Out-of-Pocket Healthcare Expenditure Burdens Among Nonelderly Adults With Hypertension

This study published in the American Journal of Managed Care in May 2014 examined healthcare expenditures among nonelderly adults with hypertension, as compared to patients with other chronic conditions and well patients.  The study found “the prevalence of high total [healthcare expenditure] burdens was significantly greater for persons receiving treatment for hypertension (13.1%) compared with other chronically ill (10.5%) and well patients (5.3%).” These financial burdens to care result in individuals foregoing or delaying care. The study found that “35.2% among the uninsured and 23.9% among those with public coverage said they were unable to get care due to financial reasons.”

In this new health care environment, patients may be transitioning to healthcare coverage and out of the safety net setting. But it is important to understand the barriers to care for specific patient populations, which may include segments of the chronic disease population such as those with hypertension in particular. Addressing these barriers is crucial for the well-being of these patients.

Click here to read the full study.

Updates from the National Medical Home Summit

The Sixth National Medical Home Summit is being held in Philadelphia from March 17-19. The Summit is co-hosted by the Patient-Centered Primary Care Collaborative (PCPCC), and brings together the leading authorities and practitioners in the medical home field to discuss how it is working, where it has proven outcomes, what lessons have been learned, where it needs improvement, and what issues and challenges lie ahead. There are a few take-aways so far from the Summit:

  • PCMH is a strategy for population health management being utilized by primary care practices, specialty practices, and health systems.
  • The medical home model is about more than recognition (NCQA PCMH or otherwise) – rather it is about sustained practice transformation.
  • To be a true PCMH, the practice must engage with its “neighbors” in a Patient Centered Medical Neighborhood.
  • To be successful, PCMH practices must engage patients in their care and employ strategies for behavior change.
  • Ask the question “Is PCMH helpful?,” rather than “Is PCMH perfect, ” when evaluating the model.
  • To effectively speak about whether there are cost savings with the PCMH model, the practice/system should be utilizing cost incentives.
  • PCMH collaborations are going on all around the country, many involving ACOs, shared information systems, enhanced payment structures, involvement of health systems and specialists, and safety net organizations.
  • Practices pursuing PCMH development should consider behavioral health integration models backed by a sound strategy and purpose for integration. This may include a behavioral health consultant, psychiatrist, or social worker.
  • Safety net organizations often serve those populations who are most vulnerable and who are affected by multiple conditions. The PCMH model is particularly effective and important for these populations. Thus, despite the challenges encountered in safety net organizations, there are many applications of the PCMH model in these organizations across the country.

AHRQ Innovations on Community Initiatives to Enhance Access for Vulnerable Populations

The February 12 issue of the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange (http://www.innovations.ahrq.gov) focuses on community-wide initiatives to enhance access for vulnerable populations.

The featured Innovations describe three community-wide initiatives that seek to increase access to health care for vulnerable populations. The programs include

  • A community collaborative that opened a free clinic for uninsured children and implemented targeted interventions for patients with sickle cell anemia and substance abuse issues (click here);
  • A community-funded, nonprofit organization that matches eligible uninsured and underinsured patients with providers who agree to serve them at a discounted rate (click here); and
  • A school-based, collaborative, community-wide program that provides mental health and other support services to students and their families living in neighborhoods plagued by poverty and crime (click here).

The featured QualityTools include

5 Ways Hospitals Can Partner with Free Clinics

This article from Becker’s Hospital Review provides a concise review of just some of the ways hospitals can partner with free clinics. The authors are Steve Lindsey and Trey Rawles III, both from the Richmond area. Plus, Julie Bilodeau of CrossOver Ministry provides a compelling patient case story that illustrates the power of community collaboration for safety net health care. Highly recommended.

