Low-Overhead Medical Home Leverages Information Technology To Attract Both Providers and Patients in Underserved Rural Areas | AHRQ Innovations Exchange

full-text ►

Low-Overhead Medical Home Leverages Information Technology To Attract Both Providers and Patients in Underserved Rural Areas | AHRQ Innovations Exchange



August 27, 2014 Issue
Enhancing Primary Care Access and Capacity

This issue includes

Innovations:

Low-Overhead Medical Home Leverages Information Technology To Attract Both Providers and Patients in Underserved Rural Areas

Snapshot

Summary Located in rural North Carolina and affiliated with a community hospital and family practice residency program, the Pardee Flat Rock Family Health Center offers an "advanced patient-centered medical home" that encourages patients to take responsibility for managing their own health and health care. The medical home features online appointment scheduling and previsit planning with same- and next-day appointments; an electronic kiosk for patient check-in; 30-minute visits (twice the length of the typical visit); and multiple options for followup and ongoing care, including in-person, electronic, and group visits, as well as telephone consultations. The center's low overhead allows it to serve many low-income patients, including those who lack insurance (who receive discounted fees) and those with Medicare and Medicaid coverage (populations that many primary care clinics no longer accept as new patients). The program, which has been in operation for nearly 3 years now and serves nearly 1,000 patients; continues to experience few if any no-shows for appointments; produces strong outcomes in treating diabetes, chronic pain, and depression; has reduced emergency department visits; and has received very positive feedback from patients, residents, and medical students. Evidence Rating (What is this?) Suggestive: The evidence consists of post-implementation data on clinic volume, operating margin, and clinical outcomes in select chronic conditions, along with anecdotal feedback from patients, residents, and medical students. Developing Organizations Pardee Flat Rock Family Health Center Use By Other Organizations Information provided in July 2013 indicates that the practice model has been adopted regionally by four additional rural or solo practices. Trillium Family Practice in Asheville, NC has shown a positive margin within the first month of operation. Three additional practices are scheduled to open by 2014. Date First Implemented 2009 November Patient Population The medical home serves a diverse population, including many low-income individuals and families. Roughly one-third of patients do not have health insurance, one-fourth have Medicaid coverage, 25 to 30 percent have Medicare coverage, and the remainder have private insurance. Information provided in June 2012 indicates that the current payer mix is 54 percent Medicare, 8 percent Medicaid, 28 percent managed care or commercial coverage, and 11 percent self-pay (more than half of which comprises Charity Care patients who pay $15 a visit if they are uninsured and have family incomes less than 200 percent of poverty).Vulnerable Populations > Rural populations