Medical Home Monitor
Medical Home Monitor
October 20, 2008
Vol. I, No. 7

Medical Home Monitor Archives

Medical Home Q&A:
Collaborating on Care Coordination

Medical Home Monitor

Q: Will medical home care coordination by health plans and providers be duplicative or supportive?

A: As part of our pilot with Cigna, their care coordinators and our care coordinators determined who has most appropriate responsibility for any individual type of patient. For example, transplant care is so rare that this responsibility is better left with the health plan. Care in the primary care office covers specialty care referrals and chronic care managed by the PCP. It has been a very collaborative process to see where the health plan has information that we don't currently have and transfer that over. There was a great deal of setup work, patient type by patient type, to eliminate confusion for the patient or duplication of resources for any patients. (Barbara Walters, senior medical director Of Dartmouth-Hitchcock Medical Center.)

For more on emerging reimbursement models for the medical home, please visit:

Data Collection Wires First Statewide Medical Home

Data collection technology will enable MDdatacor, Inc. and Blue Cross Blue Shield of North Dakota (BCBSND), North Dakota's largest provider of healthcare coverage, to create the country’s first statewide patient-centered medical home (PCMH). The MediQHome program promotes a PCMH approach to the delivery of care to all North Dakota citizens, not just BCBSND's 475,000 members.

The voluntary MediQHome program launches in January 2009 and hopes to recruit North Dakota's 4,241 providers, including 1,433 PCPs and 2,808 specialists. Initially, MediQHome will focus on diabetes, hypertension, heart disease, childhood asthma and chronic lung disease, immunizations and attention deficit hyperactivity disorder (ADHD).

MDdatacor’s CareInformatix™ technology will automate the collection of clinical data from physician practices’ EMR, practice management, lab and registry systems to provide real-time Web-based reports that identify patients whose current treatment does not meet clinical guidelines, facilitating appropriate, evidence-based medical care to patients in a cost-effective manner. Physicians will have access to data on all patients, regardless of health insurer.

For more details on this program, please visit:

HealthSounds Podcast: Healthcare Trends for 2009 Point to Integrated Care Delivery

The growing trend toward integrated care delivery systems can help the U.S. healthcare system refocus on its primary goals — providing coordinated care and returning patients to their optimal health status, explains Perry Hanson, partner with Wipfli, a national accounting and business consulting firm that provides consulting, tax and audit advice for the healthcare industry. Integrated care delivery can also help the U.S. reverse its current last-place rankings in quality, access and efficiency among the global health community, he adds. Citing the success of the medical home model of care in Minnesota, Hanson calls the patient-centered model a "beacon of hope" for a beleaguered healthcare industry.

To listen to this complimentary HIN podcast, please visit:

Hospital Is Medical Home for Chronically Ill

Free primary care provided by Floyd Medical Center's We Care Program provides a medical home to more than 1,000 low-income, uninsured patients with chronic healthcare problems, helping them to avoid ER visits. The hospital also offers these patients all outpatient ancillary, pharmacy, emergency and inpatient services at no cost. Located in Rome, Georgia, the medical center was recently recognized as the best large hospital in Georgia by the Georgia Alliance of Community Hospitals.

For more details on other preventive outreach programs from Floyd Medical Center, please visit:

Telephone Connectivity Supports Medical Home Model and Removes Barriers to Care

In a faltering economy, the value of telehealth — the utilization of the telephone to provide physician or consumer-directed cross coverage 24/7 — cannot be underestimated. This emerging and effective application can help payors and providers tackle specific issues related to episodic care as well as chronic care management for diseases such as diabetes, cancer and cardiac disease.

To download this complimentary white paper, please visit:

Study Shows North Carolina's Medical Home Boosts Cancer Screening and Prevention

The medical home efforts of ACCESS/Community Care of North Carolina (CCNC) managed care networks were further validated last week after a major study of North Carolina's Medicaid recipients found that patients with long-term medical continuity also benefit in the area of cancer screening and prevention. The study, published in the Archives of Internal Medicine, evaluated the medical records of nearly 2,000 state Medicaid recipients age 50 and older and found that patients who had been seeing the same practitioner for more than five years were twice as likely to be screened as those who had been with a practitioner less than two years. CCNC's medical home pilot for diabetes patients is described in Case Studies from Diabetes Medical Home Pilots: Key Processes, Tools, Metrics and Outcome, where CCNC nurse case manager Roberta Burgess details the best practice care coordination efforts for diabetes patients in its Medicaid population. The CCNC networks, which saved North Carolina an estimated $231 million in 2005 AND 2006, operate in all 100 counties and since 2004 have enrolled half the state’s 1.7 million Medicaid recipients into a medical home.

For more information on CCNC's medical home pilot for diabetics, please visit:

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