Telluride Med Center: Wellness Counseling Works

Wellness Counseling offers Low-Cost, Low-Intensity Preventive Care at the Telluride Medical Center

New wellness counseling services at Telluride Medical Center (TMC) are paying off for many patients and receiving national attention.

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Recognizing some patients are more willing to collaborate with their health care teams to actively improve their health, clinical leadership at TMC sought strategies to better support enlightened patients, as well as assist everyone in self-management to prevent worsening conditions and lower risk factors for disease.

In March of 2013, TMC began to explore wellness counseling as an additional patient management strategy by creating two hybrid positions to coordinate care and provide wellness counseling to patients with chronic diseases.

According to Care Manager Paula Scheidegger, the Primary Care team meets monthly to review charts of chronic disease and high-risk patients. Ideal candidates for wellness counseling are patients who express an interest in improving their health through lifestyle modifications.

Care Managers, Scheidegger and Bridget Taddonio, then call patients to schedule an initial wellness counseling visit. During the two-hour intake appointment, counselors educate patients about the conditions that qualified them for counseling, provide educational materials and emphasize the root causes and lifestyle changes needed to manage symptoms.

“We work with the patient to build a care plan specific to their goals, preferences and willingness to make changes. We discuss barriers to success and problem-solve together to identify workable, sustainable solutions. We also create a schedule for ongoing follow-up sessions, which can vary from weekly, monthly or longer intervals, although most patients are seen monthly,” says Scheidegger.

Follow-up sessions occur in the clinic or by telephone and are scheduled in 60-minute blocks, during which the counselor reviews the patient’s progress in realizing his goals, takes vitals, goes over any new lab reports and update medication history. Caregivers and family members are welcome to participate with the patient in the counseling sessions.

As TMC began to see success with patients with chronic disease, services were expanded to include patients with new diagnoses of pre-diabetes or the need for weight reduction.

When the project began, a care manager and wellness counselor saw patients on Thursdays. By August 2014, the Primary Care Team’s confidence in the effectiveness of counseling and the resulting increase in referrals pushed the need for counseling appointments to six days per month. Word-of-mouth referrals from satisfied patients also increased the requests for counseling appointments.

To date, 84 patients are enrolled in wellness counseling for a range of conditions and diagnoses, including irritable bowel disease, eating disorders and depression.

Practice data is showing consistent improvement across disease management in measures such as hemoglobin A1C, blood pressure, BMI, LDL and smoking cessation attempts.

“It’s very exciting data. We’re really seeing here how health care and not just sick care can work in our community,” said Scheidegger.

Last month, TMC was featured by the Comprehensive Primary Care Initiative National Spotlight from the Centers for Medicare and Medicaid Services as a benchmark for other primary care practices around the country.

Funding for the Care Manager positions stem partially from the Center for Medicare & Medicaid Innovation, state funds and grant monies from Tri-County Health Network, a private community foundation.

TMC leadership sees such value in these positions that budgets have been adjusted to accommodate these services.

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