A community-based oncology practice's patient-centered medical home model features oncology-specific information technology, a standardized assessment, multidisciplinary care plan, patient navigators, telephone triage line, patient education and engagement, and ongoing performance monitoring, leading to improvements in access, quality, and costs.
A children's hospital requires providers to look at a patient's picture and basic demographic information on a verification screen when entering and signing an order, leading to significant reductions in patients receiving or almost receiving care intended for someone else because of an order being placed in the wrong chart.
Using a data-matching program, the state of Louisiana allows qualified, low-income children to be automatically enrolled in Medicaid based on information submitted on applications to the state's Supplemental Nutrition Assistance Program, enhancing access to Medicaid coverage and health care services and significantly reducing administrative costs.
Health plan members due for colorectal cancer screening and at low risk for the disease receive an automated educational call and a test kit to compete at home and return by mail, leading to a fourfold increase in the likelihood of screening in this hard-to-reach population.
An alliance of government and not-for-profit agencies aided the passage of various legislative provisions in Massachusetts designed to create a more stable, systemic role for community health workers, leading to greater professional recognition, an expanded workforce and training infrastructure, and increased funding of services.
Patients track preventive health needs, complete health risk assessments, and obtain educational information through an online interactive health record integrated with their practice's electronic health record, leading to improvements in the provision of preventive care.
Large health care systems in Detroit came together to develop an organizational structure and common goals and policies designed to strengthen the safety net for uninsured residents, leading to increased enrollment in public insurance, enhanced access to primary and specialty care, and lower uncompensated care costs.
A statewide consortium of community health workers, public agencies, and nonprofits aimed to reduce health disparities by developing a standardized scope of practice, creating a training and certificate program and a stable funding strategy to secure reimbursement from Medicaid. Their work resulted in greater integration for these workers in the health care work force.
A statewide, multipayer pilot program provides technical and financial support to physician practices interested in becoming patient-centered medical homes, leading to all participating practices being recognized as medical homes and to anecdotal reports of better access and higher quality.
Specially trained and certified lay workers known as “Grand-Aides” use illness-specific protocols to ensure that patients receive appropriate treatment in primary care settings and to ease the transition from hospital to home after discharge. The primary care-based program has reduced unnecessary visits and demonstrated the potential to reduce costs. Early data from one hospital program show significant reductions in readmissions.