After months of work, a new program led by Bothwell Regional Health Center and designed to connect people with health and well-being resources has launched in the community.

In July, Bothwell was named one of six hospital community hubs to participate in the state of Missouri’s Transformation of Rural Community Health (ToRCH) pilot project after expressing interest in the program in January 2023.

The health center will receive state and federal funds over five years to implement and manage the program. Funding is from the Missouri Department of Social Services and the MO HealthNet Division, which manages the state’s Medicaid health insurance program.

Maggie Schaffer, Bothwell’s Director of Quality and Case Management, said the program is an opportunity to help Pettis County’s Medicaid population.

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“Funding from the ToRCH program will allow us to implement strategies to help people avoid preventable hospital admissions and emergency room visits,” she said. “The really valuable piece is that it brings in community partners to address ‘upstream’ causes of poor health outcomes and provide a more coordinated network of health and community resources for people who receive Medicaid."

Missouri’s Medicaid program helps people with limited income and resources with their health care costs. People who are eligible include pregnant women, children, someone responsible for a child under 19, someone with a disability or caring for a disabled family member, people aged 19 to 64, including parents and adults without children, and people 65 years or older.

According to current figures from the Missouri Department of Social Services, 13,880 or 33.4 percent of Pettis County’s population is enrolled in Medicaid.

Schaffer said someone’s health is more than just having their medical needs addressed.
“Our ultimate goal is to address what we call the ‘social determinants of health’ such as education, housing, employment and social support networks, as well as access to health care,” she said. “It’s a holistic approach. A person’s living situation absolutely affects their physical and mental health and this program brings together several organizations that will help people navigate resources to get the help they need when they need it."

The program works by connecting Bothwell and community partners to a common computer platform that allows participating organizations to securely send and receive electronic referrals while addressing Medicaid participants’ social needs.

“When we started talking with the area service organizations, we found many weren’t always aware of what other services were being offered outside of their own organization,” Schaffer said. “Through the community information exchange program and the referral process, all partners can see the services someone has visited and received. When needed, they can look up an organization and refer someone to receive additional services such as getting food from Open Door or housing or utility assistance. It’s going to be wonderful to be better connected to each other and manage the health and social needs of our community together."

The name of Bothwell’s ToRCH hub is “Be Well" and includes several clinics and organizations with representatives who serve on a leadership board and advisory committee. Bothwell is the fiscal agent for the program and the leadership board sets the budget and project priorities.

“The program is built on robust partnerships between the hospital, primary care providers, mental health providers and community-based organizations that provide important social services,” Schaffer said. “We will work together to improve the health of our community and decrease the preventable number of visits to the hospital or emergency room, which is a win-win for everyone."

The other five hospitals selected by the state to be community ToRCH hubs include Golden Valley Memorial Healthcare in Clinton, Ray County Hospital and Healthcare in Richmond, Citizens Memorial Hospital in Bolivar, Salem Memorial District Hospital and Phelps Health in Rolla.

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