[theme music] >> Research suggests the greatest health challenge we face in South Carolina is the major equity-based gap in access and outcomes.

There is growing recognition among health experts that the health and well-being of people and communities is primarily determined by the condition in which we live.

In other words, the strongest indicator for how long a person lives can be determined more by ZIP Code than a genetic code.

Many diseases, including diabetes, cardiovascular disease and certain types of cancer strike and kill minority South Carolinians at higher rates than their white counterparts.

For example, in our state, African-American men are nearly twice as likely as white men to die of diabetes.

This is a statistical fact.

Health disparities occur at virtually all geographic levels across the nation.

They affect many racial, ethnic, age, and gender population groups.

How we choose to address these disparities is a matter of great importance and a highly personal, life or death issue for an increasing number of people in our state.

Health disparities stem from a range of conditions, among them, the rural character of the state's population, access to, and the affordability of health care, and the difficulty of communicating health-related information across geographic, income, racial, ethnic and trust divides.

These disparities in health, seen throughout South Carolina, the United States and the world were illuminated in 2020 revealing the defining line between those who have and those who do not.

Welcome to Palmetto Perspectives and this very important discussion about health disparities and inequities.

I'm Thelisha Eaddy.

In rural states like ours, health disparities have been an issue for decades, and today it seems these issues have been brought to light more than ever before with the coronavirus pandemic.

The question is, how do we keep all South Carolinians healthy and safe?

We know you have insights, perspectives and questions that will help make tonight's conversation a smarter conversation.

You can be a part of tonight's show by commenting on our Facebook page at South Carolina ETV.

Our Assistant General Manager, Adrienne Fairwell, will take your questions on air.

We've also assembled a panel of stakeholders who will take part in tonight's conversation, as well.

They will join us by Webex.

And joining us here in studio is a great group of people.

We have Dr Jimmy McElligott.

He is a pediatrician at the Medical University of South Carolina and co-chair of the South Carolina Telehealth Alliance.

We also have Kathy Schwarting.

She is CEO of the Palmetto Care Connections and also co-chair of the South Carolina Telehealth Alliance.

Also joining us is Vince Ford.

He is Senior Vice President of Community Affairs at Prisma Health.

Jan Eberth is Director of the Rural and Minority Health Research Center at the University of South Carolina.

And rounding out the group, we have Juana Slade.

She is Chief Diversity Officer at AnMed Health.

Thank you all for joining us and thank you for your time on this evening.

We just heard in the opening, the opening piece, a list of different determinants to health disparities in South Carolina.

I want you to create a snapshot for us.

Before COVID, what did we know about disparities and inequities here in South Carolina?

And we can start with you.

>> Well, I think, unfortunately, we knew a lot.

You know, I started out my career as a pediatrician looking at access disparities in children, and I was quickly redirected after we did some work and showed how bad off some of the kids were, to say, that's great.

Do something about it.

So I think, you know, our maps of disparities follow a lot of historical lines and we have a lot of rurality issues.

We have a lot of issues with, from demographic disparities.

So we have baseline data to work with, and we're really into the phase of problem-solving, I believe.

Kathy?

>> So I think before the pandemic, like Jimmy said, we knew a lot about the health disparities, and a lot of them we've known for years between the rural and the urban areas and issues that folks in rural areas deal with every day.

Lack of access to transportation, lack of access to health care, lack of access to healthy foods and exercise.

I mean, you don't typically find gyms in a lot of those rural areas.

And I think we thought that Telehealth, or we, some of us, we put a lot of time into thinking that Telehealth might be a solution to increase that access to care.

And we knew that broadband was an issue, but I don't think we realized to the, to what extent of an issue it was until the pandemic hit.

And we've really seen, I think, how broadband, as said earlier, sort of really separates the haves and the have-nots a lot.

So I think we've learned a little bit since COVID, but we've known a lot about this for a long time, but I think COVID really brought it to light for us.

>> So I'd just like to add that I think there are two things that we knew before COVID and it's certainly still going on now.

One is in the opening someone mentioned ZIP Code.

ZIP Code is significant in the health disparities and including the life expectancy.

You could have people that live on the same street within blocks of each other and the life expectancy could be a 10-year difference.

But in addition to that, I think that we've finally got to get to a discussion about race and racism.

Those two things are equally important in this whole disparity and life expectancy process.

We found that even people, even when income is not an issue, there's still some disparities that occur throughout our system.

There's a lot of medical mistrust, a lot of concern about the care that African-Americans and others get, and that's something that has to be addressed, and it has to be addressed real soon.

>> Go ahead, Jan. >> Well, I'm really glad he brought that up because that was one of the things I was thinking when you mention this issue of determinants.

And I think there are lots of different types of determinants that determine what our health will be as individuals and as communities.

So, you know, you think of the social reasons.

You know, the socioeconomic position of an individual or their community.

But you also can think about the structural reasons that cause people to have adverse health outcomes.

And even when you consider an individual's income or their individual race, the community in which they live and the environment that they're there, that's equally important on the person.

And so I think, you know, that holistic view of the sociological environment of the person, economic, the political, the structural factors, all of those contribute to the individual's health outcomes.

