide Greenways Master Plan Begins. • Through Medverse, increased awareness and local partnerships to address language barriers to care • The City of Greenville unveiled its Breathe Easy campaign was implemented and a no-smoking ordinance was passed. • Opened Three Neighborhood Based Medical Centers. • Created MedWell Access and Linked with Commun-I-Care. • Linked New Horizon Family Health Services with Medical Centers. • Distributed “Health at Home” Self Help Books. • Created Healthy Connections. • Improved Medical Transportation.

8. 2008 Research Objectives • Reevaluate Greenville County trends in health status and health and wellness indicators. • Reevaluate access to health care and assess the status of the medically underserved in Greenville County. • Document the progress of closing the underserved gap. • Prioritize where key resources should be focused. • Reevaluate challenges and barriers that local businesses have in providing insurance to employees. Background

9. The study focused on five primary emphasis areas. While we explored all components of the emphasis areas, this report looks at the most compelling. Complete analysis of all areas are available on www.greenvilleforward.com. • Population • Education • Household income • Economic Climate • Recreation Infrastructure Secondary Data Scan • Obesity • Nutrition • Exercise • Substance Abuse • Family Abuse • Teen Pregnancy • Disease rates • Death rates • Infant Mortality • Cancer • Insurance/Uninsured • Healthcare Spending • Medicaid Spending • Medicare Spending • Healthcare Policy • Facilities • Uninsured • Low income • Hispanic • Neighborhood

10. The study focused on five primary emphasis areas. • Why look beyond “health” data? • Health is not measured just by the healthcare system, but also issues with the community and quality of life. • The scan is extensive, looking at a variety of sources. The primary reason is to look at as much as possible to get a complete picture of Greenville’s healthy. • However, not everything found is shown; just the most “relevant.” • Population • Education • Household income • Economic Climate • Recreation Infrastructure Secondary Data Scan • Disease rates • Death rates • Infant Mortality • Cancer • Obesity • Nutrition • Exercise • Substance Abuse • Family Abuse • Teen Pregnancy • Insurance/Uninsured • Healthcare Spending • Medicaid Spending • Medicare Spending • Healthcare Policy • Facilities • Uninsured • Low income • Hispanic • Neighborhood

11. October November December January February March April May June July August September The assessment is the result of almost a year of community investment. Background Health Indicators Data Scan Expert Interviews and Group Interviews Resident Telephone Survey Business Insurance Survey Analysis and Synthesis

12. The Research is Deep and Extensive Background

13. Some Numbers from Three Studies 48 personal interviews Background 4,710 telephone surveys 55 focus groups 285 focus group participants 85,000 minutes on the phone – 1,500 hours

14. The Facts – Household Telephone Survey 20 minute telephone survey completed with 800 Greenville County residents. Longer survey than last period among fewer people (14 minutes; 1,507 completes). Consistent with prior efforts, sample split among a random sample of residents and a lower income group of respondents (incomes under $30,000). Responses weighted to appropriately reflect trends over study periods. Greater focus on wellness, healthy lifestyles, and obesity. 28% of those who answered the phone agreed to complete the survey, and 75% completed the interview once started. Telephone Survey

15. Community Changes and Initiatives Inspired by Health Assessments 1998 - 2003 • Opened Three Neighborhood Based Medical Centers. Opened centers in Greer, Golden Strip, and West Greenville through a partnership with the Greenville Free Medical Clinic, New Horizon, and the Greenville County Health Department. The centers have had over 31,000 patient visits in the last three years. • Created MedWell Access and Linked with Commun-I-Care. Operating out of the Greenville County Medical Society, MedWell Access provides free health care services to uninsured, working individuals through a coordinated system of volunteer physician services, donated hospital services, and donated pharmaceuticals. Over 250 physicians are now participating and over $650,000 worth of services have been provided to date. • Linked New Horizon with Medical Centers. New Horizon, with grantsmanship help from CHA, was awarded a $1.2 million technology grant from the U.S. Health Resources and Services Administration (HRSA) to link the computer systems of the neighborhood-based medical centers with those of key medical institutions • Distributed “Health at Home” Self Help Books. Created outreach and education programs, including distribution of 1,200 “Health at Home” self help books. These books are distributed in targeted neighborhoods with large numbers of medically under-served families to help people make good health decisions. Distribution is accompanied by training on the value and proper use of the books. In a survey of book readers, 61% saved an unnecessary visit to the doctor and 47% saved an unnecessary visit to the ER as a result of the book. One-third of those who work say they saved an unnecessary sick day from work. • Created Healthy Connections. HRSA awarded $250,000 to develop Healthy Connections, a program aimed to help students get the medical care needed to succeed. The program has started at Hollis Elementary and will also target Tanglewood, Lakeview, and Parker Middle schools. • Improved Medical Transportation. The United Way’s Community Health Alliance provided $12,000 from its local match funds to assist Greenville Transit Authority (GTA) in developing the GAP (Greenville Area Paratransit) program which provides curb-to-curb medical transportation service as well as service for residents with disabilities.

