Medicine
Early in my career, I provided patient care at several community health centers in Washington, DC, and more recently, my wife served as the medical director for two area health centers. In fact, for several years we saw our own family doctor in a community health center. Despite the Supreme Court ruling that made the Affordable Care Act's expansion of Medicaid coverage optional for the states, health centers are expected to continue to play a big role in providing affordable primary care to millions of patients. And one of the many challenges that health centers encounter on a daily basis is how to arrange for patients to see subspecialists for diagnostic or therapeutic interventions (e.g., colonoscopy, surgery, cardiac stress testing) that their clinicians don't offer.
In a study published in Health Affairs, Katherine Neuhausen and colleagues asked directors of 20 community health centers in all parts of the U.S. how they addressed this challenge. The authors analyzed their responses to identify six distinct models that health centers use to obtain subspecialty care: Tin Cup, Hospital Partnership, Buy Your Own Subspecialists, Telehealth, Teaching Community, and Integrated System. As one might expect, health center directors who used the Tin Cup (i.e., begging subspecialists for charity care) model were least satisfied with their ability to access subspecialty care, while the most satisfied directors used the Integrated System model, which "features community health centers that are completely integrated with a local government health system or a safety-net hospital that has a comprehensive network of specialists." If a high-functioning community health center can provide its patients with a medical home, then the Integrated System represents the next essential step to meet all of their health care needs: the medical neighborhood.
In that neighborhood, it's important to recognize that the exchange of services can and should be a two-way street. Hospitals and large specialty practices have financial and material resources, while community health centers have the experience and know-how to manage care for high-risk patients with chronic conditions (the so-called "hot spotters" in Atul Gawande's widely read New Yorker article) who generate a disproportionate share of health care costs. The state of Maryland has been particularly innovative in encouraging these two types of organizations to combine forces through a matchmaking project whose results were outlined briefly in a JAMA article and further described in an innovations database maintained by Maryland's Department of Health and Mental Hygiene.
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This post appeared on Common Sense Family Doctor in slightly different form on August 22, 2012.
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Medicine
Welcoming health centers to the medical neighborhood
Early in my career, I provided patient care at several community health centers in Washington, DC, and more recently, my wife served as the medical director for two area health centers. In fact, for several years we saw our own family doctor in a community health center. Despite the Supreme Court ruling that made the Affordable Care Act's expansion of Medicaid coverage optional for the states, health centers are expected to continue to play a big role in providing affordable primary care to millions of patients. And one of the many challenges that health centers encounter on a daily basis is how to arrange for patients to see subspecialists for diagnostic or therapeutic interventions (e.g., colonoscopy, surgery, cardiac stress testing) that their clinicians don't offer.
In a study published in Health Affairs, Katherine Neuhausen and colleagues asked directors of 20 community health centers in all parts of the U.S. how they addressed this challenge. The authors analyzed their responses to identify six distinct models that health centers use to obtain subspecialty care: Tin Cup, Hospital Partnership, Buy Your Own Subspecialists, Telehealth, Teaching Community, and Integrated System. As one might expect, health center directors who used the Tin Cup (i.e., begging subspecialists for charity care) model were least satisfied with their ability to access subspecialty care, while the most satisfied directors used the Integrated System model, which "features community health centers that are completely integrated with a local government health system or a safety-net hospital that has a comprehensive network of specialists." If a high-functioning community health center can provide its patients with a medical home, then the Integrated System represents the next essential step to meet all of their health care needs: the medical neighborhood.
In that neighborhood, it's important to recognize that the exchange of services can and should be a two-way street. Hospitals and large specialty practices have financial and material resources, while community health centers have the experience and know-how to manage care for high-risk patients with chronic conditions (the so-called "hot spotters" in Atul Gawande's widely read New Yorker article) who generate a disproportionate share of health care costs. The state of Maryland has been particularly innovative in encouraging these two types of organizations to combine forces through a matchmaking project whose results were outlined briefly in a JAMA article and further described in an innovations database maintained by Maryland's Department of Health and Mental Hygiene.
**
This post appeared on Common Sense Family Doctor in slightly different form on August 22, 2012.
- Health Reform, Aca, And Primary Care: Is There Still A Conundrum?
Now that the election is over and the fact of the Affordable Care Act seems assured by the victory of the President and the increase in the Democratic majority in the Senate along with the Supreme Court’s upholding of most of the ACA’s provisions,...
- Community Health Workers Can Complement Primary Care
In late 2011, I attended an academic meeting where the subject of community health workers came up in a discussion. Earlier that year I had read about Vermont's ambitious blueprint for medical homes integrated with community health teams,...
- The Most Unheralded Posts Of 2012
It is customary for bloggers to highlight their most popular posts at year's end (see, for example, this recent compilation of posts from the AFP Community Blog, several of which subsequently appeared on Common Sense Family Doctor), but this year...
- The Best Recent Posts You May Have Missed
Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Primary Care And Health Disparities
One of the ugliest incidents in my career occurred during my faculty development fellowship year, when I spent two days each week seeing patients at several federally qualified community health centers in inner city Washington, DC. Midway through the...