>> Juana?

>> Sure.

I think I certainly have to piggyback on both of the last two comments.

My personal mantra is that relationships drive results.

And I think COVID gave us an opportunity to pause and evaluate the relationships that we have with populations that we care for.

I think perhaps 10 years ago, 15 years ago, the Hospital Association, the American Hospital Association, realized that health care systems would not be able to address the socioeconomic outcomes of their patients without the involvement of others around the table.

And so, when I think about health disparities, we certainly have to take into consideration those relationships, and then those partners within our communities that can help us to improve those data.

>> You guys, you all touched on it a little bit, but enter COVID-19 last year, and it has proven to be more than just a disease caused by the coronavirus.

It's this big magnifying glass.

What are some of the details that's been made larger for more people to see, and how are we addressing them?

How do you think we have been doing in addressing them so far?

And you can just jump in.

>> Well, I'm going to jump in because I'm really excited about the connection and the correlation between what I do, which is to involve, which involves those relationships.

But there's a direct partnership between clinicians and those of us who are not clinical.

Non-clinical relationships in connection with, and in partnership with the clinical providers in our systems.

Those are the kinds of things that we've got to do and COVID has given us an opportunity to do that.

We now can use the same example that we did in previous years with quality and safety.

We can apply some of those same principles to taking a look at COVID and what we can do, how can we can study the information, who can study the data and the information and be a part of that conversation.

>> And I'll add to that.

I agree with that, and I think that what we've experienced during COVID we knew pre-COVID, and that is access to care is critical.

And access goes across the board.

It's not just about transportation.

It's when health care providers are accessible, you know, maybe even after hours or non-traditional hours.

It may mean a person's ability to get off from work and go see a physician or get care.

But access to care is critical, particularly in a reasonably rural state as we live in, transportation is not as easy as it sounds.

Even when we take our mobile unit out to the community, access is still an issue because people may be two miles away.

I heard of a case in Florence recently where this gentleman walked two miles to get the COVID vaccine.

He had to walk.

And so we've got to be very mindful, and this is where I agree with Juana, and those relationships are important.

So we've got to partner with the faith community.

We actually have to ask the pastor and the first lady of the church to help, help identify and recruit and provide transportation to the church and maybe the mobile unit can come there and provide that care.

But I think in addition to that, access is critical, but the other part is this whole notion, and we can't leave this off the table, of medical mistrust that we're hearing a lot about, vaccine hesitancy, and that's coming, largely, from historical issues related to all kinds of things.

Of course, people want to pitch up Tuskegee.

That's often talked about.

But there's some other issues that are out there, as well.

Like, for instance, for me, one of the biggest issues for me of all the issues that we deal with with health care disparities, is the issue of an African-American woman having challenges in labour and delivery, in America.

Even at worst in some other countries, that is very concerning to me.

And there's a lot of data out there to show that.

And so even, again, when income and education is not an issue, those issues are still there.

And we've got to figure out how, I think Juana said we've got to use data to identify those things and bring it to the attention of hospitals and other organizations so that we can make some changes in these areas.

>> And I don't know, maybe I'll add, and then...

I think that data part's really important.

I think COVID has made everything, sort of, in fast-forward and really visible.

I guess there's some cautious optimism there that there's lights been shined on a few elements, when we've had data and that's been encouraging when we've, Kathy and I work with technology outreach to patients, you know.

So we've seen when we put things in place that it was disparate in terms of access.

So we're pivoting, and we're trying.

So I think, you know, there's no excuses now, right?

You have the data and then, but the disparities are still there, and we have tools.

To me, there's a lot of work to be done.

But I guess, you know, the socioeconomic and the trust and to me, you know, there's some information on who uses Telehealth to access care and there's some information even out of New York City, right, where you can take rural and urban out of it.

And the boroughs are different.

And it's not all poverty.

There's a community comfort level with accessing care in certain ways.

But again, I see it staring me right in the face.

It's a problem I think we can tackle, or I hope we can.

But I would say it's made everything visible and accelerated, and so you can't ignore that there's some solutions but the scope of the problem takes more than cell phone connections and broadband in itself.

>> So I would add to what was said earlier that I think we've known this, but COVID really brought to light that we're gonna have to bring the services and the education to the people where they are.

To the communities, you know.

For years you had to leave a rural area and for access to care you may have to drive an hour or two hours.

And we need to work with the churches.

We need to work with the community grassroots leaders in those communities.

I think that's one way that we can address the trust issue is by letting the community sort of educate itself.

But I think a lot of it has to do with education and it's not just education about Telehealth or education about broadband.

It's education about the whole vaccine distribution.

I mean, you put it out there, and I know everybody tried to do a great job, but you set it up so that certain communities don't receive the communications and the education that other communities receive.

And so I think we have to bring it to the people in an environment that they're comfortable in.

And I think that's one way that we're gonna break that barrier.

>> I will just say, you know, the data, when you looked at that from COVID's perspective, a lot of the maps that were out there were simply cases.

So you look at a map and you see that most urban areas, and you think, well, that's where the problem is.

But when you look at things on a per capita basis, and you say, wow, you know, it's Lee County, it's Bamberg County.

