For Patients with Diabetes and/or Congestive Heart Failure
We will collaborate with you to develop a single care plan that will be used by the entire care team (The care plan includes your self-management goals, treatment goals, medications (Rx), diet, exercise, education and monitoring plan).
Medication Hand-offs from one caregiver to another are seamless – there is a single ‘virtual’ system of care across Whatcom county.
We will not treat you with incompatible drugs or drugs to which you are known to be allergic.
We will help you manage your illness by providing access to information 24/7.
We will have clinical information available when needed for decisions.
You will have access to your entire medical record at all times.
We will provide you a variety of ways to receive care: office visit, group visit, e mail, phone, etc.
We will create a more efficient practice to serve you better and won’t waste your time.
By returning calls, responding to e-mail, having appointments available when you need them, and reducing waiting times.
For Patients with Diabetes
Your A1C goal will be met.
You will not experience Hypoglycemia or Ketoacidosis requiring emergent care.
For Patients with Congestive Heart Failure
You will have an ejection fraction measured and documented.
You will not have any unnecessary 911 calls or Emergency Room visits for known CHF.
You will monitor your weight and receive needed support.
For Community Members
We will treat everyone the same regardless of race, economic class, or gender.
You will have easy access to information regarding system performance, including clinical outcomes (by hospital, group, payor).
We will share with you how many patients are being seen at each practice (capacity) and how long it takes to gain access to providers (time to appointment).
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