Can Medical Homes Reduce Health Disparities?

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Patient-centered medical homes are designed to improve health care quality while lowering costs, but advocates also want to make sure that the new primary care model tackles another issue – health equality.

More Medicaid and HUSKY members will likely receive care from medical homes, which provide coordinated care to patients, as the state offers bonus payments in 2013 to facilities that serve these patients.

“It’s both the right thing to do and the smart thing to do,” said Ignatius Bau, an independent health consultant. The hope is that medical homes will reduce emergency room visits by preventing problems or treating them before they become acute.

Bau recently authored a policy brief for the Connecticut Health Foundation outlining ways that the medical home model could be customized to increase equity for groups who have historically had poorer outcomes, such as racial and ethnic minorities and low-income patients. The report recommends a number of measures, including offering interpretation and afterhours care, to accommodate a diverse population.

“The patient centered medical home model could, in fact, reduce disparities, if it’s implemented correctly, “ said Alta Lash, executive director of United Connecticut Action for Neighborhoods. Lash’s organization is working with the Department of Social Services, which administers Medicaid in the state, to tailor medical homes to serve people who may struggle to read a patient education brochure or who can’t afford to miss work to sit in a waiting room.

“Ideally the patient is doing some self care and bearing some responsibility for doing what they need to do achieve wellness,” said Lash. In some cases, that may mean teaching people who have never had primary care providers how to make good use of them. “If they’re not prepared for it, they could be excluded,” she said.

In medical homes, the primary care clinicians increase their accessibility and develop long-term relationships with their patients. Being designated as a medical home allows clinicians to be compensated for care coordination and wellness services that otherwise would not be billable.

Medical homes are increasing in Connecticut. In April, 511 clinicians in the state were certified by the National Committee for Quality Assurance to practice in medical homes. Today 732 have the certification. Other groups, including insurers, also offer certification. So the total number practicing may be higher.

According to Bau, medical homes are well equipped to address three historic causes of racial disparity: poor access, delayed care and inadequate data.  Medical homes provide continuous, accessible sources of care. They must offer rapid access to appointments to qualify. The hope is that regular access will lead to early diagnosis. Bau offered the example of diabetes being well managed, rather than leading to serious complications.  Medical homes are required to track data, and by 2014 will have to track outcomes by race and ethnicity.

Most doctors want to give culturally appropriate care, said Dr. John A. Foley, president of the Connecticut State Medical Society. But they are often practicing in systems not designed to deliver it. New structures like medical homes can be developed from the start with equity in mind. “You can put in place things that have to be followed,” he said.

“People are putting a lot of expectations and hopes on the patient centered medical homes,” said Elizabeth Krause, a program officer at the Connecticut Health Foundation. She cautioned that they are “not a panacea.” But she said that the new practice model is a way to strengthen one of the most important and elusive elements of good health care – the patient/provider relationship.

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