It's these rural counties where you have particularly high incidence and mortality.

Those counties took a long time to get to where they are in terms of vaccine uptake, as well.

So the quicker uptake was happening, I mean, and still today, we have a disproportionate amount of vaccine uptake in our white population and a disproportionate uptake in our African-American population.

And I think that, you know, that was, in particularly, bad at the beginning.

And now, DHEC is, you know, thinking about its formula, changing its formula for how it's gonna distribute these vaccines to make a more equitable and now we're doing better.

But it's unfortunately taken some time.

And so we have this disparate issue with not just incidence and mortality from COVID, but who was able to get the vaccine in a timely fashion.

>> Great information.

We're gonna turn now to Adrienne because our online discussion is giving us a lot of great information, as well.

>> Absolutely.

So one of the questions is "How can people sign up for the vaccine "if they do not have internet access?"

>> That's a good question.

>>So one of the things that they can do, that's a great question.

So there are a couple of ways.

One is, there are telephone numbers that you can call and they will help navigate you through the internet process.

So I think we started off the very beginning of this whole process that you had to have an email address and get on the internet.

But we've quickly evolved to a point where now you can just, in some cases, just make a telephone call and they will help navigate you through that process.

In addition to that, there are some walk-up opportunities where you don't have to have an appointment in certain places across our state where if you just walk up or show up you can then be put in line to receive the vaccine.

So the thing that our public has to really understand is this is the first time many of us have ever dealt with this, and the process is evolving.

I think early on it was a matter of trying to make sure they maintained contact to see exactly what impact the vaccine was having.

So when I took my first vaccine, I started getting emails from the CDC.

How are you doing today?

Did you go to work?

Do you feel good?

And when I got my second dose, the same thing.

So I think the process has evolved, I think it's getting easier.

Still not where we need it to be, but it still, I think, is getting easier as we go through this process.

>> So I will say that one of the things in rural areas is, most rural communities are like families.

Most people know each other.

They've known, they knew their grandmother, they know their grandchild.

And for example, in Bamberg County where I live, there's a rural health clinic, Bamberg Family Practice, and she does a vaccine clinic every Thursday, and you do not have to have an appointment.

And she does a great job putting it out there on Facebook for-- most people are on Facebook, right?

I mean, they may not check the internet or they may not Google or have email, but they're on Facebook.

And so, she puts it out there and she sees in an afternoon 2 or 300 people every afternoon in Bamberg County.

And then an example, I had a 75-year-old lady that had her vaccine, and I knew that she did not, I didn't think she had a computer.

And so she called the local health department and she said, "Listen, I don't have a computer, "and if I did I don't know how to use it.

"I don't know how to schedule."

And they said, you know, "Come on in.

"We're gonna help you get registered.

"Don't let that be a deterrent.

Come on this afternoon.

"We'll get you registered.

We'll get your vaccine."

And so, I think in these communities there's a lot of negative about rural most of the time.

And I really wish we would redefine rural 'cause there really is a lot of good in rural and there are lots of good people that want to help each other out.

And in times like these, that are so chaotic, they really do come together and help each other.

>> I want to echo what Kathy just said, and that's true.

I think that there are advocates, there are people all across the state who are stepping in and they're creating those conversations.

Back again, I don't want to beat the drum, but back to those conversations and the importance of those relationships, there are people in the communities that will ask those questions, and they will get that information about connections, about phone numbers, about access.

They'll get them back to the residents, the people that they know.

>> Thank you.

>> And do we have another comment?

>> We are actually going to toss to Webex.

We've got a question on our Webex.

[no audio] >> OK, great.

So we could not hear that.

We'll get that question back in.

Thelisha, I am going to toss it back to you.

>> Alright, thank you, Adrienne.

Is there a cost to health disparities?

I think it's easy for us sometimes to think about how an individual is impacted, but what about the individual's family unit, the larger community and the state of South Carolina?

Is there a financial cost to these gaps that we have in our state?

>> I think we could all answer that, [all chuckle] I think, but it's... ..it's enormous.

You know, you only have to look at things like that conditions that show up with costly things in a shorter-term such as diabetes, if you have complications, or mental health if you're sent to the emergency room to see it showing up in there.

So I'll let some other folks chime in, but I just have to say that's one of the biggest drivers for folks like myself who work in this arena is, it's you can see the cost happening and building up on families, on the health care system, and in many other ways I'm probably not articulating very well.

>> Oh, I think you did, and I think that there's no question there's a cost.

So as we pursue the North Star of health and well-being, which is where everyone wants to be, when we start to look at what impacts that, there are a lot of things that if it's not done well it's gonna have a cost, gonna to have a cost on health care system, school system, on business and industry where people are gonna be out of the work, etc.

Families, certainly, there's no doubt about that.

I'd like the comment that one of our chief medical directors made some years ago.

Someone asked him the question, "What is the future hospital look like?"

And I like his response, and his response was, "An empty one."

So we've got to get out of sick care and get to health care and create an opportunity where people are healthy and well.

If you were to take a look at a picture years ago of a person in a hospital, you would see, typically, a man laying in a bed and he'd have a lot of tubes coming out of him, going all kind of ways.