16. Community Changes and Initiatives Inspired by Health Assessments • 2003 - 2008 • Expanded Neighborhood-Based Medical and Community Health Centers for the Medically Underserved. New Horizon Family Health Services and Greenville Free Medical Clinic expanded space and capacity in GreerNew Horizon Family Health Services is in the process of building a new facility to expand its space and capacity for serving northern Greenville/Slater-Marietta area. Taylors Free Medical Clinic opened its doors in 2005. These centers serve over xxx patients annually, representing an overall x% increase in number of patients served since the initial study in 1998. (note: I am waiting on numbers from Taylors) • Dental Services for Medically Underserved Adults and Children are Created. Through a unique partnership between Bon Secours St. Francis Health Services, Greenville Technical College, New Horizon Family Health Services, and United Way of Greenville County, affordable dental services are now available to medically underserved individuals through a mobile dental unit and the new New Horizon Family Dental Practice. Over xxx was raised to create a dental facility that provides preventative, restorative and some specialty dental services and to up-fit a mobile unit, donated by Bon Secours in order to provide dental education, check-ups and cleanings on the unit. • The South Carolina Business Coalition on Health Was Developed to Improve Healthcare Quality, Efficiency, Consumerism and Overall HealthThe South Carolina Business Coalition on Health (SCBCH) was established in 2006 as a partnership between the business community and organizations in the healthcare field to focus on improving healthcare quality and efficiency, promoting greater consumer responsibility in healthcare decisions, and improving the overall health of South Carolinians. The SCBCH offers educational and training services to assist members in understanding mechanisms for controlling health care costs. In addition, through a partnership with the United Way of Greenville County, the Coalition offered an educational and mentoring program to small businesses to help them learn ways to control their health care costs. • Opened New Greenville Hospital System Eastside and Greer Campuses. • Announced the Building of the Bon Secours St. Francis Millenium Campus. • FAVOR – Faces and Voices of Recovery Was Createdto address substance abuse and behavioral health service gaps, address access issues and advocate for improved insurance coverage for those services. • Activate Upstate Kicks-Off and Encourages Active Lifestyles. Through a partnership among Furman University, the Greenville Hospital System, and the YMCA, an annual community-wide initiative has been implemented to encourage all residents to participate in exercise and healthy lifestyle activities. The initiative, Activate Upstate, builds and expands on previous efforts of Greenville Shrinkdown and Get Fit. • Greenville City Creates a Plan for Greenways and Trails. The City of Greenville has developed and begun implementation of a master plan for greenways and trails throughout the City. The Greenville County Recreation Department is working with the city to expand greenways and trails throughout the County and to develop a greenways master plan for the entire county. • Development of theSwamp Rabbit Trail and a County-wide Greenways Master Plan Begins.Through a partnership with the Greenville County Recreation District and Greenville Hospital System, the Swamp Rabbit Trail is under development. The Swamp Rabbit Trail is a 10-mile trail spanning from downtown Greenville to Travelers Rest that will serve walkers, joggers, cyclists, and may also include a hybrid, slow moving tourist Tram for public transportation. In addition to the development of this trail, an effort is underway to create and implement a county-wide Greenways Master Plan. • Through Medverse, increased awareness and local partnerships to address language barriers to care. As a result more healthcare providers are increasing capacity for translation and other services to address language barriers. • The City unveiled its Breathe Easy campaign was implemented and a no-smoking ordinance was passed. The City’s new Breathe Easy campaign promotes Greenville’s unique atmosphere, charm and amenities in a smoke-free environment.   The City of Greenville passed a smoking ordinance to ban smoking in any business and public facilities in downtown.

