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High Plains Community Health Center Care Teams

Summary 
  • Need: To meet demand for health care with a limited number of physicians, in a region where recruiting additional providers was impractical
  • Intervention: Implement care teams of 3 medical assistants to support each provider, with additional patient support through health coaches
  • Results: More patients seen per provider hour, with improved patient outcomes and clinic cost savings
Evidence-level
Promising (About evidence-level criteria)
Description

Rural Prowers County in Southeast Colorado has higher rates of chronic disease, poverty, and uninsured than much of the state. The High Plains Community Health Center, located in Lamar, serves over half of the county, with many patients who are elderly, uninsured, or dealing with chronic conditions.  High Plains, which was established in 1995, found itself struggling in the early 2000s with long patient wait times, low productivity, and financial strain.

In 2002, through funding from the Health Resources and Services Administration Patient Visit Redesign grant, High Plains redesigned its work teams with the goal of seeing more patients in a more cost-effective manner, with better patient outcomes. Through additional grant support from a Federal Office of Rural Health Policy Rural Health Care Services Outreach grant, the State of Colorado and several foundations, the center has worked to address chronic disease management and health disparities.

This Hitachi Foundation video provides an overview High Plains Health Center and its care teams:

The High Plains Health Center care teams are also featured in this Hitachi Foundation story on Storify:
Four Reasons Medical Assistants are Key to Transforming Healthcare

Services offered

High Plains Health Center has 30 patient facilitators (medical assistants) and 9 health coaches who provide support to 9 providers (physicians, nurse practitioners and physician assistants). High Plains cares for 9,000 patients per year.

Features of the High Plains care teams include:

  • Medical assistant patient facilitators who rotate between front- and back-office work in constant teams supporting the same provider.
  • Use of wireless laptops by patient facilitators, who handle clinical support tasks, answer phones, process medical records, and more, from anywhere  in the facility.
  • Patient facilitator role funded by operating budget, not grants.
  • Health coaches who help patients develop self-management plans and goals and who work to address health disparities
  • Spanish-speaking staff (health coaches) who can provide culturally and linguistically competent care to Hispanic patients
  • Grow-your-own approach to training new patient facilitators and to developing current staff into more advanced work, including additional skills like pharmacy technician training, and new positions such as health coach
  • Team bonus pay for meeting goals of average patients seen per day
Results

As a result of implementing care teams, High Plains has seen:

  • Higher productivity, with more patients seen per provider hour
  • Clinic cost savings of nearly $500,000 per year
  • Better health outcomes for patients with chronic diseases like diabetes and cardiovascular disease
  • Good jobs and opportunity for advancement for health center staff

High Plains Community Health Center has been recognized as a Pioneer Employer by the Hitachi Foundation.

To learn more about this program and its impact:

Broughton A., Strong T. & Faulkner L. (March 2016). How Innovative Teamwork Saved This Rural Health Center, Forbes.

Strong T. & Faulkner L. (October 2013). Care Team Redesign: High Plains Community Health Center, Hitachi Foundation.

Blash L., Dower C. & Chapman S. (November 2011). High Plains Community Health Center - Redesign Expands Medical Assistant Roles, University of California- San Francisco Center for the Health Professions.

Replication

Some issues that organizations may face in implementing similar care teams include:

  • Initial turnover as staff not comfortable with rotating front- and back-end responsibilities leave
  • Need for acceptance of the new model by providers
  • Staff technology skills may need to be upgraded
  • Turnover of physicians and nurse practitioners, who may come to an underserved area through a loan repayment program and stay only a limited time. Changes in provider staffing will impact the team's productivity and can be disruptive for patients.
  • Sustainability of positions focused on prevention and self-management, such as health coach, that may initially be funded by a grant.
Contact Information
Jay Brooke
High Plains Community Health Center
719.336.0261
jbrooke@highplainschc.net
Topics
Care coordination
Federally Qualified Health Centers
Health aides and assistants
States served
Colorado
Date added
October 14, 2013
Date updated or reviewed
October 6, 2015

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.