May All Be Well

Greer Transitions Clinic breathes life into the Roper St. Francis Healthcare mission of healing all people with compassion, faith and excellence. Through a broad range of healthcare assistance and social services, this unique program has helped thousands of underfunded patients steer clear of unnecessary emergency room visits and find greater well-being. Learn how this bold new approach to health equity is strengthening the local community.

WRITTEN BY Stratton Lawrence
PHOTOGRAPHS BY Scott Henderson

The first thing that strikes you upon entering Greer Transitions Clinic is the sunlight. Soaring ceilings lined with windows allow natural light to pour in, creating a welcome, calming atmosphere. It’s the same design seen at several Roper St. Francis Healthcare offices around the Lowcountry, but this Rivers Avenue facility boasts a particularly bright vibe, thanks to its altruistic purpose. Here, in addition to healthcare, the staff also helps patients find a place to live, a new suit for a job interview or a ride to their next appointment.

A Fresh Outlook

People in lower-income households visit emergency rooms for preventable reasons two-and-a-half times more than individuals with higher incomes, according to the U.S. Census Bureau. Rather than perpetuating the ER as a place to receive primary care, Greer Transitions Clinic connects patients to the routine, preventive care they need while also steering them away from unnecessary ER visits. “Our greatest impact is in the quality of the care we provide to the underserved,” says Amanda Biondi, Clinic cofounder and program director. “I shouldn’t receive better care just because I have commercial insurance and someone else doesn’t. That’s the bottom line—equitable care across our system.”

Some 2,500 patients come to the Clinic each year, many of whom discover the program after landing in one of Roper St. Francis Healthcare’s six emergency rooms. The Clinic’s services are free to patients, and its goal is to be a one-stop destination for healthcare and social aid. There’s mental health counseling, a closet stocked with complimentary professional clothing, a fresh food pantry and an in-house social worker. A destitute patient may arrive with a problem such as debilitating diabetes and, in the best scenario, feel healthy six months later and have a new job along with a fresh outlook on life.

Although many other hospitals have similar aid programs, they’re often tucked away in the basement or in less attractive properties. Greer Transitions Clinic stands out by mirroring the same care that any insured patient receives in the Roper St. Francis Healthcare system. “Our mission is to heal all people with compassion, faith and excellence,” says Vice President and Chief Medical Officer Dr. Robert Oliverio, cofounder of the Clinic. “This space conveys intrinsic worth to every patient. Why wouldn’t we show our best face to every patient who comes in?”

Equitable Care

A registered nurse, Biondi has spent her entire career with Roper St. Francis Healthcare. Early on, she noticed that some patients returned over and over to the ER. When she asked why they kept coming back, all gave the same answer—at the ER, you can always get care, regardless of insurance or money. So Biondi built a spreadsheet of doctors willing to see uninsured patients and began calling for appointments. “I thought there had to be something better we could do for these patients, so that they could get consistent care at the right time without going to the ER whenever they ran out of medication,” she recalls.

The first Transitions Clinic opened inside Roper Hospital in 2012. Within six months, the program reduced the number of unnecessary emergency room visits by 50 percent, while also improving patient outcomes. By 2015, that success led to the founding of Greer Transitions Clinic, named for Roper St. Francis Foundation members Hank and Laurel Greer as thanks for their financial generosity. Just two years later, the Clinic moved into a standalone brick-and-mortar location.

“Every hospital admission costs the health system money,” explains Dr. Oliverio. But while the total expense of an ER visit could reach the thousands, an appointment at Greer Transitions Clinic may only run $250 (though patients aren’t charged for services). On an annual budget of $2 million, the Clinic saved Roper St. Francis Healthcare roughly $1.5 million in avoidable emergency room use and an estimated $15.8 million in avoidable hospitalization in 2021, simply by offering free health care to the people who needed it most.

In addition to its operating budget, Greer Transitions Clinic is supported by the Roper St. Francis Foundation. Donations to the Foundation go directly to supplies and resources for the Clinic’s patients, including medications like insulin.

A Life-Saving Refrigerator

Two-hundred seventy visits. That’s how many times one patient went to the ER in a single year for insulin to treat his diabetes. When he arrived at the Clinic, he claimed that he took his insulin daily, but his health didn’t improve. Every day was a new emergency.

