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April Book of the Month

Case Studies from Diabetes Medical
Home Pilots: Key Processes, Tools,
Metrics and Outcomes


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As the patient-centered medical home (PCMH) model moves from blueprint to implementation, there is some debate over its ability to deliver quality care and coordination while reducing healthcare cost and utilization. Overburdened physicians are also unsure how to meet the PCMH's time and technology demands under current reimbursement formulas. While the conversation continues, results from recently completed medical home pilots show promise for patients with diabetes as well as lower costs for those who treat and insure these patients.

10% Discount on Case Studies from Diabetes Medical Home Pilots
10% Discount Case Studies from Diabetes Medical Home Pilots: Key Processes, Tools, Metrics and Outcomes offers a detailed look at two physician-health plan partnerships in diabetes disease management a care coordination pilot for New Jersey state employees with diabetes and a hands-on case manager-driven initiative for Medicaid beneficiaries with diabetes in North Carolina.

Dr. James Barr, medical director for Partners in Care, and Roberta Burgess, a nurse case manager with Community Care Plan of North Carolina with Heritage Hospital in Tarboro, North Carolina, provide profiles of their medical home initiative, as well as a host of checklists and tools for a diabetes medical home. They also furnish details on the following:

  • Transforming a physician practice into a diabetes medical home;
  • Defining the roles and responsibilities of a successful diabetes medical home team;
  • Facilitating the cultural shift from patient managers to population managers;
  • Applying the NCQA's "Must Pass" elements of the patient-centered medical home to a diabetes-focused initiative;
  • Developing goal-directed patient management plans;
  • Identifying the practice buy-in to support a diabetes medical home and engaging practices in the effort;
  • Reducing hospital admissions and ER utilization through the medical home model;
  • Launching a comprehensive multi-phase diabetes disease management program for Medicaid patients from selecting a diabetes quality improvement champion to developing patient and provider education materials;
  • Identifying potential patients for the diabetes medical home and engaging them in the program;
  • Developing a case identification database;
  • Measuring outcomes and cost savings from the diabetes medical home;
  • and much more.


Order online by April 30, 2009 and receive a 10% discount!


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