Engaging vulnerable patient populations can improve health, decrease costs, and ensure healthcare equity. Learn how the Diabetes Health Partnership at Atlantic Medical Group (one of AMGA’s 2023 Acclaim Award finalists) uses a team-based population health model to reduce disparities in care for vulnerable populations by addressing medical and social challenges through diabetes education, social service, community health workers, and pharmacy support.
Key takeaways/Learning Objectives
· Understand the impact that social determinants have on diabetes control in patients with positive SDOH barriers
· Understand the importance of a well-trained multidisciplinary team, including community health workers, social workers, and clinical pharmacists in the care of patients with diabetes.
· Be able to identify resources needed to impact the care of patients with HbA1C ≥ 9%