245537 Where are we in our journey? A 20-month review of an effort to implement the patient-centered medical home within a South Central Texas public hospital district

Tuesday, November 1, 2011

Camerino I. Salazar, MS , Director Clinical Outcomes and Program Evaluation, University Center for Community Health, University Health System, San Antonio, TX
Theresa De La Haya, RN, MPH , Senior Vice President, Community Health and Clinical Preventive Programs, University Health System, San Antonio, TX
Priti Mody-Bailey, MD, MA , President/CEO, Community Medicine Associates, San Antonio, TX
Angela Casias, MSN, RN , University Health System, Women's and Preventive Health Services, San Antonio, TX
Suhaib Haq, MD , Associate Medical Director, Primary Care, University Center for Community Health, San Antonio, TX
The passage of the Affordable Care Act in March 2010 marked an important milestone in the national conversation on healthcare reform. With nearly 46 million uninsured Americans; the salient feature of this effort is to begin addressing longstanding disparities in access to health care services and coverage. As part of this reform; public hospital districts will become critical in addressing the legislative mandate of providing health care that is accessible, affordable and patient-centered.The patient-centered medical home or integrated care model is best defined as providing the patient with: (1) a consistent place for sick/well care, 2) a personal doctor or nurse, 3) ease obtaining needed referrals, 4) care coordination, and 5) family-centered care. With a service catchment area of 1.6 millions residents, the Bexar County Hospital District d/b/a University Health System (UHS) embarked on a journey in early 2010 to improve access and enhance delivery of health services through implementation of its North Region Medical Home.Implementation of this model of care occurred during the first quarter of 2010 (March) and paired two traditional preventive health clinics (Naco-Perrin and Kenwood) with University Family Health Center North.Data will review progress with respect to personnel, policy and technology changes essential to advancing this care model and based on the American Academy of Family Practice recommendations for patient-centered care that encompasses four core areas: quality measures, patient experience, health information technology and practice organization.This model of care will be evaluated to identify characteristics currently in place and the extent to which operational characteristics of the medical home model are being implemented (i.e., care coordination and case management). Additional measures of quality and performance will be included (process in terms of patients reached as well as clinical quality and cost-effectiveness). The use of multiple sources will provide a robust profile of the current healthcare initiative and allow stakeholders the opportunity to not only view the current clinical and financial impact of this model of care, but provide the necessary feedback to shape future directions in delivery and design of patient-centered care. In conclusion, the organizational transition underway demonstrates a commitment by UHS to share in the national conversation of identifying ways to reduce healthcare costs and improve access to care.

Learning Areas:
Administration, management, leadership
Program planning
Provision of health care to the public

Learning Objectives:
Explain the strategic drivers involved in the formulation and implementation of a patient-centered care with an urban county hospital district. Describe the core processes involved in the administrative and clinical development of a regional medical home including development of a comprehensive care team, use of health information technology to assess coverage and impact of clinical preventive care and case management to more effectively address chronic disease management. Evaluate the clinical and financial performance of a health service delivery model directed at addressing disparities in access to health care.

Keywords: Community-Oriented Primary Care, Ambulatory Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Camerino I. Salazar is Director of Clinical Outcomes and Program Evaluation at University Center for Community Health a member of University Health System, Bexar County, Texas. Within this capacity his responsibilities include designing and coordinating pilot projects and/or feasibility and evaluation studies to demonstrate capability and effectiveness of population-based interventions designed to improve health outcomes and modify behavior in populations most at risk for chronic disease. He currently holds a Masters of Science from the University of Texas at San Antonio. His research interests include health disparities in minority communities, program evaluation and health services research. As part of the project his presentation involves Mr. Salazar is a member of the performance management team that is assessing the impact of this health service intervention.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.