3 Ways Medical Home Physicians Can Help Patients Manage Care

Tuesday, February 1st, 2011
This post was written by Jessica Fornarotto

Dr. James Kerby, vice president of medical affairs at Grand Valley Health Plan, suggests three ways that physicians and/or practices can assist their patients in managing their health and wellness.

Question: What are some best practices for medical home physicians or practices beyond standard appointment scheduling or asking the doctor a question online etc., to help patients better manage their wellness and chronic disease?

Response: We have implemented several approaches to enhance our patient’s capabilities. For those that have chronic illnesses, we have implemented shared appointments where a practitioner along with a health coach and often a nurse meet with eight to 10 individuals at a shared appointment to conduct their actual diabetes visit, for example, but do it in a group setting in terms of education and support in developing individual disease management (DM) plans.

Also, we issue report cards for our patients with diabetes. After their diabetes visit, we give them a report card of where they stand with goals that have been established for different parameters, such as the HbA1C level or completion of their annual diabetic retinopathy eye examination. Also, for wellness support, we use health risk assessments (HRAs) to interact with our well individuals and try to enhance their activities and maintain their health.

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