Transforming The Role Of Medical Assistants In Chronic Disease Management

PRACTICE UNITE Health Center. WHO AND WHERE Multiservice health center in New York City, funded primarily by capitation, for union members and their families. Provides care to 10,000 patients, who make 55,000 visits annually. CORE INNOVATIONS Medical assistants are trained to teach patients to manage their chronic diseases and facilitate behavior change. They monitor patients' progress and function as key members of medical home teams. Those who pass all modules of the nine-month curriculum are promoted to become health coaches, who work with patients individually, lead support groups, and coordinate care. KEY RESULTS Between 2005 and 2009, a subgroup of 510 diabetics who were continuously followed showed statistically significant improvements in the percentage with control of their blood sugar levels, blood pressure, and cholesterol. The percentage with all three markers controlled rose from 13 percent to 39 percent. The entire cohort of 1,100 diabetic patients also showed significant improvement for each marker. Among 3,000 New York City union members, health care costs in 2007 were 17 percent lower, and emergency room costs 50 percent lower, for those receiving their care at the center. CHALLENGES Medical assistants received training that included participation by nurses, other staff members, and consultants and required dedicated meeting time. An electronic health record system was essential for tracking patients. Monthly capitation payments permit the center to deliver innovative programs involving nonbillable services.