High Plains Community Health Center Care Teams
- Need: Meeting health care demands in a region with a limited number of physicians, where recruiting additional providers is considered impractical.
- Intervention: Using the additional support of health coaches, implementation of care teams consisting of 3 medical assistants to support each provider.
- Results: More patients seen per provider hour, with improved patient outcomes and clinic cost savings.
Evidence-levelPromising (About evidence-level criteria)
Rural Prowers County in Southeast Colorado has higher rates of chronic disease, poverty, and uninsured than much of the state. Located in Lamar and serving over half the county, the High Plains Community Health Center, cares for patients who are elderly, uninsured, or dealing with chronic conditions. These geographic and demographic parameters created survival struggles for High Plains in 5 years since its 1995 opening. Long patient wait times, low productivity, and financial strain also put pressures on its healthcare delivery.
In 2002, through funding from the Health Resources and Services Administration (HRSA) Patient Visit Redesign grant, High Plains modified its work teams with the goal of seeing more patients in a more cost-effective manner, anticipating better patient outcomes. With additional grant support from the Federal Office of Rural Health Policy's 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.
During the grant cycle, High Plains Health Center had 30 patient facilitators (medical assistants) and 9 health coaches who provided support to 9 providers (physicians, nurse practitioners and physician assistants) who provided care for 9,000 patients per year.
Features of the High Plains care teams included:
- Medical assistant patient facilitators who rotated between front- and back-office work in constant teams supporting the same provider.
- Use of wireless laptops allowing work from anywhere in the building, patient facilitators handle clinical support tasks, answer phones, process medical records, and other tasks.
- Patient facilitator role funded by operating budget, not grants.
- Health coaches addressed health disparities by helping patients develop self-management plans and goals
- Spanish-speaking staff (health coaches) provide cultural and linguistic competent care to Hispanic patients
- Grow-your-own approach to training new patient facilitators and to developing current staff for more advanced work, including additional skills like pharmacy technician training, and new positions such as health coach
- Team bonus payments for meeting goals of average patients seen per day
As a result of the implemented care teams, High Plains saw:
- 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
High Plains Community Health Center was recognized by the Hitachi Foundation.
This Hitachi Foundation video provides an overview High Plains Health Center and its care teams:
Additional information can be found in these features:
Broughton A., Strong T. & Faulkner L. (March 2016). How Innovative Teamwork Saved This Rural Health Center, Forbes.
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.
Issues that organizations may face with similar implementation includes:
- Initial staff turnover due to job skill fit for rotating front- and back-end clinic responsibilities
- Awareness of change management principles to anticipate/accommodate provider attitudes
- Clarify specific technology skills
- Anticipate clinic flow and care disruption as well productivity impacts that may arise from provider turnover rates associated with workforce associated with loan repayment programs.
- Consider staff position sustainability issues after grant funding ends, such as health coaches focused on prevention and self-management
Federally Qualified Health Centers
Health aides and assistants
October 14, 2013
Date updated or reviewed
February 19, 2019
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.