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Delivering High Value Care

The Journal of the American Medical Association refers to high-value care as “providing the best care possible, efficiently using resources and achieving optimal results for each patient.”  How does this translate into our day-to-day operations? 

Consider two different approaches to a patient visit with their primary care provider for ongoing treatment of a chronic illness:

PATIENT ONE

Patient Visit

  • The patient comes in for a scheduled appointment.
  • The provider realizes the patient’s labs have not been ordered.
  • They have a general discussion on the patient’s condition, managing the patient’s chronic illness, and what a care plan could look like for different scenarios based on the lab.

Post-Visit

  • The provider orders the necessary labs.
  • The patient has their labs completed.
  • The provider reviews the results and relays a message to the nursing staff.
  • A nurse relays the provider’s notes to the patient.
  • A second appointment is scheduled to discuss a care plan.

PATIENT TWO

Pre- visit

  • The health center’s team meets to review the list of scheduled patients for the following week.
  • Pre-visit lab testing and other diagnostics are arranged.
  • Necessary information for the upcoming visits is gathered.

Patient Visit

  • The patient arrives for their visit with their provider
  • The patient and provider discuss the lab results in-hand.
  • The provider answers patient’s questions, face-to-face and in real time.
  • The patient and provider discuss next steps and the care plan moving forward.

    Pre-planning is key to the successful delivery of high-value care.  Jun Chon, MD, ECH’s Chief Medical Officer and Program Administrator said, “pre-visit planning saves time, reduces costs and improves patient care as well as the patient experience.” It demonstrates to patients that our practice is planning ahead to make their next visit as meaningful and productive as possible.

Crown Point Health Center to Launch High Value Care Pilot

In October 2023, the Crown Point Health Center will launch a High Value Care pilot program to help improve care delivery and patient outcomes. Chon added, “preliminary meetings with staff have helped us build a foundation through sharing purpose and expectations.” These meetings along with key learnings from the University of Vermont Medical Center’s Primary Care Test & Learn Sites, will help the pilot get off to strong start leveraging four tenants:
 

  1. Engage patients: Communicate care needs to patients and emphasize the importance of patient participation in their care.
  2. Pre-visit planning: Prepare for visits by conducting pre-visit planning protocols, noting gaps in care that need to be addressed.
  3. Close care gaps: Schedule and see patients in a timely manner for the care they need.
  4. Document correctly: Correctly update patient records to ensure provider follow up on chronic or potential conditions for review of chronic or suspected conditions.

The pilot program is designed be replicated and rolled out to all of ECH health centers over the next year.  A new staffing model will be put in place that includes the addition of a new RN to assist in pre-planning, triaging patients and ordering appropriate tests.  A total of six RN positions, one for each health center, have been budgeted. 

By transitioning to the high value care model, we can better emphasize and coordinate and patient-centered care as a way to promote wellness, reduce the impact of chronic disease, improve patient outcomes and control costs.