We've got to exchange that picture for that same man and his family being at the park running around catching a ball.

Because our responsibility ought to be to try to keep him and the family healthy as opposed to waiting for them to get type II diabetes or cancer, and then end up in a hospital when the costs are going to be significant at that point.

>> I think all of our provider community, we would love to go back to doing house calls, right, and bringing the health care home.

But the future of that, I think, is community-based, right.

There's other professionals, there's lay workers and, you know, the health care system has to get closer to where families live.

And, you know, I got into the field of technology not because I like technology, but because of that reason, to get closer.

But I think there's so much work to be done and it starts with that intention.

That you really, you know, it's not about coming into the office or, let alone, the hospital anymore.

We've gotta go out.

>> I have a physician colleague who talks about the fact that his practice changed when he made connections around equity, inequity, diversity, disparity, all of those things that fed into the decisions that he made and the connections that he made with his patients.

And so he said as a result of that experience, his practice will never be the same.

And I think that when you can impact a clinician's engagement with his or her patients based solely on suspension of stereotypes and having conversations and understanding that all patients are not going to interact or interface with their guidance, their recommendations the same way, when those differences are taken into affect then yeah, you can go back to practicing the old-fashioned way, even if it's in a traditional environment.

Because that practitioner recognizes that every patient that walks through will be bringing a different set of experiences to that encounter.

It then makes the difference.

Doesn't matter where it is, that connection happens.

>> So the thing that I would add to that is even though I think, and I worked in a rural hospital for many years and absolutely love the work that we did, our health care system is not patient-friendly all the time.

And it is a little complicated for patients.

And it's hard enough sometimes, I think, for patients to, that absolutely have to go to the clinic or to the hospital because they're sick and they don't have a choice, but we have to create an environment where it's not difficult for them to go for the preventive care or the maintenance care or the education around help that they need.

And I think as health care providers, and this is not to knock health care providers 'cause I thinks we have some of the greatest hospitals, health systems, providers, I would match it up with anybody else in the country, But again, we have to put ourselves in the patient's, in their position, and we have to make it easy for them, and if it's not gonna be easy for them and easy for them to understand and to navigate, then a lot of times they're just not gonna go.

>> You know I think that, I think that I agree with that and everything that's been said.

I think from an ideal standpoint, if you take a look at Dan Buettner's research, body of research.

He wrote a book called 'Blue Zones'.

And you look at those places around the world, there are about 10 or 15 blue zones in the world.

And what you find are some common things.

And, interestingly enough, healthcare is not one of them.

It's about community, support, those relationships.

It's about gardening, it's about walking.

It's about doing things, actually even their faith.

The Seven-day Adventists tend to show up in these areas as well.

So, there's some things that we know that can be done that if we can help those people in our communities, we believe that we can eliminate or at least start to reduce some of the health disparities and certainly shrink the gap in the life expectancy as well.

So, a lot of work can be done but we still need a great healthcare system and physicians and others, so that when people do need them they have access to them.

>> How close... were you?

>> Yeah, I was just gonna say we gotta get people in the door first, though.

So if you don't have insurance, you can't get in the door.

So that's another element of this is that some counties in South Carolina, 20% of the people don't have insurance.

So, that's a big problem.

And, you know, from a policy angle, what are we going to do about that?

Are we going to expand Medicaid?

Are we going to have some other kinds of programs that help these individuals get insurance?

Hispanic populations have even more than 20% of the population that doesn't have insurance.

And even if you do have insurance, if you're on certain plans you can't get preventive care.

You can only get sick care.

So when we're talking about getting people to come in for these wellness visits, you know we've got to get the insurance companies on board here too and think about the reimbursement policy.

>> And we have to remember that we have to treat people with dignity and respect, whether they have a great paying job or have good insurance or not.

And a lot of people are very proud and some of them are too proud to even go to the doctor's office when they know they need to go or their wife needs to go.

And unfortunately, we lose a lot of people that we wish would come to the doctor, but because they don't have insurance and maybe they're afraid of the way they're going to be treated or looked upon, they just don't go.

And we should not have that in 2020...at this point in our life, that should not be an issue.

But it still is.

>> Yeah, one of the things we've done is we've politicized healthcare and that is a big mistake.

Two examples of that.

One is the most recent discussion about wearing and not wearing masks.

Is an example.

That became so political.

The other is that we live in a state, unfortunately, that decided not to expand Medicaid so we left a lot of people out there, all across our state, we left them out there with the inability to receive insurance or receive the necessary insurance that they would need to be able to go to a healthcare provider.

Thus, they wait and wait and wait and then end up in ER.

And that's not a good formula for shrinking healthcare disparities and decreasing the gap of life expectancy.

And both of those are clearly tied to political issues.

>> Coming back to Jimmy's original question, that is the issue of uncompensated care.

You know, if we want to know, if we ask the question, what is the impact?

What does that mean to us?

Systems, the health system individually and collectively.

We've got to figure out how to absorb that cost.

We don't get a pass because we're not going to get paid for it.

If we got emergency room there are people who are going to come to us.

Is it going to be more advantageous to try to figure out how to make those connections early on?

