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Preventative Care: A Conversation with Two Clinical Experts

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Preventative care initiatives are foundational in value-based care. With the new year here, what better reason to talk about setting up new preventative care campaigns for your patients? In September’s podcast, we talked specifically about cancer screenings, and in November’s, we talked about targeting patients with prediabetes to prevent them from converting to adult-onset diabetes or Type 2.

Today, we want to continue the conversation and dive deeper into other preventative care measures that should be taken. Once again, I had the privilege of speaking with Christine DiNoia, BSN, RN, a registered nurse and Clinical Transformation Advisor at Lightbeam. In addition, we also had a second guest: the newest clinical transformation team member, Shelley Davis, MSN, RNC, CCM. To listen to the entire podcast episode, visit our website.

Christine and Shelley, why is preventative care so important?

Christine DiNoia: Preventative care appointments and initiatives are critical when managing chronic disease development in all patient populations. Each healthcare industry member has a role to play, especially payers. A 2019 interview study conducted by the Centers for Medicare & Medicaid Services (CMS) determined that in 2014, 60% of American adults had one chronic disease or condition, while 42% had multiple diseases.

Concerning still, research projects that 80 million American adults will manage three chronic conditions by 2030. Researchers concluded that there was not a lack of knowledge among the healthcare community of the benefits preventative care provides, but rather an “implementation gap” and lack of prioritization.

Two significant contributors to the gap are the financial aspect of preventative care services and fewer incentives to perform preventative care. This is something the payer market could substantially influence with their role in creating payment models and contractual requirements. Beyond Annual Wellness Visits (AWVs), chronic obstructive pulmonary disease (COPD), pulmonary function tests (PFTs), fall prevention, and the like, we also have the opportunity to improve health literacy and create comprehensive care plans.

Shelley Davis: No surprise, according to the Health Cost Institute, there was a substantial decline in claims data in 2020 versus 2019. Two concerning findings they pointed out were the decreases in mammograms and colonoscopies. In April of 2020, mammograms were down by 80%, while colonoscopies were down by 90%. Colonoscopy screenings are historically challenging to schedule because of the procedure’s preparation and extent, but colon cancer only becomes more complicated, dangerous, and expensive the later it is caught. It is undoubtedly an important target initiative for patients over 50.

We have serious ground to cover to make up for lost time, as preventative screenings can speed up diagnoses, promote early detection of chronic illnesses, and get patients on the road to treatment quickly. There is a lot of buzz around immunizations right now with the rollout of COVID-19 vaccines to essential workers. But immunizations like the flu-shot are preventative services to prioritize at appointments. Organizations should keep in mind that administering preventative care services can require innovative approaches.

A few years ago, we published a patient impact story about how our client Mohawk Industries addressed their female workforce’s mammogram care gap. After using the platform to identify women that were past due for their annual screening, Mohawk dispatched a mobile mammography unit to their workplace and identified a woman with stage one breast cancer. With early detection, her chance for remission and positive outcomes increased.

What are the first steps a care team should take to begin initiatives like these?

Christine: For many organizations, it begins with identifying metrics that may need performance improvement, financial incentives they want to increase, assessing open opportunities, or even starting from the ground up with an overhauled organizational strategy. If the organization has a specialty, there could be a condition they want to address.

Staffing also comes into play when it comes to the bandwidth care teams can handle. The beginning of care management initiatives is time-consuming and requires hefty research, which is one of the primary reasons we brought on Shelley!

Shelley: Definitely! As Clinical Engagement Manager for Lightbeam, my role is to educate and provide support for client care teams and strategize together to improve workflows, identify cost drivers, deliver results, and ensure satisfaction. These personalized interactions with care teams help them develop staffing models, advise which clinical conditions programs they should focus on for their population, and identify the best engagement techniques to deploy to meet their specific patient populations’ needs.

What do you recommend for groups who have a lean staff but want to increase their uptake of preventative services?

Christine: When coming up with a strategy, care teams should analyze these four items: leadership, education, measurement, and reimbursement. Leadership begins with staff members committed to adopting value-based care principles and helping others on their team do so as well.

Education and communication go hand in hand to promote alignment across a care team, and the right technology takes care of measuring and tracking reimbursement. One product that aids care team members are Lightbeam facesheets. Facesheets can be printed before providers’ appointments to review open care gaps and address preventative service gaps that same day.

Part of our scope as the Clinical Transformation team is managing Lightbeam Client Services (LCS). LCS expands an organization’s capacity to manage patient care between office or telehealth services. We have the power to augment a care management team with care team extension.

The care team extension program allows clients to outsource all or some care management staff if they need assistance, especially with administrative tasks like phone calls to follow up with patients. The program is fully operational in only a few weeks and currently supports Annual Wellness Visits (AWVs), Principal Care Management (PCM), Chronic Care Management (CCM), Transitional Care Management (TCM), and Remote Patient Monitoring (RPM). Anyone interested in LCS can email

For more information on preventative care, listen to the full podcast episode and visit:

Download the Mohawk Breast Cancer Patient Impact Story and read other client success stories in the Lightbeam Education Center.

Laurel Derr

Laurel Derr is Lightbeam’s Marketing & Event Coordinator.

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