Investor Presentaiton
Affinia Healthcare - SMBP Patient Criteria and Workflow
= occurs inside the health center
= occurs both inside and outside health center;
patient performs SMBP outside of center
Initial visit
1-2 weeks
Initial visit
Stage 1 Uncontrolled
HTN, (BP of 130-
159/80-89): Patient is
referred for YMCA
BSPM lifestyle and
patient engagement
program
Health center care
team does a warm
hand-off, or electronic
referral to an YMCA
Healthy Heart
Ambassador (HHA),
who is embedded in
the health center's
cardiology clinic
Patient is enrolled
in BPSM lifestyle
and patient
engagement
program by HHA
From HTN Registry
Patient attends
BPSM classes at
health center and
local YMCA; YMCA
provides home
blood pressure
monitor to keep
2-4 weeks
16 weeks
Patient
identified and
Says "Yes"
6 weeks
From HTN Registry
Stage 2 Uncontrolled
HTN, (BP of
160+/90+): Patient is
referred for SMBP
Hypertension
Education Program
(HEP) and/or
cardiology clinic
Patient is enrolled in
SMBP and health
center HEP and
trained on SMBP by
Chronic Disease staff;
home blood pressure
monitor provided for
patient to keep
Patient attends 6-
session HEP at health
center and patient
does SMBP
After completion of 6
sessions, pt referred to
YMCA BPSM program
Cardiology referrals
from other providers
Patient sees
Cardiologist based
on referrals;
Cardiologist and
Internal Medicine
providers refer
patients to
Pharmacist.
Pharmacist
addresses barriers
to blood pressure
control and
medication
adherence
Patient has a
follow-up visit with
pharmacist and
referred to YMCA
BPSM or health
center HEP.
https://millionhearts.hhs.gov/files/MH_SMBP_Clinicians.pdf
Clinical FlowView entire presentation