Summary

Wellspring Family Medicine developed out of the vision of Dr. Damon Daniels, MD, MPH to create a primary care practice with an emphasis on the healthcare needs of families in the Metro Columbia, South Carolina area. The mission of the practice is to provide the highest quality healthcare in a compassionate manner with an emphasis on the whole person.

It is based on a model he created during his work in academic medicine at the University of South Carolina.

Challenge

Prior to partnering with HealthSnap, Dr. Daniels and his team attempted to launch Chronic Care Management (CCM) within the Wellspring practice. Since many of the current patients within the practice are managing chronic condiitons, they realized it would be an excellent way to connect and check in with patients on a monthly basis. While implementing their own CCM program with a smaller patient population initally worked well, it eventually became too time consuming for the clinical staff to run the program, as their time was already allocated and essential to the day-to-day operations of running the practice. Ultimately, they ended up suspending their CCM service offering simply because it was causing workflow issues for the practice.

Following this, the practice then partnered with a company that offered Remote Patient Monitoring (RPM) services, but not CCM, at a time when there were many new RPM companies launching, and that company did not end up lasting. Then, HealthSnap came into the picture for Wellspring, and they shared that working with an experienced partner with both an RPM and CCM offering was a much better experience for the entire team at Wellspring.

Program Highlights

Dr. Daniels recounted, “My overall vision was to understand the realities of the healthcare system and how reimbursement works. Knowing that everything is moving toward value-based care, a partnership that helps bring value to the patients and also proves to the payers that we are managing patients successfuly is invalubable.” He also shared that his long-term vision is to meaningfully help patients clinically, while Wellspring could also prosper as a practice in a tough reimbursement environment: “We operate as a patient-centered medical home, so we have certain benchmarks we want to meet for blood pressure control and glycemic control measures.”

HealthSnap’s partnership with the inVio Health Network was one of the deciding factors to move forward. Dr. Daniels explained that being a smaller practice, Wellspring would benefit from HealthSnap’s help handling the overall volume as well as the cost to the practice of implementing and carrying out the operations of the program. 

Dr. Daniels shared that the onboarding process was another reason Wellspring chose to partner with HealthSnap, “what the HealthSnap Team said they would do, they did. I’m a busy practitioner, we have a small staff, and we needed a partner to be alongside us to help get us onboarded and offer the necessary support to get the program up and running.”

Results

Patients with hypertension at Wellspring saw medicinal-like effects when using HealthSnap’s programs.

Across all patients at the practice, (sample size of 136 that met the criteria), the practice saw: 

• A 5.6 mmHG drop in blood pressure across all patients that have been monitored on Wellspring’s program.
• A 6 mmHg drop in systolic blood pressure over 6 months for patients that started the program with stage 1 hypertension. This is significant for patients that are in the stage 1 group that might not have to drop as many points in order to reach a controlled level.
• A 12.2 mmHg drop in systolic blood pressure over 6 months for patients that started with stage 2 hypertension.

Using HealthSnap’s evidence-based approach to instill self-efficacy and improve health literacy allows patients to achieve these significant results after a short time-frame of only 6 months of the program.

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At the time of enrollment, close to 70% of the patients were in a state of uncontrolled blood pressure. Over the course of the program, Wellspring saw a statistically significant and clinically meaningful improvement, where now only 54% of patients enrolled are in an uncontrolled state. Furthermore, Dr. Daniels shared excitement that approximately 80% of all patients enrolled in HealthSnap’s programs experienced an improvement in their systolic and/or diastolic blood pressure: “Across the board seeing an average drop in blood pressure by 10 points, especially an increase in control across the patient groups, is very impressive,” he shared.

Dr. Daniels shared a story that encapsulates why he offers the programs in his practice: 

I have a patient on dialysis with dementia, and who lives far from the practice. We started monitoring and noticed that her systolic blood pressure is out of control (in the 200’s). Once she started working with HealthSnap and getting measures under control, she moved but was still able to be monitored remotely in the program. We continued to monitor her remotely, and we figured out a medication regimen with her and now her systolic is between 130-150 consistently. This not only helped her clinically but demonstrates how the program allows the flexibility to manage chronic patients when they are unable to come into the office.

From a financial perspective, with 186 patients enrolled in CCM and 224 patients enrolled in RPM, Wellspring has seen a reimbursement of close to $150,000 for the CCM program and $158,000 for the RPM program. The average monthly reimbursement is $16,500 for CCM and $17,500 for RPM. The pricing is based on CPT code attainment throughout the month by all patients who are enrolled in their respective programs. Ultimately, the team is reaching its aforementioned goals of making meaningful clinical improvements for patients, while also supporting the practice from a revenue standpoint.

Wellspring Patient Testimonials

“I don’t have the same concerns about my blood pressure that I used to. It’s getting better. There ain’t nobody like you! Thank you for helping me out so much.”

“Nobody can replace you, nurses. We become attached to each other, it feels like we become family with Tabatha [the HealthSnap Nurse]. It’s a strong intimate relationship that we form together.”

“I had a bad reaction to some medication that I had taken before, so I didn’t realize that was the cause. Because of the team’s fast action and checking up on me, I was able to resolve my symptoms very fast. Thank you for taking such great care of me.”