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.
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.
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
Within the Collaborative we have been discussing the impact of the PCMH model on direct patient care and on the broader health of the community. Healthy People 2020 provides one lens for examining the connections between PCMH and community health improvement. We have recently posted an article that provides an overview of Healthy People 2020 and draft framework for linking the PCMH model to Healthy People 2020 objectives. We welcome your ideas for improving this framework. Click here to read the article and view the framework.