Transitioning Bundled Services for “One Well Visit”

Authors:

Lynette Phillips, Utah Department of Health
Shellee Smith (Presenter)
Utah Department of Health

Public Health Statement: Transition to a medical home can increase screenings

Purpose: To establish medical homes, the Utah Breast and Cervical and WISEWOMAN programs transitioned clients from their largest provider, a local health department, to multiple Federally Qualified Health Centers (FQHCs) in the area impacting roughly 50% of program clients or approximately 2,500 women annually.

Process included—

• Establishing protocols for clinical breast exams, Pap tests, cardiovascular services, and lifestyle coaching to clients at the same ‘well visit.’
• Developing paperless pre-registration and phone scheduling processes to reduce FQHC/client barriers.
• Creating forms for client eligibility information, screening history, and preferred mammography facility.

Goals and Objectives—

1. Transition 50% of target clients within 12 months.
2. Reduce paperwork burden at clinic appointment.
3. Collaborate with FQHCs to develop a workflow process.

Methods/Approach: Reminder letters were sent to established patients with a toll-free pre-registration number. A database tracked the number of reminder letters sent, patients transitioned to FQHCs, and new clients enrolled in the affected area. A survey was sent to FQHCs to gauge the pre-registration process and any clinic burdens.

Results:

1. Letters were distributed to 3,512 clients between November 2015 and October 2016, and 1,375 transitioned to an FQHC (39.2%).
2. FY15 showed 2,176 women (680 new clients). FY16, 2,331 women enrolled (956 new clients) with a 40.6% increase in first-time clients and a 7.12% increase overall.
3. 100% of FQHCs rated the process sustainable and would recommend to other clinics.

Conclusions/Implications: Data indicates transition was highly effective.