Improving Health Care for Medically Vulnerable Patients

The Robert Wood Johnson Foundation Safety Net Value Champions Fellowship was launched earlier this year.

It was created to support clinicians, particularly in safety-net provider settings, who have the potential to be remarkably effective in addressing overuse by increasing the engagement of providers.

The nine-month program offers training based on the Taking Action on Overuse framework — a road map for action and behavior change that leads to reductions in medical overuse — and what has been learned from implementing it since its publication in 2017.

The curriculum includes not only in-person convenings, but also one-on-one mentoring by faculty as fellows implement projects to reduce overuse in their home institutions during the program.

“We selected fellows based on their potential to be extraordinary change agents,” says Michael L. Parchman, MD, who is principal investigator of the Taking Action on Overuse program.

“We are thrilled to support individuals with a variety of clinical backgrounds — not just physicians — as fellows because we believe in the power of team-based care,” he adds.

A safety-net provider is someone who serves vulnerable populations — such as low-income patients, patients with physical and mental disabilities, refugees and patients who are under-insured or uninsured.

“I met the other fellows in Seattle, and I think we all shared the same barriers to providing care — poverty, uninsured patients and lack of jobs,” Diaz Del Carpio says.

“Buffalo may be somewhat unique because of our refugee population,” he adds. “It makes it more challenging and also motivates us to be more creative in our approaches to deliver high-value care.”

Medical overuse (or low-value care) is widespread and includes unnecessary diagnostic tests, treatments and hospitalizations. Unnecessary services can drive up costs and — most importantly — cause physical, emotional and financial harm to patients.

Reducing overuse is a long-term proposition that requires new approaches to what were once standard ways of delivering care.

The fellows will help build cultures where clinical teams can take ownership for reducing overuse — for all populations, and with special emphasis on those with fewer resources to access care.

“I am working on delivering high-value care for chronic pain and implementing safer opioid prescribing interventions within our safety-net practices at Kaleida Health and Erie County Medical Center,” Diaz Del Carpio says. 

​The fellowship is sponsored by the Robert Wood Johnson Foundation and the MacColl Center for Health Care Innovation at Kaiser Permanente Washington Health Research Institute.