Thursday, August 25, 2011

Patient-Centered Care, Where Does it Begin?

Often we think that patient-centered care is all about the communication between the patient and provider.  However, as much it is a core element, we need to look at the bigger picture.  The concept of patient-centered care is driven by the Medical-Home Model.  We have to keep in mind that some primary providers will say that their practice takes a patient-centered approach.  But how a patient and/or family will know that?  There is we formal institution monitoring primary care providers meeting all the standards and requirements as to truly identify patient-centered care approach.  The National Committee for Quality Assurance (NCQA) describes Patient-Centered Care as follow:

NCQA’s Patient-Centered Medical Home 2011 is an “innovative program for improving primary care.”  In a set of standards that describe clear and specific criteria, the program gives practices information about organizing care around patients, working in teams and coordinating and tracking care over time.
The Standards:
1.     Enhance Access and Continuity
2.     Identify and Manage Patient Populations
3.     Plan and Manage care
4.     Provide Self-Care and Community Support
5.     Track and Coordinate Care
6.     Measure and Improve Performance
Here are the must-pass elements required by NCQA:
1)    Access During Office Hours
2)    Use Data for Population Management
3)    Care Management
4)    Support Self-Care Process
5)    Track Referrals and Follow-up
6)    Implement Continuous Quality Improvement
So, there are different ways and reasons why some primary providers will identify themselves as patient-centered care providers.  There is not to say that some primary providers aren't working hard to make sure that their patients receive the best care while during the visit and post visit.  But, we do need to be very clear about who is accredited based on truly meeting the standards, and who is not and just uses the concept to draw in more patients. Another thing that I want to mention is the different "models" or "initiatives around the patient-centered care approach.. Take for example  the Federal government investing in a new approach to patient-centered care, Health Home Services Option.  New York State is in the beginning phases of this initiative.  The idea is to establish health home services to reduce cost.  I know I am merging tow things, but they are interrelated.  Both the patient-centered care (Medical Home) and Health Home Services Option are to at the end lower health care cost, if done and implemented properly.

Federal Health Home Requirements

Section 2703 of the federal Patient Protection and Affordable Care Act (ACA) establishes authority for states to develop and receive federal reimbursement for a set of health home services for their state's Medicaid populations with chronic illness. Health home services support the provision of coordinated, comprehensive medical and behavioral health care to patients with chronic conditions through care coordination and integration that assures access to appropriate services, improves health outcomes, reduces preventable hospitalizations and emergency room visits, promotes use of health information technology (HIT), and avoids unnecessary care.

Health home services include:

  • comprehensive care management,
  • health promotion; transitional care including appropriate follow-up from inpatient to other settings,
  • patient and family support,
  • referral to community and social support services,
  • use of health information technology to link services.
Medicaid eligible individuals must have: (1) two chronic conditions; (2) one chronic condition and are at risk for a second chronic condition; or (3) one serious persistent mental health condition to qualify for health home services. Source: At the end, we realize that a patient-centered care approach is not just the communication and relationship between the patient and provider, it takes a team and many resources to accomplish this.   What other comments do you have?

Thursday, August 11, 2011

Integrating Cultural Competence Strategies in Community-Based Settings

Cultural Competence Strategies can be as complicated or simple as we want them to be.  Sometimes going back to basics makes more sense then testing complicated models that create, sometimes more confusion.  One of the strategies that I am very passionate about is Cultural Brokering, it allows health care professionals and communities come together and find a common ground.  On September 27th from 10:00 am - 12:00 pm, I will be doing a workshop at UMDNJ School of Public Health, for those of you who are local, I invite you to attend.

Program Location:
UMDNJ-School of Public Health Building
683 Hoes Lane West, 1st Floor, Room 135, PO Box 9
Piscataway, NJ 08854
Phone (732) 445-9700