Oral

Current strategies to improve the health of underserved and chronically ill individuals center on principles of a chronic care model and patient-centered medical home (PCMH). These strategies aim to improve health outcomes by focusing on the provider and/or the patient. Provider-focused interventions include coordination and integration of care across the spectrum of services and patient needs while improving timely access and quality. Patient-focused interventions include integrating the patient in delivery of care by teaching appropriate self-care and patient empowerment. The emphasis on the medical home in the 2009 health care reform legislation is evidence of the anticipated promise of PCMH to improve efficiencies, though the evidence to support the success of these interventions is slowly emerging. This panel reports on the impact of two California demonstration projects designed to improve delivery of care to the low-income uninsured (Health Care Coverage Initiative-HCCI) under a PCMH care delivery model and the chronically ill Medicaid fee-for-service population under a disease management model (Disease Management Pilot Program-DMPP). The first two studies on PCMH highlight the positive impact of this medical delivery model on reducing emergency room visits and hospitalizations. The third and fourth studies illustrate minimal impact on expenditures, utilization of services, and some quality of care measures by the vendor-based DM programs that primarily focus on teaching patients self-care within 1-2 years of program implementation. The findings suggest that a fundamental change in delivery of care to underserved population is required to prepare the nation for expanded coverage of millions of underserved and chronically ill populations.

Session Objectives: Learn current strategies to improve the health of underserved and chronically ill populations. Describe the principles of the patient-centered medical home (PCMH) model. Evaluate the impact of PCMH and disease management on health care use. Identify policy approaches to improve health of underserved persons, given the success of current strategies. Highlight the positive impact of this medical delivery model on reducing emergency room visits and hospitalizations.

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH) , Masters Certified Health Education Specialist (MCHES)