Andrea Wicher: At Community Health, our focus is on prevention | #education | #technology | #training


This commentary is by Andrea Wicher, Community Health’s director of population health and quality. Community Health is Vermont’s largest Federally Qualified Health Center, a network of primary care, pediatric, behavioral health, dental and pharmacy services with offices in Rutland, Brandon, Castleton, West Pawlet and Shoreham. 

The evolution of care management as a critical primary care service in Rutland County has illuminated how prevention has become a key opportunity to improve outcomes. 

While that may seem obvious, the complexities and cost of delivering health care have overshadowed the importance of prevention. Care management is the service that can address the need for increasing the focus on prevention by providing patient education, recognizing social determinants of health and addressing complex care needs with preventive programs that can potentially head off health issues in the future.

As director of population health and quality, I focus on education, communication and prevention, which have become top priorities at Community Health.

In Vermont, we are committed to improving the system of health care available to everyone. The state’s accountable care organization, OneCare, is supporting an all-payer, value-based model funded by the federal government. 

Value-based care encourages and rewards our primary care mission to deliver quality care in the form of treatments, early intervention and prevention in an effort to reduce health care spending. The Rutland Region Community Health Assessment completed in 2021 identifies social determinants — such as access to food, housing and transportation — as having a significant effect on health issues in the future. The report also zeroed in on conditions, such as diabetes, and populations, such as those over age 65, as being at risk. 

At Community Health, we have identified several priority prevention programs as the basis for the creation of clinical responses to prevailing issues in the region that were highlighted in the health assessment. These are the three programs that we are currently focused on: 

  • Medicare annual wellness visits
  • Sepsis/UTI awareness
  • Pre-diabetes/diabetes education

The Medicare Annual Wellness Visit is a free service offered through Medicare that focuses on prevention and is designed to keep people healthy, lower their risk of illness and injury and provide the support needed for a healthy quality of life. The purpose of the visit is to review an individual’s wellness and develop a personalized prevention plan. Medicare covers one free annual wellness visit each year for those enrolled in Medicare Part B for at least 12 months. There’s no copayment or deductible for the visit.

Sepsis, the third-leading cause of death in the U.S., is a life-threatening condition caused by the body’s response to an infection. Urinary tract infections are common infections that are mostly preventable. If ignored or untreated, a UTI can lead to sepsis. UTI is one of the most common emergency department illnesses in Rutland County. 

Diabetes, a condition that occurs when blood sugar or blood glucose is too high, was identified in the Community Health Assessment as affecting 13% of the population in Rutland County. Community Health supports an ongoing certified diabetes education program for those with diabetes. Our focus has turned to educating and informing the public about preventing diabetes by identifying those at risk for diabetes and educating about the signs of pre-diabetes. 

Education, training and use of technology are ways that Community Health is improving the delivery of preventive care services. Access to data about health care and its outcomes has helped identify the gaps in care and where preventive services would have the most impact. 

According to the National Library of Medicine, “The Affordable Care Act has led to several key policy changes that incentivize both patients and providers to engage more in preventive care. For patients, the ACA removed cost-sharing for a wide range of primary and secondary disease prevention services, and it introduced Medicare annual wellness visits that focus on prevention. ACOs, according to the government, “are increasingly motivated to deliver preventive care services.” 

By sharing the data and preventive care mindset with health care providers, we have been able to elevate the impact of preventive care services and encourage value-based care as having an added focus on quality improvement while delivering the highest level of health care to improve outcomes.

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Tags: Andrea Wicher, care management, community health, preventive health care, Rutland County

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