Health Partners Program
Relationships act as the glue which holds the healthcare system together. In healthcare, nearly every healthcare provider has a significant number of patients who could benefit from extra relationship-based support. These patients—such as seniors, those with mental illness, those with multiple chronic illnesses, and those struggling amid psychosocial stress and turmoil —require assistance in areas that fall outside of the current scope of the healthcare system. Because of this, these vulnerable patients tend to be the highest utilizers of health services and largest drivers of health costs.
Because the system is not well designed to meet their needs, these patients often miss appointments, struggle with their medications, and have difficulty communicating accurately with physicians about their home life or other medical care. With only 5-10 minutes to spend with each of these patients, providers understand that they are being set up for failure.
Our model provides gap year Fellows to work with providers and act as “health partners” with these patients. This changes the clinical model in two ways: first, it provides help with behavioral change, psychosocial support, and other needed high-touch support for patients outside of the clinical setting. Second, health partners help bring order to visits so that providers can be more effective in helping patients. Our Fellows do this by accompanying patients to their clinic visits with a current medicine list, providing an accurate contextual understanding of what is going on with the patient and what has happened between visits, and assisting in follow-up care.
Almost all providers understand that filling these simple but underappreciated gaps helps improve quality, reduce costs, and increase patient and physician satisfaction. Each Fellow is able to provide needed extra support to 10-12 of these high utilizing patients which allows a 12 Fellow team to cover a total of 120-150 patients.