Our Model of Care
Whittier Street Health Center utilizes the Patient-Centered Medical Home model of health care delivery to ensure continuity of care. Continuity of care includes ensuring that patients have access to their primary care provider (PCP) and Primary Care Medical Home Team (PCMHT) at every visit.
As new patients join Whittier, we are:
- Developing educational materials and strategies so that new patients can choose their primary care provider during their first visit;
- Educating patients about the role of each PCMH team member;
- Training frontline staff on the different provider panels, members of the care team, and why it is important that patients always see a member from their care team.
Whittier has affiliations and admitting privileges with several hospitals including the Boston Medical Center, Dana-Farber Cancer Institute, Children’s Hospital Boston, St. Elizabeth Hospital, Carney Hospital and the Brigham and Women’s Hospital. To ensure continuity and continuum of care when patients are accessing services at referral sites we have several mechanisms in place:
- Patient charts can be accessed through a network that includes Boston Medical Center and Partners HealthCare Hospitals, including Brigham and Women’s Hospital and Massachusetts General Hospital.
- Children’s Hospital Boston faxes daily reports to Whittier’s Pediatrics Department for Whittier patient ER visits and visits with specialist.
- Whittier has a Registered Nurse Case Manager that coordinates care for patients and support for patients who have had an ED visit or inpatient hospitalization.
- We have Nurse Case Managers that serve as the liaison for our partner hospital’s Emergency Department (ED) and works with them to reduce the unnecessary use of emergency rooms during our hours of operations.
- Combined, these relationships allow Whittier providers and patient navigators to ensure that care provided to Whittier’s patients both at the center, area hospitals and partnering health care organizations is continuous and coordinated.
Population Health: The Boston Health Equity Program
Whittier is “mid-course” in implementing its Boston Health Equity Program, a system of care for people with chronic illnesses that fully integrates innovative community outreach, wellness support and care coordination and explicitly seeks to eliminate health disparities and their associated costs. Specific innovations within this system will be:
- Innovative and culturally appropriate community outreach to increase access to care and early detection of illness with hard-to-reach populations;
- Primary care that includes visit redesign and a system of off-site Virtual Clinics and that integrates medical care, mental health care and social supports;
- Medication management to maximize safety for those with multiple complex health issues and to support optimal recovery;
- Wellness programming that is fully integrated with primary care, tailored to individual needs and buttressed by ongoing support to ensure patient compliance and self-management;
- Targeted care for cancer patients that fully integrates specialized medical care with wellness, psychosocial support and primary care;
- Education and assistance in properly utilizing primary care and the WSHC urgent care center to avoid hospital re-admissions and reduce emergency room use.
- Infrastructure improvements to technology systems to gain efficiency, effectiveness and provide data for continuous quality improvement, including a Personal Health Portal, an enhanced Cancer Registry and on-line transmission and review of Virtual Clinic data.
- Establishment of a fitness center to provide an integrative medicine model of care for the whole person.[Read More about BHEP].