Someone once said, this was many years ago, we have a fairly robust language services program in my organization and we were talking about providing services and someone said kind of off-the-cuff, I think they attempted to be funny and said, "Well, are we sure those of the patients that we want?"

And so I went to a department and got them to run a report for me of self paid patients and stratified by ethnicity and language preference.

The data showed that the individuals who were registered and self identified as Hispanic and they were paying their bills, those individuals were paying their bill at a higher percentage than other populations.

So that says that that cultural norm perhaps, that particular snapshot in time, that cultural norm, those individuals and that cohort were willing to pay their bill.

Perhaps because of the pride we have.

Perhaps because for their population, for their community responsibility doesn't have anything to do with insurance coverage, it has to do with paying a bill.

So, again, I think if we...

I hate to simplify the response, but if we can try to figure out how to connect and how to have those relationships, those one-on-one relationships patient to provider that's going to make the difference.

That'll give me an opportunity with my provider to have conversations about race.

That'll give my provider to have conversations with me about who I am and perhaps what perspectives I bring to the table.

>> And the conversations are important and just to give rural another big plus again, because I like to do that.

You know, patients love their providers.

And they listen to them, they listen...

They know a lot about their social determinants of health even if it's not in the chart.

They know each other.

And not to take away from urban areas, but in a rural community you see your physician in the grocery store.

You see your physician at the ballfield, you see her in the bank.

And they do have those really strong relationships.

And those clinicians are so instrumental to the health of that community and it's something that I think we need to build off of.

You know?

And it's just something we could learn.

They they don't just go see that doctor once a year.

They see them all the time.

And they have a relationship with them outside of the office.

And I think it helps in the whole process.

>> Relationships really do matter.

We're going to turn out Adrienne because we have a comment on Facebook and we're going to try WebEx again.

>> Yes, we have a... first, a comment on WebEx.

So if you'll unmute your mic and we'll be able to hear you in studio.

We're ready when you are.

>> Can you hear me now?

>> Yes sir, we can.

>> Oh, hey, hey.

It's Dr Rick Foster and let me start off by just applauding SC ETV for doing this wonderful and very important program and for having such a dynamic and diverse panel.

You've already touched on the fact that the pandemic has put a real spotlight and amplified the racial and rural inequities and injustices that already existed, and I'm glad to hear that you're referencing the fact that we've got to address specific policies and find better ways to work together on the policy front.

But I did want to share and just get some comments additionally maybe from both Juana and Vince about my experiences of being a board member with federal health care, which is a community health centre here in Charleston, South Carolina.

Amazing what they've done.

I think they're getting close to 20,000 people they vaccinated.

They went out and worked with the churches and faith-based communities with the local libraries, with other community-based partners.

And they had trusted voices going into particularly the African-American community and with their vaccination they've had over 60% of the population that's been vaccinated being African-American.

And so, I think understanding maybe hopefully we'll learn from this by bringing together those partners and include healthcare but also include those trusted voices and organizations in the community, we can break down those barriers.

The other thing they did very quickly is that they realized that many of these people did not have broadband access to internet registration and didn't have the digital literacy.

Just weren't comfortable with doing this.

And so they created an environment where you could actually go and register on-site and they would help you with completing all the forms that need to be completed.

And they found that over 60% of those people that came in for vaccination just did not have the comfort level in being able to complete the forms fully.

Forms fully.

And now, Vince has said we have phone access and other.

But I'd love to hear some more comments about how you most effectively work with other community partners in a way we haven't done before?

To reach those who are most vulnerable and most at risk.

Thank you.

>> So, Dr Foster, I wish we could clone him.

We need more Dr Foster's out there.

But in my view it's imperative that we do partner, I think Juana pitched this up earlier.

We've got to partner with traditional and nontraditional partners out there.

That may mean the faith community, it may mean neighborhood associations, that may mean schools, K-12 and colleges and universities.

Fraternities and sororities.

We've got to get to those partners out there who can be influencers.

One of the things that we learned early in my process of working at the hospital is we would go out into the community.

Particularly working with the faith community, not just the pastor but the First Lady of the church.

Particularly in the African-American church.

That First Lady, if she were to stand up and say to, particularly the African-American men, "I need you to show up on Saturday morning for an event."

That mother figure was then listened to by the men of that church.

And they would show up.

And so there's some things that we know.

I'm encouraged by Bishop Green of the AME church.

They had an event on 19 March over at Reid Chapel here in Columbia where they partnered with Walgreen.

They had 500 people show up to receive the vaccine and I saw a picture and I was very encouraged.

Not encouraged by a long line but I was encouraged that there was a long line.

But seeing even seniors out there with canes standing in line to get the vaccine.

I talked with him right after that and they were in Charleston the week after that and another 500 showed up for the vaccine.

So we have to have those partners.

And I think Juana said this earlier again, hospitals have learned over time that if we're going to affect change in the community we better partner with the community.

We better not try to do this on our own.

We need to partner with the community.

We can bring the clinical expertise but we need their talents and expertise to help recruit, help encourage, help influence people to take care of their healthcare needs.

That's what a partnership really is all about.

