Improving Primary Care Medical Homes for Persons with Disabilities in Rural State

<>The Affordable Care Act and the Primary Care Medical Home Model (PCMH) practices promise better health care for all Americans. This presentation summarizes recommendations for improving the PCMH for Montanans with disability that were developed through a series of key informant interviews and policy forums. The Montana PCMH Act was created by Senate Bill 84, which was passed by the 2013 Montana Legislature. The law requires a council of stakeholders in creating standards for the program. The Montana Disability and Health (MTDH) Community Planning Group targeted increased awareness and programmatic input from the disability population and advocates about PCMH practices to build the capacity of health care providers and their aligned systems to promote and perform primary and preventative healthcare for persons living with disabilities. Subsequently, MTDH conducted phone and in-person interviews (15-20 structured and unstructured survey questions) with key informants (five primary sources on PCMH policy and health care systems; four administrators of PCMH-recognized CHCs-- 3 had satellite clinics; and six rural health clinic administrators). Findings characteristized PCMH practices as having: 1) no specific patient population limitations; 2) “patient navigation” systems for coordination of care/case management; 3) chronic disease performance metrics;  4) unknown proportions of patients with disabilities; 5) ADA accessible features and improvement objectives; and 6) cultural competency education lacking disability content. Interview results were summarized and presented with relevant public health surveillance and administrative data at six state-level disability and health care policy forums. Findings and policy recommendations for PCMH implementation and other care coordination initiatives will be discussed.