Role of medical home in care delivery for those with chronic conditions

Background: Emerging evidence supports the effectiveness of patient-centered medical home (PCMH) as a potential means of improving the health of populations with chronic conditions and reducing the costs of care. Objective: The Affordable Care Act (ACA) promotes PCMH. ACA's success partly depends on broad implementation of PCMH. PCMH is a promising approach to care and includes receipt of care from a personal doctor, who coordinates the patient's care, and develops an individualized treatment plan among other criteria. Yet, baseline population data on prevalence of these fundamental PCMH criteria are sparse. This study examines the availability of these three fundamental PCMH criteria in the general population with asthma, diabetes, and heart disease and identifies the starting point for PCMH implementation efforts. Methods: We used the 2009 California Health Interview Survey (CHIS)) and modeled doctor and emergency room visits, flu shots, timely communication with the provider, and confidence in managing one's chronic condition given availability of one or more PCMH criteria. We controlled for demographics, income, insurance, and health status in these logistic regression models. The adult population ages 18 and older who reported having asthma, diabetes, and heart disease (N=10,990) were selected for this study. Results: The data showed that uninsured, Medi-Cal beneficiaries, those at or below 133% of the FPL, Latinos, and Asian Americans less often reported all three PCMH criteria studied. Respondent with all three PCMH criteria were more likely than those without to report at least one doctor visit, no emergency room visits, and a flu shot in the past year. These respondents were also more likely to have received a return call from their providers always or usually. However, these respondents reported similar odds of 5 or more doctor visits (vs. 1-4) and the same confidence in their ability to manage their chronic condition than those without PCMH. Conclusions: The findings revealed that having access to three fundamental aspects of a PCMH may improve the care of those with chronic conditions. These individuals are more likely to receive primary and preventive care and avoid emergency room visits. The findings highlighted the population groups who would most benefit from interventions that increase receipt of care concordant with PMCH, particularly Medicaid beneficiaries and those eligible for the Health Benefit Exchanges. In addition, the potential for lower health care expenditures for those with chronic conditions with the receipt of more preventive care and less emergency room care exists.