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Prevention in Practice: Managing High-Risk Patients with Dr. Andy Mayberry

Prevention in Practice: Managing High-Risk Patients with Dr. Andy Mayberry

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In this insightful episode, Dr. Rhiannon Winsor sits down with Dr. Andy Mayberry, a longtime family physician at Chiricahua Community Health Centers, to explore the art and science of managing high-risk patients.
From chronic disease and smoking cessation to care coordination and patient follow-up, Dr. Mayberry explains how proactive communication, preventive screenings, and consistent visits can dramatically improve outcomes. He also discusses the Risk Adjustment Factor (RAF) score as a useful framework for identifying high-risk patients and designing visit schedules that catch problems early.
Listeners will walk away with practical ideas for improving chronic care management, supporting patients with multiple conditions, and re-centering healthcare around prevention and human connection.

Key Topics:

  • Defining and identifying high-risk patients using RAF scores
  • The long-term impact of preventive care
  • Coordinating care among specialists
  • Empowering patients through follow-up and advocacy
  • The role of chronic care management programs (CCM) in improving outcomes
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