17. We have a solid base of knowledge and there are advantages in building on the previous effort. • Comparable base of knowledge and consistency of collection modalities insuring data comparability. • Understanding from past effort on the geographic areas with the greatest needs, and thus the ability to focus even deeper into geographies. • Understanding that the data represents individuals, and the face of individuals is what differentiates and inspires change. Background

18. 2008 Research Objectives • Reevaluate Greenville County trends in health status and health and wellness indicators. • Reevaluate access to health care and assess the status of the medically underserved in Greenville County. • Document the progress of closing the underserved gap. • Prioritize where key resources should be focused. • Reevaluate challenges and barriers that local businesses have in providing insurance to employees. Background

19. Health Indicators Data Scan Expert Interviews • Revisited issues explored in 1998 and 2003 with more emphasis of changes over time. • Deeper analysis including census tract level reporting. • More emphasis of health and wellness. • Benchmarks against other similar communities. • One on one interviews with community leaders and health care providers. Citizen Telephone Survey Business Insurance Survey Community Focus Groups • 16 focus groups wrapped around health care issues. • 110 participants included a wide representation of health care, community and neighborhood leaders and representatives. • 800 completed telephone interviews with over-sampling of ZIP codes with higher levels poverty. • 20 minute survey focusing on the uninsured. • Precision of +/-3% at 95% confidence interval. • Respondents given the opportunity to complete the telephone survey on-line. • Web-based survey among local Chamber of Commerce members. • Completed by 197 respondents • Focus on providing insurance to employees and the barriers to providing coverage. The study used many tools to give breadth and reliability. The Face The Facts Background

20. Focus groups gave a face to the research. 16 Community Focus Groups , over 100 participants Background • Notes on the Process • Participation was strong in most groups. • Participants were vocal, interested, and engaged. • Some new collaborations and partnerships developed through the dialogue.

21. Elderly and Senior Care (10 participants) March 2008 Neighborhood Centers (3 participants) March 2008 Substance Abuse (5 participants) March 2008 • Department of Social Services • Meals on Wheels • Diligent Hands Gracious Hearts • Alzheimer's Association • Senior Action • Appalachian Council of Governments • Bon Secours St. Francis Lifewise • Foothills Family Resources • Golden Strip Center for Community Services • Northwest Crescent Child Development and Family Services Center • Greenville Family Partnership • FAVOR Greenville – Faces and Voices of Recovery • Alcohol and Drug Commission • The Phoenix Center • Compass of Carolina Mental Health (5 participants) March 2008 • Carolina Center for Behavioral Health • Mental Health America of Greenville County • Greenville Mental Health Center • NAMI Greenville Emergency Preparedness (4 participants) March 2008 • Bon Secours St Francis Health System • Greer Police Department • Greenville County Emergency Planning • Greenville Hospital System Human and Health Services (8 participants) March 2008 Community Health Agencies (9 participants) March 2008 • Catholic Charities • Greenville Literacy Association • Goodwill • Pleasant Valley Connection • SHARE • Urban League of the Upstate, Inc. • United Ministries • Cancer Society of Greenville County • American Cancer Society • Bon Secours St. Francis Homecare • Family Connection • Greenville Hospital System – Asthma Alliance • Greenville County Health Department • Greenville Medical Society Emergency Departments & Clinics (6 participants/) March 2008 • New Horizon Family Health Services, Inc. • Exigent Urgent Care • Greenville Technical College Dental Program • Greenville Hospital System • Greenville Free Medical Clinic • Taylors Free Medical Clinic Childhood and Education (7 participants) March 2008 • Greenville County Schools • Early Childhood Development, School District • First Steps for School Readiness • Communities in Schools • Center for Developmental Services • Pathways to Success • Graduation Greenville Health and Wellness (5 participants) February 13, 8:00 • YMCA • YWCA • Greenville Hospital System • ZestQuest • Wellness Trainer – Independent Business Focus Groups 16 Groups Conducted Involving 10310 participants Hispanic Residents (3 groups, 24 participants) April and May 2008 Business/Employers Representatives (4 participants) April 2008 Community Residents/ Underserved (2 groups, 20 participants) May 2008

22. Look at the Changing Greenville County…. Background