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Patient-Centered Medical Home: A Case Study

556 Words3 Pages

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. …show more content…

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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Consequently, “welfare expenditures increased $104.0 million which is attributed to increased state support required for the Medicaid program” (16). Last, Medicaid assistance exceeded its budget by $433,385,000 (173). The increases in expenses and funding for Medicaid assistance indicates a more pressing issue: increased resident dependence on Medicaid. Medicaid is primarily for those with lower income and disabilities, and its increased enrollment of 14.2% in 2016 should raise concerns.

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Unfortunately, EDs are meant for urgent care issues and are the most expensive place for treatment. Uninsured patients usually do not seek preventive care as majority of them cannot afford medical bills or manage chronic conditions. They are known to seek care at late stages when the sickness has already exacerbated and costs much more to manage. Lack of access to health care also results in reduction in the workforce and many may die of preventable / treatable diseases. Using Texas as an example, Texas is one of the 20 states that did not expand Medicaid under the ACA.

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A rising number of hospitals throughout the U.S. are applying a service model known as integrated health care (Kathol, Perez, Cohen 2010). The need for this is center around this area: Integration has made its approach into the health care settings gradually. This can assist in treating one’s medical and behavioral health needs within patient’s primary care provider’s office, recommending a proper evaluation as a whole person (Blout, 2003). Medical clinics have been used for a many years but its recognition is growing nationwide because of its effectiveness. Impact all parties involved, including but not limited to, patients, providers and insurance companies can be very effective.

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