Primary care

Innovations

Primary Care Physician Communication With Patients at or Soon After Discharge Significantly Reduces Medication Discrepancies 03/17/14

After being briefed by hospitalists, primary care physicians meet or talk by phone with patients who have complex medication regimens at or soon after discharge, leading to a significant reduction in medication discrepancies.

Community Health Workers Embedded in Inpatient and Outpatient Clinical Teams Enhance Access to Primary Care and Improve Health Outcomes for Low-Income Patients 03/13/14

Community health workers embedded in clinical teams in medical offices and hospitals support low-income patients in setting and achieving health-related goals and accessing needed medical and community-based services, leading to better communication and access to postdischarge primary care, increased patient activation, fewer readmissions and depression-related symptoms, and positive feedback from patients.

State Provides Financial and Technical Support to Underserved Communities Designated as Health Enterprise Zones, Leading to Enhancements in Primary Care Capacity 03/11/14

The State of Maryland provides financial and technical support to five communities designated through a competitive bidding process as health enterprise zones, leading to an expansion of primary care capacity in these areas.

Hospital-Affiliated Physician Group Offers Modest Performance-Based Incentives to Salaried Physicians, Leading to Sustained Improvement on Quality-Related Metrics 03/07/14

A hospital-affiliated physician group offers modest performance-based incentives to salaried physicians, leading to sustained improvements in performance on a broad array of quality-related metrics.

State Medicaid Program Pays Additional Capitated Fee to Integrated Primary Care and Mental Health Homes, Leading to Better Outcomes and Lower Costs 03/01/14

The Missouri Medicaid Health Home program provides capitated payments to primary care and mental health medical homes that adopt an integrated staffing model that allows patients to receive both medical and mental health care, leading to better health outcomes and lower utilization and costs.

Community Health Workers Offer Culturally Tailored Interactive Workshops and Counseling to Filipino Americans, Leading to Improvements in Medication Adherence and Cardiovascular Risk Factors 02/28/14

Community health workers provided culturally tailored workshops and one-on-one counseling and support to Filipino Americans at high risk of cardiovascular disease, leading to greater adherence to medication regimens, better attendance at scheduled appointments, improved blood pressure control, and lower body mass index.

State-Financed, Primary Care–Led, Accountable Care Collaborative Provides Comprehensive, Coordinated Care to Medicaid Beneficiaries, Reducing Admissions, Use of Imaging Services, and Costs 02/05/14

A State-led accountable care collaborative provides comprehensive, coordinated care to Medicaid beneficiaries through primary care medical homes, reducing use of inpatient, imaging, and emergency department services, and generating estimated savings of $6 million for the State.

Mental Health Center Provides Integrated Primary Care and Care Coordination to Medicaid Beneficiaries With Severe Mental Illness, Enhancing Access to Services and Improving Outcomes 12/20/13

With support from State funding, a community mental health center provides integrated mental health, primary care, care coordination, and wellness services to Medicaid beneficiaries with severe and persistent mental illness, leading to better chronic disease outcomes.

Peer Specialists in Federally Qualified Health Centers Enhance Access to Behavioral and Physical Health Support Services for Clients With Co-Occurring Medical and Mental Health Issues 12/13/13

Certified peer specialists provide emotional support, education, links to community services, and other support to individuals with co-occurring medical and mental health diagnoses at two Michigan federally qualified health centers, generating high levels of satisfaction and anecdotal reports of improvements in physical and mental health.

Foundation Develops Community-Based HIV Testing and Partnerships With Medical Homes, Leading to More Timely Linkages to Care for Newly Diagnosed Patients 11/25/13

A local foundation developed community-based testing programs and partnerships with medical homes to provide real-time linkages to HIV care to newly diagnosed patients and to support these patients in transitioning to care, nearly doubling the number of patients initiating treatment.
 

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