We know how to do it, we just have to be willing to do it.

And when we do that we can get and have success throughout our communities.

>> That's a - sorry go ahead.

>> No, I was just going to say that our organization has put together an amazing operations team and that's the exact kind of thing that we're doing.

Looking for innovative locations, innovative opportunities and partnering with other entities across the community to try to connect with the populations where they are.

I have to admit, I attempted to steal one of Vince's ideas with the faith community and of course, COVID didn't allow us to make good in person the way I imagined.

But our chief quality officer and I were on with Reedy River Baptist Associations training event last week and the feedback for that, having that opportunity to talk about the challenges and issues and some of the historical challenges that we have in making connections with the faith community, with the African-American community in particular, I think we were able to have conversations to break those barriers down.

So, in addition to the issue of access, there's the issue of information.

>> Mmm-hmm.

That's a perfect segue to... we've got another question.

"How do you feel the pandemic has impacted "the future of telehealth "and what are the barriers to implementation?"

>> I guess we can get to say some things positive about our state and our areas.

You know, I think we should all be very proud of how our healthcare systems responded.

We were some of the fastest in the country to use telehealth to get the early testing done, to triage.

When everybody was so scared, we were some of the fastest in the country to get the drive-in lines lined up, because we used telehealth to triage the patients and organize them.

We were also really quick at getting to communities that weren't necessarily urban or affluent.

So, although it didn't solve all those problems, I want to be careful about saying that, we were intentional.

My organization, MUSC but others and DHEC and all of them were out there in sort of day .5, not even day one.

And I think we had infrastructure that our state invested in and we learned a lot of lessons about how to use these different technology tools, your smart phone and those kind of things that we did really well.

Now, a year passed, they're still using it.

And as Kathy kind of pointed out at the beginning, I'll pass on to her, now we're understanding that we also exacerbated some access disparities.

But it's not as clean as we've been talking about.

There are pockets of communities and areas using it in ways, using these tools, these distance tools.

Your phones and your video and your monitoring devices in ways that we didn't expect all would.

So, there's a lot of hope and I think we can be proud of that.

So I'll stop there but I think we should be proud as a state that we're not looked at as a sort of New York City or Northern California or whatever, but we were fast and we were digital.

And we used it in good ways.

But now there's a lot more work to be done.

>> So I think our legislature, they had a lot of foresight a few years ago and invested a lot of funding into telehealth which created the South Carolina Telehealth alliance that Jimmy and I work with.

And Jimmy and I, and Dr Foster, we've been preaching, preaching, preaching telehealth as a way to increase access for the last 10 years.

And one thing that COVID did is it pushed us forward about 10 or 15 years.

I mean, it took a lot of the work out of it for us because for a lot of folks in urban areas and rural areas that were not comfortable going to the doctor's office, that was the only way that they received care.

And telehealth isn't the answer for every specialty service or every person but it is a good way to infuse services.

But one of the barriers that has come out of that, and we knew this but we didn't know to what extent, was your access to the internet.

And not just that, but Dr Foster alluded to the digital literacy.

So, in working with one of our rural health clinics in the state, not a very large rural health clinic, but she's in Bamberg.

They did 850 telehealth visits last year during COVID.

And I think that's pretty huge.

And in talking with her, probably 25% of their visits that start out with telehealth, they have to drop and go to a phone call.

Either because of an internet issue or because it's a patient that doesn't know how to use the technology, use their phone, use their iPad, they can't navigate it very well.

So, I think it all goes back to - I preach and preach on education because I think education is huge but when you put all this money that the state and the feds and I think it's wonderful that we're investing a lot of money into broadband - we have to teach people about it, right?

We have to teach them how to use the technology so they can see the benefit of having the internet, right?

And they need to understand they can use it for health, they can use it for education, they can use it to get a job.

I mean, they can use it to run their tractors if they're in a farming community.

I mean everything now runs off of Wi-Fi.

And I think we have to educate them on the technology.

We have to put devices in their hands, right?

There's no need for them to have the internet if they don't have a device.

So we're embarking on this really cool project with about 100 senior citizens in five rural counties in the state in an unusual partnership with the arts commission and the Department on ageing.

But we're going to put the devices in the hands of seniors who have been living alone.

We're going to teach them how to use it, we're going to pay for their service, we're going to teach them how to do telehealth.

Connect with their existing providers, right?

Not mess up that continuity of care.

And then teach them how to connect virtually with their family and their friends.

How to get on Facebook and connect and see pictures and you know, the things that we don't think about.

But a lot of our seniors have lived in isolation and have faced some really mental health challenges during COVID.

And I think it's incumbent upon us to find a way to help.

Not only the seniors, but I think they need help with the technology a lot but a lot of folks in our communities.

>> Perfect transition for us as we talk about telehealth and technology and how it is necessary, needed and hopefully a dominant part of our future.

Take a look.

[ambient music] >> I would say that telehealth is not really the wave of the future, it's here and it's now.

What we can do now is leaps and bounds greater than what we could've done five years ago.

In the future, you know, telehealth is just going to be healthcare.

>> As we transition to population health and to value-based care, we've started to realize we have to care for patients in different ways than we have in the past.

