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Wellness Connexions™ Disease / Medication Therapy Management
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Wellness Connexions™ is Healing Our Village’s solution to improving patient outcomes for chronic disease states. The model is designed to empower patients to take control of their illnesses; especially patients that are economically challenged, ethnically diverse and medically underserved. Many socio-economic factors result in these patients “slipping through the cracks” of most disease state management program. Extensive medication review and disease management, outcomes tracking and patient centered care improves clinical and educational contacts and “closes the gap” found in most disease state management models. Additionally, HOV helps physicians to document clinical outcomes and quality measures that will be required by Medicare and Pay for Performance (P4P) programs.
The Wellness Connexion™ begins with the identification of targeted “at risk patients” with multiple co-morbid diseases. After the patients are identified, “Wellness Coaches” are the first point of contact. The role of the “Wellness Coach” is to provide basic health information, training in health care devices (blood glucose monitors, blood pressure cuffs) and enrolling the patient in the Medication Therapy Management or Disease Management Program. The Wellness Connexions™ model consists of wellness coaches, clinical pharmacists, registered dieticians, certified diabetes educators, and physician assistants.
If a drug therapy problem is identified, the Clinical Pharmacist will provide a consultation to the patient. The pharmacist communications with the primary care provider (PCP) via an e-FAX to alert the Physician of any health threatening situations, concerns and suggestions for modification in the drug therapy regimen.
Wellness Connexions™ provides e-Consults using state of the art videostreaming allowing patients to have “real-time” conversations with HOV health care professionals regarding chronic disease self-management skills. During the e-Consult the patient is updated regarding their clinical and behavioral goals via a Personalized Health Assessment. The Personalized Health Assessment form is given to the patient and also placed in the medical record. It serves as a tangible tool for improving the dialogue between patient and provider.
The Wellness Connexions™ program is built on the premise that additional professional intervention and more exposure to patient education will assist in moving clinical measures into preferred ranges, (for example, HEDIS measures for diabetes) decreasing health care costs and improving lives.
Other products and services available in the program include:
- Wellness on Demand ™ Medical Nutrition Therapy - “Live” nutrition classes (small group or individual appointments) offering personalized nutrition education and meal planning
- Wellness on Demand™ Patient Video Education Programs via the internet or DVD