Featured Practice: Charis Health Center– Identifying Patient Barriers

This week, we’re looking at Charis Health Center, located in Mount Juliet, Tennessee. They operate as a primary care office providing service to the medically uninsured in Wilson County, TN, as well as surrounding counties. With support from the community, they have been able to limit costs for all patients, charging only $25 for a visit. The clinic is affiliated with the Tennessee Charitable Care Network (TCCN) and The Safety-Net Consortium.

Charis struggled with educating their ESL patients on the mammography procedure and with a lack of patient knowledge of family history. Reports were not consistent or shared consistently with the practice. To address these concerns, they began educating patients on the importance of screening, informing them of high-risk factors, and encouraging them to perform self-checks at home. They worked with their team on consistent reporting and transparent sharing throughout the practice regarding patients who are in need of breast cancer screenings.

The practice also didn’t have a process to track ED visits or schedule follow-ups with patients in a timely manner. As such, they educated patients on the importance of preventative care, informed them about vital levels and when they are at risk, and encouraged patients with cold-like symptoms to “pretreat,” i.e. plenty of rest, symptom control with over the counter medicine, continue hydrating, etc. They also created an option in their check-in form for patients to record visits to the ED. They began using a logging system to track ED patient visits between appointments, and they performed follow-ups with patients within 24-72 hours of hospital visit. Additionally, an afterhours number with 24/7 access was provided to all patients.

As a result of these implementations, they decreased patient ED visits by 2% in 2018 Q4 from a 4.31% baseline in 2017 Q4. Overall, reporting on these metrics has helped strengthen the provider/patient relationship, streamlined workflow and processes for providers and patients, and made their workflow more efficient and effective.

Charis Health Center’s diabetic patients also faced a number of hurdles to maintaining and controlling their A1c levels. The prescriptions unavailable through PAP (Prescription Assistance Program) were too expensive for many patients, which made them non-compliant with diet plan. The clinic was not studying care gap reports on patients who needed or missed testing, so reports were not consistent, nor were they shared consistently with the practice. To change this, they identified the barriers with patients to plan a targeted approach to patient education and shared decision making. They set up pre- and post-visit check-ins and special appointment types, increased their patient education program, and worked to increase availability to the medications and PAP program. Through these efforts, they reduced the number of diabetes patients whose A1c levels >9 from baseline (33.3%) to 5.55% in 2019 Q1 and clinic has seen a 27.8% decrease from baseline.

Since reporting on this metric, the Charis Health Center patient experience has become immensely positive. Providers are now better prepared for the day in clinic and know what to expect from their patients, who now feel more empowered and engaged with their healthcare and are significantly more compliant with self-management logs. Charis teaches us an important lesson about how managed care can improve patient education by encouraging them to be their own medical advocates in their healthcare. Providers have implemented shared decision-making techniques within their team can and will make a tangible difference in the lives of patients.

The views expressed in this story are those of the authors and do not necessarily represent the official views of Charis Health Center. Additionally, this work was funded by the U.S. Department of Health and Human Services – Centers for Medicare and Medicaid Services’ Transforming Clinical Practice Initiative, under grant number 1CMS331549-03-00. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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