And in a more appropriate venue in many cases.

We look at try to control costs and providing patient focused care.

We've got to get into things like telehealth.

>> Certainly, telehealth really does a lot to help improve access to care.

Working with both, Palmetto Care connections and Telehealth Alliance, two statewide efforts that I think are helping to promote telehealth throughout the state to make sure that the patient gets what he or she needs and the local provider gets the support and the resources and the consultation that he or she needs.

>> It can be difficult for many of our patients being in a rural community to leave the community.

We are at least 20 minutes to Orangeburg and about an hour to any other major referral area so if the patients have to go to Charleston or Columbia, it can be a very time-consuming for them, it can be very costly.

>> It's very difficult to recruit providers to rural areas, let alone specialty providers.

So, instead of bringing the providers to our rural communities the thought is that we bring the services from the providers to our communities.

So even if your providers live in larger areas, you can still infuse those services into these rural communities.

So I think it is incumbent upon us to make sure that telehealth is part of today and it's part of the future.

It really is going to be the future of healthcare.

>> Telehealth technology is just a tool and it's a tool that we can use to solve problems that healthcare providers and patients have been experiencing for years.

>> Using tele-stroke, which is a way of videoconferencing in to these remote sites with neurologists at other facilities, we have the ability to examine and treat these patients in a much shorter time frame and a much quicker timeframe where they can get the treatment they need.

>> We are an area where in order for us to get healthcare that we need we have to travel.

This particular program is a much-needed resource as far as healthcare is concerned.

>> For my community, the African-American community, we do have a issue with trust in healthcare.

So, when you can get that established you can definitely reach more people.

But getting a phone call from someone and just speaking to that same person, you build a relationship.

>> Being able in the future to be able to transmit that data ahead of time, before the patient arrives at the emergency department so they can be ready, the physicians can have an opportunity to review all of the data and know exactly what's about to walk in the door before it walks in the door.

This has real applications to improving human lives.

Saving lives.

>> How's your breathing?

>> So far pretty good.

They get me where I need to be.

You know, they're still with me, they're still here.

I've got God and doctors.

They're sticking with me.

And I thank God for that.

>> I have a lot of students with chronic illnesses.

We have almost 99% of our student population who have Medicaid coverage.

So we hope to bring telehealth here for convenient healthcare access.

>> They instilled something in me that I can trust a little bit more, the virtual care.

You know?

I can trust the remote care.

It made me feel real well knowing that even though we didn't see them personally, they seem like they had my best interest at heart.

And I was ecstatic.

I was thrilled about the situation.

>> We're gonna turn now back to Adrienne because our online community has questions and comments as well.

It was a really good piece.

Really good piece.

>> Yes, they are very active tonight and we appreciate that.

So I have several questions and I'll ask these questions and you all can respond.

So, "Those that are living with pre-existing conditions "may be apprehensive about getting the vaccine.

"What advice do you have for that portion of our community?"

>> Well... [laughs].

The doctor has to answer?

No, I appreciate that.

You know.

This is tough.

You know, before I got into the work that I do now, I was in other versions of sort of, population health and vaccine hesitancy is part of it.

For a paediatrician, you know, it's a big one And so, I think it gets back to that trust, right?

And I think it gets back to that open dialogue about your concerns.

And about what your concerns are.

To have that trust to work with the provider that, you know, you can have that open dialogue about it and get to the bottom of that.

So I think that's the first channel is, everything we've been saying about opening trust.

I do like to sort of recall some of the lessons we talked about.

You know, when the polio epidemic hit earlier on and you so how about it was.

It happened to children and things like that.

People were lined up for their vaccines back then.

But vaccine hesitancy in any engagement healthcare has always been something to worry about.

So, I would say one, I would just plead to people to have an open conversation about their concerns and try to depoliticize it.

And I do think it gets back to stereotyping and racism and unknown things like that, that I think as a healthcare community we have to keep talking about.

We have to keep getting past to understand when someone has concerns about getting the vaccine that there's something deeper there that's worth partnering with and managing wellness and health with them.

And not think of it in other ways so...

It's a big problem but, you know, sometimes things, crises like these, sometimes they can bring up good in us too.

And I'm hopeful that as long as we keep this intentional conversation and talk about trust that we can get past a lot of that.

>> Thank you.

>> And I want to add to that because I think it's important as we have been listening to our community throughout, we've encouraged people to get factual information from a provider or someone who can provide them with informed information.

I will tell you, a lot of people out there are passing information from person to person from different sources, maybe the internet or somewhere else and as I hear them I'm saying, "Man, where are they getting this from?"

And so what I've encouraged people to do with pre-existing conditions and maybe those that may not, talk to your physician.

Sit down and talk to someone that you trust and can provide you with factual information and then make an enlightened self-interest decision that's best for you and your family.

And not make it based on all kinds of other things.

And that's why we've tried to use influencers.

One of the things I like, we have not tried to push the vaccine on anyone.

What we've tried to do is educate them, keep them informed and then I think that when they do that and they hear an influencer.

Maybe their pastor, their physician or someone else then the more likely to start thinking about it.

And maybe I do need to make that informed decision.

