Western Maryland Health System — Cumberland, MD



IMPROVING DIABETES CARE FOR UNDERSERVED COMMUNITIES IN CUMBERLAND, MD

Western Maryland Health System aims to transform primary care for low-income, rural populations with diabetes who often face geographic barriers to care.

To reach this population, the program embeds diabetes care managers in primary care practices. The program also involves community paramedics who conduct home visits, uses telemonitoring to promote communication between vulnerable patients and care providers, and offers education on diabetes self-management that is culturally appropriate. The organization fosters community partnerships to facilitate access to healthy food and provides referrals to local resources that can address needs related to housing, health insurance coverage, or transportation.

STRENGTHEN PRIMARY CARE & BUILD SUSTAINABLE PARTNERSHIPS
OUR INTERVENTION APPROACH



Improve access and outcomes for vulnerable individuals with Type 2 diabetes and related comorbidities within the WMHS Service Area of Allegany County, Maryland, and the surrounding area.

  • Address geographic and economic disparities through pop-up clinics, home visits, screening for social determinants, and partnerships that support food security and culturally tailored disease self-management.
  • Transform primary care practices to improve quality of care for individuals with Type 2 diabetes through the addition of embedded diabetes care managers utilizing risk stratification and telemonitoring technology.

Enhance sustainability of partnerships by utilizing collaborative intersectoral interventions to reduce disparities and improve patient outcomes.

  • Engage multi-level teams including non-clinical and community partners to engage vulnerable populations in best practices to address social determinants and improve the health delivery system.

Improve access to diabetes self-management education and tools for patients and families in three pilot clinics. Identify strategies to advance population health efforts.

  • Building upon 3 years of clinical experience and strong data analytics, expand efforts to work with new intersectoral partners to identify effective strategies.
  • Utilize existing relationships with over 1000 individuals and groups who have visited or studied the WMHS Center for Clinical Resources to disseminate outcomes.


Jo M. Wilson, MBA, FACHE

Vice President of Population Health

Jo M. Wilson, MBA, FACHE, is Vice President, Population Health for the Western Maryland Health System (WMHS) in Cumberland, Maryland. She joined WMHS in September 2003 as the System Director of Radiology and was named Vice President, Ancillary Support Operations, in 2006.

As WMHS transitioned to value-based care in 2011, Wilson became involved with the logistics associated with transforming care delivery to improve patient outcomes and reduce unnecessary admissions. She developed a successful, award-winning model for chronic disease management and oversees the health system’s population health efforts, including telemonitoring.

Wilson is a graduate from Towson State University and obtained an MBA degree from Loyola College. She completed a Fellowship in Healthcare from the Kellogg Graduate School at Northwestern University and a Certificate in the Business of Medicine from Johns Hopkins University. Jo is a Fellow of the American College of Health Care Executives and board certified in healthcare management.

Contact Jo M. Wilson