Thursday, May 16, 2013

Population Health Must Include Social Determinants: The Approach in the Patient Centered Medical Home

Diabetes control isn't
their top concern
The Disease Management Care Blog's primary care colleagues are undoubtedly aware of how "social determinants" can undermine the best care planning. So, if you're going to rely on the Patient Centered Medical Home (PCMH) to increase health care quality and reduce costs, ignoring the impact of poverty or health literacy could lead to poor diabetes control, worsening high blood pressure or more hospital readmissions.

Arvin Garg, Brian Jack and Barry Zuckerman have written a JAMA "Viewpoint" that offers five lessons from pediatric medical homes that can mitigate harmful social determinants:

1) Include social determinants (for example, community factors, substance abuse, education, malnutrition or poverty) in the creation of national treatment guidelines.

2) Develop and implement screening programs to identify any social determinants that could impact medical treatment.

3) Colocate community resources that address social determinant in PCMHs.  Examples include housing programs, job training programs or food pantries.

4) Colocate "outside the box" social programs in PCMHs also.  This is an area ripe for piloting or researching innovative interventions

5) Integrate visiting nurse programs with the PCMH.  Think of the visiting nurses as an extension of the medical home.

As readers of the DMCB are aware, not all PCMH's can build the full suite of services that make up a medical home. Since health insurers and care management vendors are partnering with primary care physicians to build medical homes, this approach to incorporating social determinants in their programs is worth a closer look.


Anonymous said...

Who is going to pay for the job training programs and food pantries? Private insurance companies? Health service vendors? Somehow I doubt it. Now if we had a truly functional system on the other hand, such as an improved and extended Medicare that covered everyone automatically, the resulting efficiencies and cost savings would probably allow for funding of the social-determinate-changing programs that you describe in this post. Until we do, your suggestions unfortunately sound like so much wishful thinking.

Insurance blog said...

that will shoot up the premiums. wouldn't it?