Achieving Health Equity via the Affordable Care Act Promises, Provisions, and Making Reform a Reality for Diverse Patients: Workshop Summary (2015) / Chapter Skim
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4 The Patient-Centered Medical Home
4 The Patient-Centered Medical Home
Pages 33-44
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From page 33... ...
(Wong) • T he patient-centered medical home -- a relationship with a health care provider and health care team that knows a per son's health issues and is accountable for taking care of that person -- offers multiple opportunities to advance health equity.
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From page 34... ...
" -- Winston Wong STANDARDS FOR PATIENT-CENTERED MEDICAL HOMES The term "patient-centered medical home" may not be the best name for the concept, said Ignatius Bau, who has been a consultant to many different groups on how to meet the needs of vulnerable populations. It is too narrow because it refers to a place more than to a relationship.
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are helping community health centers make the transition. At 500 sites around the country, federally qualified health centers are taking part in demonstrations of Advanced Primary Care Practice, which are designed to result in the development of patient-centered medical homes.
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2. Identify and Manage Patient Populations The standard for identification and management of patient populations mirrors the meaningful use requirements for electronic health record incentive payments, Bau observed.
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Providers and community health centers will need to address the social determinants of health over which they do not have much control but they can provide linkages, coordination, and referrals. The current standards are "gentle," said Bau, and currently require the provision of educational resources or referrals to at least 50 percent of patients and families to assist with self-management, use of an electronic health record to identify patient-specific educational resources and provision of these resources to more than 10 percent of patients if appropriate, and maintenance of a current resource list on five topics or key community service areas of importance to the patient population.
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Medical homes need to implement continuous quality improvement to reduce disparities. This effort will require engaging patients and families in quality improvement teams or on a practice's advisory council, over sampling vulnerable patients for feedback on their experience of care, improving the patient experience for vulnerable populations, and engaging diverse patients in improvement efforts.
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From page 39... ...
• Each patient-centered medical home should monitor the NCQA standards specific to health equity to ensure compliance with these standards. The NCQA framework is still evolving, and issues such as patient-centered care and equity require continued advocacy.
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Under the ACA, states with Medicaid 1115 waivers1 that explicitly focus on health system restructuring may consider using matching funds to test health homes for diverse patient populations. Some states are using this provision to undertake initiatives not directly supported by the ACA, such as using community health workers to support health homes and advance equity.
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What are the effects of these initiatives on patient satisfaction, quality improvement, disease management, and treatment adherence? Another opportunity to advance racial and ethnic equity through the workforce and the delivery of care is the expansion of health home and equity programs to other practice settings supported by the ACA, including teaching health centers, nurse-managed clinics, and school-based health centers.
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From page 42... ...
For example, exchanges opting to be "active purchasers" may require health plans to implement quality improvements that include quality reporting, establishment of the features of health homes, and the actions that they will take to address racial and ethnic disparities in health and health care. Another promising option is to encourage pilot payment programs to test new patient-centered models of care, including health homes that disproportionately serve diverse patients.
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Active purchasing may be a small step, Andrulis observed, but it is a step in the right direction. Some safety net providers are aggressively pursuing opportunities for change and transformation, and some hospitals are trying to move toward community-based and integrated care, but the examples are still rare.
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Look to what's coming out." -- Dennis Andrulis DISCUSSION Cheri Wilson of the Center for Health Disparity Solutions at the Johns Hopkins Bloomberg School of Public Health asked the first question, which focused on the NCQA standards. She wondered why those standards did not incorporate the NCQA multicultural health care standards into the overall framework.
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