Community Health Home Model in New Mexico

The Advanced Care Community is concept promoting significant change in the health care system. It seeks to create a vibrant and broad range of preventive services through financing and delivering innovation. It goals are to: Integrate services horizontally across four primary care core services medical, dental, behavioral health, broadly defined community health and family support services, and vertically to include subspecialty, and inİ\patient care to create real and virtual teamİ\based services. Define distinct roles of all core services providers across the spectrum of health services: Prevention, Diagnosis, Treatment and Management Develop a workforce of community health workers and care coordinators to provide family support services at varying intensities to address social determinants of health as well as the complex patients in a continuum of nonİ\clinical and clinical support services. Train existing providers along with student and residents to work effectively within the four core services environment. Establish a global primary care payment system with shared savings incentives vertically to provide longterm sustainability for model.

The model is community based utilizing health status to inform primary prevention and community services using global payment. This will create a better functioning supporting system for individuals, families and communities.

The model has been presented at the CDC CTG TA Conference, IOM Commission on Primary Care in Health Care Reform, National Conference on Medical Homes, NASHP Committee on the role of Safety Net providers in health care reform, endorsed by the NM Legislature, NM Departments of Health and Human Services.