Accountable Care Organization Q&A with Amy Chenoweth, LPN

The Accountable Care Organization (ACO) team plays a vital role to Barbour Community Health Association from coordinated patient care to providing education to the staff that works within BCHA’s organization to help best treat and assist our patients. The team promotes integrated and higher quality care and seeks alternatives to fee-for-service for BCHA patients.

We chatted with Amy Chenoweth, LPN, Team Lead Coordinator for BCHA’s Accountable Care Organization about the value that this team brings not only to BCHA but the Barbour County community.

Q: How long has the ACO team been a part of BCHA?

A: We have been providing these services for a while, but within the last year we noticed these services overlapped and decided to bring this team together for a more integrative approach with our services such as Accountable / Quality Care, Follow up ED calls, Advance Directive Care, Transitional Care Management and Annual Wellness Visits.

Q: What services does this team offer?

A: Our team provides many services. The Annual Wellness Visit (sometimes referred to as a Medicare Wellness Visit) offers one free visit a year with your primary care physician. During this visit, we make sure your chart is completely updated and make sure all necessary screenings are done. These visits are for anyone with Medicare Part A and B coverage. The nurses on our team who conduct these visits are trained by Aledade, an organization that helps us pull all the data together for these visits.

Another service is Transitional Care Management. After a patient spends time in the hospital, our nurses contact them to help make sure they have all their orders in place and arrange a hospital follow up with their PCP. After a visit to the hospital, it can be difficult for patients to locate oxygen, canes, or anything else they might need and that’s where our Transitional Care Nurses come into play. They work as a liaison between the hospital, patient, and the patient’s PCP to make the transition back to home and regular appointments easier.

Finally, we offer Accountable/Quality Care Management, which is where one of the nurses on our team will check in with patients that are due for screenings or tests and help educate them on the importance of this screening. They answer questions regarding procedures, medication, diet, and much more. This program is designed to help capture past due screenings to prevent health problems before they occur. We want to assist patients to live a healthy lifestyle and reach their health goals!

Q: What kind of patients, typically, are utilizing these kinds of services?

A: The patients who typically use or are eligible for these services have Medicare Insurance and are usually 65 and above.

Q: What kind of projects and tasks do you do to keep the team running smoothly?

A: Our team gets together monthly for meetings. Communication is a key for our team so being able to get together and check in on how things are working with everyone is important and if there are any problems or concerns that need to be discussed. I have a great team that I trust, so it’s not hard to keep it running smoothly!

Q: Who makes up the ACO team?

A: Erica Weese, RN, and Chelsea Reed, LPN, our Accountable Care/Quality Nurses at our Belington Medical Clinic and Myers Clinic, they handle the emergency department follow-up calls, Advance Directives Care, and ordering screenings and tests for Quality care of patients. Brandy Cunnigham, LPN works as our Transitional Care Nurse and helps with Annual Wellness Visits at Myers Clinic. Jamie Carpenter, LPN handles our Annual Wellness Visits at Myers. At Belington Medical Clinic, Ashley Spencer, LPN, works as our Transitional Care Nurse and helps with Annual Wellness Visits. And I am the Team Lead Coordinator of the ACO Team and work with the Annual Wellness Visits.

Q: What are probably the biggest parts of this whole team that you would like the community to know about?

A: An ACO is a group of medical professionals that’s providing high-quality care. Our goal is to make sure that patients are getting the right care at the right time, avoiding duplication of services, preventing medical errors, making sure patients’ medical histories, medication and allergies are up to date, as well as vaccinations and screenings. It’s more of a preventative care. We want to prevent illnesses and problems before they begin, and that’s the importance of these screenings.

If you or a loved one is eligible for any of these ACO services, give our talented team of experts a call at either our Belington Medical Clinic or Myers Clinic! They are here to help, educate and guide you into the right direction.