On average, chronically ill patients fill 49 prescriptions per year, have 37 physician office visits annually, visit 14 unique providers each year, and stay seven days in the hospital annually. Medical Network One aims to reduce these statistics with its proprietary Community Care Travel Team (CCTT). The CCTT is an innovative, cost-effective chronic disease management program that provides a range of support services to patients in their Medical Network One primary care physician’s office, rather than an offsite medical facility or hospital. Through our CCTT, we also have pediatric programs, to learn more click here.
The Community Care Travel Team is comprised of registered nurses, lifestyle coaches, wellness counselors, certified diabetes educators, registered dietitians, and exercise physiologists. Services include education in self-management practices, group visits involving CCTT members, patients and the primary care physician, and proactive phone calls by the CCTT to patients.
The Community Care Travel Team targets chronic conditions some of which include:
- ADHD/ADD
- Asthma
- Chronic Pain
- Congestive Heart Failure
- COPD
- Coronary Artery Disease
- Diabetes
- Hypertension
The CCTT concept is based on research performed by Edward Wagner, M.D. at the McColl Institute in Puget Sound, Washington and Kate Lorig, Ph.D. and colleagues at Stanford University, and shows that self-management, group visits and integration of the telephone into the care program work to diminish symptoms, enhance activity and increase independence for patients with chronic disease.
Medical Network One’s program encourages patients and caregivers to become more proactive in communicating with each other. For example, physicians or their assistants frequently call patients to discuss treatment plans and care issues before a scheduled appointment, in some cases eliminating the need for that particular office visit. Further, group visits are giving patients with similar illnesses an opportunity to set agendas for talking with their physicians and each other to learn more about effective ways to cope. This is important because studies show that patients learn most about coping with long-term illness and getting on with their lives from fellow patients.
The Community Care Travel Team program offers chronic disease management services in a cost-effective manner and lays the foundation for the creation of a “Patient-Centered Home.” A Patient-Centered Home is a health care setting that facilitates partnerships between individual patients, their personal physicians and, when appropriate, the patient’s family. To learn more about a Patient-Centered Medical Home, please click here.