Chronic care


Plan-Supported Medical Home Model Helps Clinics Enhance Access, Improve Quality, and Reduce Admissions for Medicaid Managed Care Enrollees 03/03/13

A plan-supported medical home model used by clinics serving Medicaid managed care beneficiaries enhances access to care, improves quality, and reduces inpatient admissions.

Personal Health Record Generates Little Use, Has no Impact on Blood Pressure Control; Utilization; or Patient Activation, Empowerment, and Satisfaction 02/27/13

A personal health record for hypertensive patients to monitor blood pressure and other health data had no impact on blood pressure control; health services utilization; and patient activation, empowerment, and satisfaction.

National Academy and Affiliated State Chapters Support Pediatricians in Improving Asthma Care, Leading to Better Guideline Adherence and Disease Control, Fewer Acute Episodes 02/26/13

The American Academy of Pediatrics and four of its state chapters trained and supported pediatric practices on asthma care, leading to better adherence to established guidelines and improved asthma control.

Self-Directed Budget Enhances Access to Home Health and Other Needed Services, Resulting in Fewer Unmet Needs, Better Health Outcomes, and High Satisfaction for Medicaid Beneficiaries 02/22/13

A program known as Cash & Counseling gives Medicaid enrollees a monthly allowance for home care and related services that they can spend at their own discretion, leading to enhanced access to services, fewer unmet needs, improved health outcomes, and high levels of beneficiary satisfaction.

Multistakeholder Community Collaborative Spurs Development of Initiatives That Collectively Have Improved Blood Pressure Control Among Hypertensive Individuals 02/19/13

A multistakeholder collaborative, the Rochester Blood Pressure Initiative supports the development and implementation of a variety of provider-, employer-, and community-based programs that have collectively improved blood pressure control among hypertensive individuals in metropolitan Rochester, NY.

Health Plan Leadership Promotes Shared Decisionmaking Through Use of Decision Aids by Surgeons, Contributing To Lower Joint Replacement Rates and Overall Health Care Costs 02/15/13

A health plan supports providers in orthopedic clinics in distributing decision aids to patients and using shared decisionmaking, contributing to reductions in joint replacement surgeries and overall health care costs.

County-Based Accountable Care Organization for Medicaid Enrollees Features Shared Risk, Electronic Data Sharing, and Various Improvement Initiatives, Leading to Lower Utilization and Costs 02/14/13

A county-based accountable care organization integrates medical, behavioral health, and social services and assigns a care coordinator to newly enrolled Medicaid beneficiaries to promote use of appropriate services, leading to fewer readmissions and emergency department visits and lower costs.

Patients With Crohn's Disease Report Symptoms and Behaviors Through Computer Applications, Leading to Better Self-Management and Provider–Patient Communication 02/06/13

Patients with Crohn's disease reported information on nine observations of daily living (cues about health experienced in everyday living) using applications on a tablet computer, leading to more tracking of symptoms and health-related behaviors, better patient self-management and patient-provider communication, and high levels of patient satisfaction.

Community Partners Offer Financial Incentives and Support for Primary Care Practices, Improving Access and Reducing Utilization for Children on Medicaid 02/06/13

The Children's Healthcare Access Program offers financial incentives and support services to primary care medical homes serving children covered by Medicaid and their families; the program enhanced access to primary care, increased the percentage of children with asthma action plans, reduced emergency department visits and hospital admissions, increased well-child visits, and reduced costs.

Rural Practice Redesigns Care Processes To Allow Multidisciplinary Teams To Leverage Electronic Health Record, Leading to Better Screening of Medically Underserved 01/29/13

A rural medical practice redesigned its care processes to allow multidisciplinary care teams to use a new electronic health record system that features real-time documentation and information sharing and various tools to facilitate the provision of appropriate care, leading to significant improvements in screening rates and high satisfaction for medically underserved patients in Alaska.


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