Tuesday, June 15, 2010

Disproportionate Share Clinics Are More Likely to Have Features of the Medical Home

The Disease Management Care Blog would have guessed that primary care sites serving socioeconomically disadvantaged populations would be more likely to be shut out of coming medical home payment bonanza. Given the assumption that their practice income is lower than average, it follows that they'd probably be unable to afford the added costs of a practice redesign to qualify for the additional payments.

Not so, says this paper* just published in the Archives of Internal Medicine. Titled "Medical Home Capabilities of Primary Care Practices That Serve Sociodemographically Vulnerable Neighborhoods," Bostonian authors Mark Friedberg, Kathryn Coltin, Dana Gelb Safran, Marguerite Dresser and Eric C. Schneider used their own survey to determine how much 'medical homedness' was already present in sample of Massachusetts primary care sites. They then used geomapping to assess the sociodemographic case mix of the sites' surrounding neighborhoods.

The authors' survey included asking if interpreters and multi-lingual physicians are available (features not specifically spelled out in this and this description of the optimum features of a medical home, but heck, it's their survey). It turned out those two features and - depending on the definition used of being a disadvantaged primary care clinic - electronic records, having staff for patient education and being aware of patient experience ratings were all more likely to be present in clinics located in socioeconomically vulnerable neighborhoods. None of the other medical home features that were assessed were less likely to be in these sites either.

While the study may be limited by the lack of generalizability (the sites surveyed were physician owned practices that were not public health clinics, plus this was Massachusetts) and by the vagaries of the survey that was used (as opposed to the more widely accepted NCQA assessment tool), the DMCB thinks this counterintuitive study may have important policy implications. Clinics that serve populations with care disparities may be helped by a payment stream promoting medical homes.

In retrospect, it makes sense to the DMCB that 'disproportionate share' clinics might have access to funding or other resources that enable them to have electronic records and rely on non-physicians for patient contact. If that is the case outside of Massachusetts, the DMCB suspects that NCQA accreditation would be within reach for these clinics if they decided to go through that process.

Hopefully this study will be replicated in other areas of the country to see if it holds up. If it does, it may make sense for disease management organizations to anticipate possibly not having to support disproportionate share clinics in their medical home activities and being able to count on them as resources in their ongoing care management.

As an added bonus, the DMCB notes that if you can get past the manuscript and into the online article itself (requires a subscription), the Archives has an on-line copy of the survey that was used to assess the clinics' medical home characteristics. This could be theoretically be used by a payer or purchaser in their own network.

*Hat tip to HealthHombre

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