New department brings new care to CMMC

Jenny Gessaman

Pattie Carr, left, and Dana Smart, right, sit in CMMC’s old ER Tuesday afternoon. The space will soon serve as the office for the new Care Coordination Department.
Photo by Jenny Gessaman

There’s a new department at the Central Montana Medical Center, and although it’s not bringing in any new physicians, it is bringing in a new level of care. That’s the goal of Pattie Carr and Dana Smart, CMMC’s new care coordinators, and of the Care Coordination Department.

This new addition aims to help chronically ill patients who rely on regular medical visits, but it won’t stop at the hospital: The Care Coordination Department hopes to makes patients’ lives generally healthy, too.

Smart explained care coordinators take a comprehensive look at patients, reviewing treatments with any and all doctors, nurse practitioners and other medical providers. In addition, the coordinators look at the patients’ lives to identify any outside factors affecting their health, including economics, education and even the infrastructure where patients live.

“In the past, in traditional medicine, you just went to the doctor when you were sick,” she said.

Now, the new department will work to create management plans to keep patients out of the ER and healthier in general. In short, Smart said, the care can happen when a person isn’t sick.


Pieces of a puzzle

Despite being in the same department, and having similar job descriptions, Smart and Carr are two different halves of one comprehensive whole.

Smart’s job came about because of the hospital’s involvement with CPC+, a federal program aiming to improve patient management and care for clients on Medicare. The program deals with providers and payments, but emphasizes coordination across a patient’s providers, and care that considers health influences beyond medications and doctor’s visits.

Carr’s care coordinator title came from a three-year federal grant meant to improve the quality of small rural hospitals. Doris Barta wrote the grant application for CMMC, and was hired to be its program director when CMMC was selected as one of the 23 hospitals across the nation to receive award monies.

She explained Carr would help a more limited group of patients.

“For the quality improvement grant, initially the patient either needs to be diabetic or have hypertension or other cardiovascular disease issues,” she said, adding, “But they don’t have to have both, they can have either.”

Barta explained the similar goals of the two programs made them a great combination for the new department.

“They’re two separate programs, but they have basically the same ultimate goal,” she said. “That is to provide improved access to health care services, and to improve the patient’s experience with receiving those services.”


Seeing the big picture

So how do two different things make one department that coordinates ... well, lots of things?

Carr and Smart explained that the combination of their backgrounds and their different programs created a comprehensive resource for patients.

Carr covers patients from nine counties with specific chronic illnesses. Smart covers only CMMC patients, but where they’re from or what the illnesses are doesn’t matter.

“I have a little larger spectrum, and I focus on anyone who needs help and has two or more diseases,” Smart said. “Patti can have a certain population that isn’t part of the clinic, and I focus on the clinic.”

Their backgrounds and medical knowledge mesh well together, too.

“What I really like about us as a team is I have an extensive background in the disease process from being a nurse,” Smart said. “Then she [Carr] can bring her exercise and physiology background.”

“We’re definitely two jigsaw pieces meant to be put together,” Carr agreed. 

“In this role, we really focus on preventative health, and the fact that we’ve had careers prior to implementing this program really gives us more experience and creativity in eliminating some of the barriers that prevent patients from being healthy,” Carr continued.

So what does this all mean for the patient? Direct support, according to the care coordinators.

“We are the hub helping to put together a plan that involves lots of different professionals,” Carr said.

And the plan won’t stop at the hospital doors, either.

“We can refer patients to more traditional services, like social services, but we’ve also made referrals to things like the library,” Smart said.

The idea, according to Smart and Carr, is that they and the new department will act as a comprehensive resource for those trying to manage chronic illnesses. They will gather all the medical information into one place to make a complete management plan, and then help the patients reach out to the resources they need.

And, Smart added, they can get the department’s help as much as needed.

“We can work those patients on a daily, a weekly or a monthly basis to make sure they have the resources they need,” she said.

A valuable service at a bargain cost: Smart said none of the department’s patients would have an upfront cost.

To learn more about Care Coordination, or to see if you might be eligible, call the department at 535.1420. 



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