Optimus Health Care is a Federally Qualified Health Center (FQHC) with 21 primary care locations in Bridgeport, Norwalk and Stratford. It also includes seven school-based health centers in public and technical schools in Bridgeport and Stratford, and two homeless health center sites in Stamford.
Over the past two years, Optimus developed new care team models to support the patient centered medical home (PCMH) model. Optimus will integrate technology into the new care team models and launch a career development program for 15 Medical Assistants employed at Optimus to become Health Coaches. The Health Coaches will incorporate health coaching as a critical skill set to interact with patients and engage them in their own care by helping patients understand the care team’s advice; discuss how the patient feels about the advice; and work with patients to implement the advice to improve their health. Health Coaches will facilitate communication within the care team (including the patient, health care provider, nurses, health coach, and any other providers involved in the patient’s care).
Optimus will conduct a pilot program at two Bridgeport sites to incorporate health coaching and care coordination interventions for patients who are newly diagnosed with diabetes and cardiovascular disease, as well as chronically ill patients struggling to manage these diseases. Optimus will track diabetes management for Latino men and African American patients, respectively, who have poorer outcomes with care currently being provided. The University of Connecticut Health Center will conduct a program evaluation, and Optimus will partner with Connecticut Appleseed, WSP Health Workforce Transformation, and Norwalk Community College to launch this pilot.
Grant funds will support staffing, consulting, and support services for the participating Medical Assistants.