Caswell County Near Rock Bottom: The Community Clinic

Caswell County Courthouse

Caswell County Near Rock Bottom

The Community Clinic

In Carolina’s Piedmont, Yanceyville is just 40 miles northeast of Greensboro, 42 northwest of Durham. But it’s a different world. The ornate Caswell County Courthouse, completed in 1861, with its domed cupola and Romanesque arches, harkens back to an era when bright leaf tobacco (and later textiles) were king. That’s gone; nothing has replaced it. Once the wealthiest county in the state, Caswell is now near rock bottom; its small commercial strip has a vacant, defeated air. People who are employed drive well beyond Yanceyville to a minimum wage job or service sector job -- until the car breaks down and they can’t afford to fix it.

It’s also the home of the Caswell Family Medical Center, which has seized on every tool it can to walk the value-based walk and improve the health of not only individual patients but its broader community. The Caswell clinic is what’s known as an FQHC, a federally qualified health center. Pretty much everyone who walks in is low-income, though not all are uninsured partly because even without Medicaid expansion Obamacare boosted insurance coverage in North Carolina. Working with Blue Cross, the clinic has brought in data and dashboards for “population health,” making it easier to track a patient due for a cancer screening, or immunizations, supporting prevention and chronic disease management. But coordination is hard when local people scatter for work across such a broad region.

“Our patients are all over the place,” said Shannon Moretz, the clinic’s director of strategic initiatives. Ten hospitals, two states, it’s hard to keep track, hard to follow up, hard to coordinate, hard to address the social drivers. There aren’t enough Caswell patients in any given hospital to make a dent in the bottom line, so unlike WakeMEd these hospitals have little incentive for them to step in big-time to help this small depressed community.

Caswell Family routinely screens for social needs like transportation, housing and access to healthy food, said nurse Casey Moore. But it relies on a patchwork of services, churches, volunteers and philanthropies to fix things. For instance, the local summer lunch program for school kids, such as it is, is cobbled together by two retired kindergarten teachers, at least one of whom is in her 70s.

“The rest of the free world is talking about opioids – but there wasn’t even an AA meeting in this county,” said the clinic’s CEO, William Crumpton, who was a patient here as a child and returned midcareer to run this place (and help the community get two AA meetings started).

He and other staff at the Caswell clinic sees the state’s “Healthy Opportunity” Medicaid program and its new online social service network on the horizon. But they fear they are too remote, the community too limited in resources and capacity to take part or benefit.

“We’re not sure,” Crumpton said, “we’re ever going to see any of that money in Caswell.”

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Joanne Kenen is POLITICO’s executive editor for health care.