Team of the Month 


The Team of the Month recognition is awarded for the amazing work that numerous teams, groups, committees and departments perform either on a regular or occasional basis that directly relates to any of our five cornerstones: People, Quality, Service, Growth and Finance.

The Team of the Month is given a luncheon celebration hosted by Alan G. Macdonald, president and chief executive officer; banners listing their team name are featured throughout our facilities; a framed certificate; and an opportunity to present at a leadership meeting.

Nomination Form

ยท Nominate Team of the Month online here

Nomination forms may also be picked up in the Human Resources office at Lawrence Memorial Hospital of Medford.


Team of the Month: September 2017

Collaborative Outreach and Adaptable Care at Hallmark Health

 

In December 2015 through a grant from the Massachusetts Health Policy Commission CHART grant program, Hallmark Health launched a significant initiative called COACHH (Collaborative Outreach and Adaptable Care at Hallmark Health). The goal of COACHH is to develop and implement an innovative service delivery model to align patients with appropriate health care resources, reduce overutilization of emergency departments, and enhance services for defined cohorts of complex patients with behavioral health and substance use disorders. The program is designed to extend services into the community to better reach the people who need them.

The multidisciplinary COACHH team consists of primary care physician consultants, a nurse practitioner, social workers, a pharmacist consultant, and three collaborative care coaches, based at Hallmark Health Medical Center in Reading. The team meets with patients in their homes or other community-based settings to develop individualized care plans to identify and remove barriers to accessing appropriate health care services. Services are provided at no cost to the patient and include case management, consultation, community outreach, links to resources, medication review, behavioral health and substance use disorder services, and collaborative management of challenging issues such as chronic pain.

The COACHH team works with complex patients who face many challenges in the health care system including stigma, lack of coordination of services and difficulty in accessing care. Most patients have behavioral health, substance use disorders or chronic medical concerns. Many patients have nonmedical hurdles to manage that impact their health status including homelessness, food insecurity, poverty, mobility challenges, cognitive limitations, trauma and domestic violence. The COACHH staff helps patients address each of these challenges.

The COACHH team has helped patients with opioid use get into treatment, helped pregnant women secure needed prenatal and postnatal services, assisted with identifying housing and food options, and provided a myriad of services to help patients manage the health care system. There has been a 44 percent decline in emergency department use for patients enrolled in COACHH for at least six months compared with the six months prior to the program. A small number of patients post-overdose have been successfully referred to detox and medication assisted treatment programs. In addition to the one-on-one work with patients and their families, the COACHH team works collaboratively with first responders (police, fire, ambulance) and substance use coalitions in the Hallmark Health service area on prevention efforts and to ensure that patients post-overdose are seen as quickly as possible.

The COACHH program is an integral part of Hallmark Health and the surrounding communities. The success of COACHH rests on the compassion, commitment, innovation and professionalism of the COACHH team who came together with a pioneering spirit to launch a program for patients with complex behavioral health, medical and social needs in our community. The team is an invaluable resource to patients, their families, the emergency departments, physicians and community partners. The team is exemplary for not only what they do, but for who they are.

 

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Not to be missed... 

Hallmark Health Medical Center
Wednesdays, September 20-October 25
 
 
Melrose Church of the Nazarene
Tuesday, September 26


5K Walk and Run
Saturday, September 30
 
 
Lawrence Memorial Hospital
Wednesday, October 11
 
 
North Suburban (Malden) 
WIC Program
Saturday, October 14
 
 
Winchester Country Club
Monday, October  23
 
 
 
 
 
 
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