Patient-Centered Medical Home: A Case Study
Medicaid accounts for 16 cents of every U.S. healthcare dollar, 24 cents of every State budget dollar. Of the 60 million Medicaid beneficiaries in the U.S., Seniors and Persons with Disabilities (SPD) who represent just one-fourth of program enrollees yet account for 70% of overall Medicaid cost. As California (Medi-Cal) is the largest Medicaid program in the nation with total 12 million beneficiaries as of Jan 2015, almost one in three Californians are in the Medi-Cal program, seeking solutions to manage and ensure the efficiency of care delivery has an extensive impact to the State’s budget and resource allocation.
As a result of the launch of Medicaid expansion in 2014, the already high ED use in the Medi-Cal population is expected to grow faster than other types of health insurance programs. How to bend the curve of ED use, and how to ensure the quality of care to the staggering number of Medi-Cal beneficiaries become two urgent questions to the policy makers, care providers and all Medi-Cal enrollees.
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By integrating patient engagement, coordination of care, quality of care, adopting health information technology and access to care, encouraging results in improving the quality of patient care, reducing hospitalization and ED visits were presented in some pilot projects mainly from integrated delivery systems and multi-payer sponsored PCMH initiatives. As the evidence is thin for the Medicaid population, especially for the people with disabilities, this dissertation presents timely and essential evaluation of the potential of the PCMH model in guarding against the explosion of Medi-Cal
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