A clinician visited the patient’s home and discovered that his refrigerator door wasn’t properly sealing. The patient’s insulin was losing efficacy because it wasn’t being kept cold enough. He was injecting it correctly but receiving little benefit. Clinic volunteers found him a replacement refrigerator for $300 at Habitat for Humanity. And because he no longer has to go to the ER every day, he is now able to hold a job.

Not every patient’s story is as dramatic, but the impact on individual lives is just as significant. About 40 percent of the Clinic’s patients have diabetes or prediabetes, and many arrive with mental health issues stemming from the difficulty of making money when they don’t feel well. At an intake appointment, patients see a clinician for 30 minutes. (The typical primary care visit for the greater population is half that.) Many patients have never seen a doctor outside of an ER before or had routine blood work.

“We use the discovery period to sort through all of those issues,” explains Biondi. Some patients are homeless or underhoused, so there’s a shower and free toiletries at the Clinic as well as a room stocked with shirts, suits and dresses. There’s also an in-house professional counselor, and the Clinic’s social worker assists with housing and, eventually, employment. Beyond that, a community health advocate connects patients to appropriate social aid programs. If patients need a ride to and from the Clinic, that’s offered via Uber and a branded Nissan Rogue, gifted earlier this year by Hudson Nissan. And the Clinic’s location in the heart of North Charleston’s food desert means its pantry—including fresh produce stocked in two refrigerators donated this summer—is in high demand.

Even simple items like reading glasses and feminine hygiene products can be lifesavers for patients. “If you have to make a choice between feeding your kids and buying a box of tampons, you’re going to buy food,” stresses Biondi. “But then you can’t be successful outside of your home, because you don’t have the supplies you need to live a healthy life.”

Dr. Oliverio emphasizes that providing for basic needs at a one-stop shop is a logical step toward improving health care. “People are here because they have difficulty accessing the traditional healthcare system,” he explains. “We try to anticipate patients’ needs, so they can overcome barriers to good health, whether that’s food, transportation or literacy.”

In Growth Mode

During the pandemic, Greer Transitions Clinic quickly pivoted, offering drive-through COVID-19 testing to over 100,000 people. Now that the program is again open for in-person services, they’re quickly increasing their offerings, including the new fresh food pantry. Video translators make it possible for non-English-speaking patients to directly communicate, and an expanded lab allows for a quicker turnaround on blood tests. “The more information we have at the point of care, the faster we can make decisions that will benefit the patient,” says Dr. Oliverio.

Three physicians, one nurse practitioner and an OB-GYN see patients at the Clinic throughout the week. Dr. Oliverio works there every Thursday. “It’s my happy day—I get to help find solutions for 10 to 15 problems in one shift,” he beams.

Whether it’s counseling for depression or assistance getting a cell phone, the Clinic’s all-encompassing approach accelerates patient recoveries. Rather than being sent off to specialists, patients may be seen weekly to check their progress and ensure they’re taking medication properly. When patients can’t afford medicines, the Clinic also helps them find assistance programs or covers medication expenses.

Return visits may include preventive care such as mammograms and prostate checks, and a paramedic makes house calls. In addition to addressing patients’ immediate health needs, the Clinic’s staff helps identify issues such as leaks causing mold, heating and cooling problems, even an inoperative refrigerator.

Moving Forward

As successful as Greer Transitions Clinic is in serving patients and saving money, it’s only able to serve a fraction of the total community need. Demand for medical care at Roper St. Francis Berkeley Hospital already indicates a need for a second Clinic, although funding and plans for expansion are not yet underway.

Today, the Clinic serves new clients by graduating others into more traditional primary care. Most patients arrive at Greer Transitions Clinic as the next step to an ER visit; as they discover they have a consistent place for routine care with a doctor who will listen, they may call daily with questions. “It’s our responsibility to teach people how to be a patient,” Biondi explains. Once they’re stable and comfortable within the confines of a typical 15-minute appointment, they transition to the greater Roper St. Francis Healthcare family of practices.

Dr. Oliverio believes the results speak for themselves, both in fostering healthy, productive citizens and in helping fix the broken parts of the healthcare system. “The easiest thing for folks to do is to pick up the phone and get an ambulance directly to the most expensive level of care,” he says. “We prevent that from happening.”