Study suggests 'medical homes' key to promoting health equity.

PROVIDING minority patients with health insurance and a "medical home" could help eliminate racial and ethnic health care disparities, according to a new report from the Commonwealth Fund.

The report, based on results of a 2006 Commonwealth Fund health care quality survey of more than 2,830 adults across the United States, showed that linking minority patients with a medical home--a place where a patient could receive timely, well-organized care and enhanced access to providers--helped patients to better manage chronic conditions and obtain preventive care services.

Patients who noted a regular provider or place of care, ease of contacting a provider by phone, ease of getting advice or medical care when needed on weekends or evenings and well-organized and efficient office visits were said to have a medical home. Having insurance strongly predicted whether patients had a medical home. In turn, community health centers and public clinics, which often serve low-income or uninsured adults, were less likely than private doctor's offices to fit the medical home criteria.

Hispanic and black adults with a medical home experienced no disparities in receiving preventive care reminders, the report found. Such reminders significantly improve routine screening for conditions such as heart disease and cancer, the fund reported.

Adults with a medical home were also better prepared to manage chronic conditions, such as diabetes or hypertension. While 65 percent of patients without a regular medical home reported that their doctor or doctor's office did not give them a plan to manage their care at home, the rate dropped to 23 percent of adults who did have a regular source of care.

The Commonwealth Fund report concluded that health insurance and access to a medical home are equally important to eliminating health care disparities. To expand access to medical homes across the country, report authors recommended providing stable health insurance for all, publicly reporting which providers meet the standards of a medical home and recognizing and rewarding high-performing medical homes.

Thomas A. LaVeist, PhD, director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health, said that an incentive structure is needed in order for providers to move toward such a model across the United States.

"This can only happen if payers buy-in to the medical home concept and demand that providers meet that standard," he said.

Anne Beal, MD, MPH, senior program officer for the fund's Quality of Care for Under-served Populations Program and coauthor of the report, said that the funding to promote medical homes on a wide scale is a worthwhile investment and will help save money spent on unnecessary services and emergency room visits for patients without a regular source of care.

"People want to know what will it cost to do this, but I think the more important question is: What does it cost for us to not do it?" she told The Nation's Health.

According to APHA member Kevin Grumbach, MD, who studies access to care, health care work force and minority health issues as chair of the Department of Family and Community Health at the University of California, San Francisco, increased investment in the quality of medical homes, such as electronic data systems, would help improve health outcomes. At the forefront of quality concerns is the dwindling number of primary care physicians in the United States who earn "well under half" the salary of other specialties, and the gap continues to widen, Grumbach said.

"Medical homes might be vacant unless we address the training of primary care physicians and also change the payment policy so that primary care is more attractive," he said.

Showing that safety net providers can make the model work, Anna Maria Izquierdo-Porrera, MD who directs the Spanish Catholic Center of Catholic Community Services in Washington, D.C., spoke at a news conference releasing the report in June. She told The Nation's Health that her organization is able to serve more than 40,000 patients from around the world because the center's workers "reflect the population of patients" and "speak their language." She suggested that health care funding directed toward quality of care and meeting the cultural needs of patient populations could help reduce disparities.

For more information on the Commonwealth Fund report, visit www.commonwealthfund.org.