Jessa Dunivan: Cohesiveness Is Vital to Maintaining a Successful Care Management Team

Everyone at the practice is vital to the success of value-based care, which is really patient-centered care, said Jessa Dunivan, patient services manager, Northwest Medical Specialties.

How are patients educated and informed about the care management team and the role the members play?
We work really hard as care coordinators to make sure that every person in the practice understands their role. In order for value-based care to work, it requires complete practice transformation. That means that everyone is vital to this. We have our core care teams, but everyone at the practice is vital to the success of value-based care, which is really patient-centered care—highly coordinated care—for these patients.

The patient care coordinators help to educate the staff by helping them understand why they’re doing what they’re doing. For example, medication reconciliation. Under the [Oncology Care Model] medication reconciliation is defined as a medication being listed with the dose, the frequency, and the route of administration for every single med, and to be reconciled at each encounter. If there’s one medication upon chart review that might have the dose and it might have the frequency, but it doesn’t give you the route, the patient care coordinators are looking at that information and tasking the appropriate people to make sure that that gets added in.

Where this becomes very important is if that same patient comes into our clinic and their medications are not reconciled properly and then a day or 2 or hours later, they end up in the emergency room. The information that the doctor that’s taken the handoff from us needs to be as accurate as possible in order to maintain that high quality of patient care. Without the medications being reconciled properly you run into other errors that could happen down the line.
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