5 Ways Hospitals Can Partner With Free Clinics | Strategic Planning

Behavioral Health Organization offering community-based services

Shared by Peter Prizzio, The Daily Planet

  • New Directions Community Outreach Services, Inc
  • 3105 W.   Marshall Street
  • Richmond, VA23230
  • 804-447-8419
  • www.ndcos.com

New Directions Community Outreach Services is a behavioral health organization that offers a variety of community based services including: Intensive In-Home Services, Mental Health Community Support Services, Therapeutic Day Treatment Services/After-School care, and Mentoring Services throughout Central and Southern Virginia. Additionally they  offer Parenting Groups and Peer-Support Groups to our clients and the general public. Our services are individualized and flexible, utilizing individual and family strengths. They believe over “time” individuals will maximize their potential and reciprocate their success by employing an “each teach one, each reach one mindset” to rebuild their families and communities.

Nurse Case Management services for diabetes

Shared by Peter Prizzio, The Daily Planet

Case Management Associates LLC, Richmond, Virginia



Case Management Associates LLC is a unique Nurse Owned organization providing a wide range of educational resources regarding Diabetes and Heart Disease. Our educators have more than 20 years of Nursing and disease management experience. Case Management Associates LLC of Richmond, Virginia, is your diabetes education specialist providing resources and nurse case management for your benefit.
We provide Diabetes Education and Nurse Case Management Services to Physicians, Community Health Care Centers, Churches and other places of worship, fitness centers and other entities in the Richmond Tri-City area.  We also offer Diabetes Education in the Home.  Case Management Associates will come to you!  This is an ideal option for those who prefer to learn how to control their diabetes in the comfort of their own homes.

Interactions between a PCMH and a PCMH Neighbor

The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices

This position paper by the American College of Physicians, published in 2010, addresses how Patient Centered Medical Home (PCMH) organizations interface with specialty/subspecialty practices. This paper posits that the specialty/subspecialty practice should be a PCMH Neighbor (PCMH-N). The concept of a PCMH-N draws from the idea that the success of the PCMH model is dependent on the availability a “hospitable and high-performing medical neighborhood” that aligns their processes with the critical elements of the PCMH.

In the case of the Greater Richmond PCMH Collaborative, the PCMH-N is not limited to specialty/subspecialty medical practices. The concepts and roles of the PCMH Neighbor hold true for all organizations within the Greater Richmond patient-centered medical neighborhood. Consider the framework presented here as a way to begin thinking of your PCMH Neighbors.

“A specialty/subspecialty practice recognized as a Patient-Centered Medical Home Neighbor (PCMH-N) engages in processes that:

  • Ensure effective communication, coordination, and integration with PCMH practices in a bidirectional manner to provide high-quality and efficient care
  • Ensure appropriate and timely consultations and referrals that complement the aims of the PCMH practice
  • Ensure the efficient, appropriate, and effective flow of necessary patient and care information
  • Effectively guides determination of responsibility in co-management situations
  • Support patient-centered care, enhanced care access, and high levels of care quality and safety
  • Support the PCMH practice as the provider of whole person primary care to the patient and as having overall responsibility for ensuring the coordination and integration of the care provided by all involved physicians and other health care professionals.”

Review the types of interactions between a PCMH and PCMH-N outlined above. Consult the paper for more details and examples of care coordination agreements between a PCMH and PCMH-N.

Click here to read and download the full article.


AHRQ Guide on Coordinating Care in the Medical Neigbhorhood

Many of the goals of the PCMH rely on improved communication and coordination among health care providers and  institutions. Specialists, hospitals, other providers, health plans, and other  stakeholders play key roles in ensuring a close-knit and high-functioning  medical neighborhood. This paper examines the various “neighbors” in the medical neighborhood and how these neighbors could work together better, thus allowing the PCMH to reach its full potential to improve patient outcomes.

Click here to view and download the document from AHRQ.

Care Coordination and the Patient Centered Medical Neighborhood

The Improving Chronic Illness Care project defines care coordination is “the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services.”  In this definition, all providers working with a particular patient share important clinical information and have clear, shared expectations about their roles.  Equally important, they work together to keep patients and their families informed and to ensure that effective referrals and transitions take place.  This resource provides a wealth of knowledge and tools for coordinating chronic care at the community level as part of a patient centered medical neighborhood.

Click here to view and download resources.