I've had people say to me, even in my own family, "Well, I want to wait and see."

My response is, "Let me tell you what I see."

I see that if you've taken the vaccine you are reasonably OK and not had any problems.

But if the virus affects you then there's 530,000 people in America that died from the virus.

So, just look at those two things and then again make your own informed decision based on trusted information as opposed to what I call internet information.

>> Absolutely.

Absolutely.

So how do we make sure that the broader scope of telehealth based services like prenatal care and home newborn assessments, how can they be continued as we move out from under the pandemic?

>> I'll just say I keep going back to policy because I think it's such an important element.

Just over and beyond service delivery.

And I think the pandemic was in one way it was brought that, like you said, we moved 10 to 15 years ahead.

And part of that was because we had policies that began to reimburse all different types of services for telehealth that had not been reimbursed before.

And the modalities were expanded.

You know, not only could you do it on video, you could do it on a simple phone.

You didn't have to have a video call.

And so if we can think about, how can we expand this?

You know, have group sessions.

There's been tested interventions where they've shown that groups of moms who come together and have prenatal care in a group setting can not only get that support from their provider but from one another.

So there's all kinds of ways that modalities can be there.

But we've got to make sure that the physicians and healthcare systems are having enough reimbursement that we want to continue incentivizing them to do this down the road.

>> So I agree, policy is crucial.

And I think when the pandemic hit and the federal government loosened up all of the regulations around Medicare, I think in our state the private insurers and Medicaid, they all stepped up and they did a great job of loosening those regulations to allow those patients to receive care.

And now we have to work with those payers to find common ground so that we continue with that reimbursement.

But I think a lot of it comes down to, I think something Juana said is the data.

You know, let the data lead it for you.

You can use the data.

We've had, I was on a call with Blue Cross and I think last year they had over a million telehealth claims filed, which is amazing.

Just in South Carolina.

And so we need to take that data and work together.

Not in silos, not as Prisma, not as MUSC, not as Medicaid.

Right.

We need to collect the data and see what the cost-effectiveness was.

What was the quality like for that patient?

And I think that will impact... And I think prenatal care has some...

I know Dr Donna Johnson down at MUSC has done some phenomenal work around prenatal care use in telehealth and I think the data will help us with that tell that story and lead that policy change that needs to be made.

But I think that we've got to come together as payers, as health systems, as community organizations and encourage people to put all that data together and let's look at it.

>> There are just so many good questions and we're running out of time.

These conversations are always so fruitful but as we start to wrap.

A great question off of Facebook.

"As we've been dealing with the pandemic now "for more than a year, "what mental health resources are available for folks "that feel isolated or family members concerned "about a loved one?"

>> Go ahead.

>> I was just about to say I was fascinated by the project that you've described.

That's innovation that's bringing unusual, nontraditional partners together to address the issue and challenges around mental health.

There been so many people over the past year that I know who did not previously struggle with the isolation who've had no choice but to deal with being alone and changing those relationships or ceasing or terminating those relationships hopefully for a very short period of time.

But we've got to create the opportunities for people to connect.

To look out for each other.

And perhaps replicate the kind of project that Kathy and her team are doing.

>> I hope so and I think for the mental health we have mental health agencies in each of our counties but now we're able to bring the mental health to the primary care practices so that stigma is removed and MUSC does a great job.

DMH does a great job of bringing the services into the clinics.

So, you can go in and people will just think you're there to see a regular doctor.

And you can go in and do a tele-mental visit.

Most federally qualified health centres offer mental health services and a lot of folks don't know that.

But go to your primary care provider if you don't have a mental health provider or are not comfortable and let them guide you on that.

And they can help you find those resources because there are lots of resources out there, people just don't know about them and we need to make sure that they're available.

>> And let me add to that, both of those because while I agree with everything that's been said but let's also extend that to the area of depression.

That some people may not attribute it to mental health but there's significant depression out there.

And as we go out into the community and people are dealing with chronic health issues, they're dealing with unemployment or lack of employment, food insecurities.

I could go down the list of those determinants.

Depression starts to creep in.

And so we want to encourage people to seek out your medical provider, seek out your pastor.

Seek out your neighborhood association president.

Sit down and talk to someone, a family member, and let them help guide you.

There's nothing wrong with that at all.

As we work with our senior citizens we found at one point they were calling EMS.

Not necessarily because of a chronic health issue but because of isolation and depression.

They would go to the emergency room just to make sure that they were around someone else.

I read a study recently that talked about Meals on Wheels.

Just as important as the food, was someone coming to the home so that they could have contact.

So let me also put that out there as well.

>> And I think that there, clearly again there is the juxtaposition of race and issue.

And so I think that there are some populations that struggle more with mental health challenges than others.

And so, I think it's really important to have a conversation with the provider if you believe that there's a mental health issue or challenge.

You gotta talk to somebody.

>> And we're gonna have to leave it there.

A really great conversation and hopefully a great springboard into another show because mental health and mental issues is a really important topic for us to tackle.

But we want to thank you guys very very much for joining us for South Carolina ETV and South Carolina Public Radio.

And all of us here.

I'm Thelisha Eaddy.

Good night.