The health care home model (also referred to as the medical home model) has the potential to improve health care delivery at the patient level by redesigning and improving the linkage between primary care clinics and public health agencies. The Health Care Home Model (HCHM) was first implemented in the 1960s, but it has gained considerable momentum in the 2000s. Although not all HCHMs are successful, several research studies have found that these models can improve the quality of health care services, reduce costs, and improve the health of the population.

In Nebraska, the model is rapidly spreading across the state. In 2011, Blue Cross Blue Shield of Nebraska initiated a medical home model in nine cities by focusing on management of diabetes, using test results for the patient’s blood sugar, blood pressure, and cholesterol levels. In 2012, this model was expanded to 33 clinics and about 42,000 Blue Cross subscribers.

In 2010, the State Legislature appropriated funds for two medical home pilot projects for Medicaid patients. In 2011, two pilot projects were launched in clinics located in Lexington and Kearney. Also, as part of the Medicaid managed care contract, Coventry and Arbor Health are expected to develop medical home models in twelve new communities over a three-year period. Blue Cross Blue Shield of Nebraska has experienced early success with this model and the Medicaid program is rigorously evaluating the results of the pilot projects.

The HCHM has the potential to improve the health of the population by improving access to care (e.g., after hours care and electronic communication), and reducing health disparities. For example, racial and ethnic minority populations tend to have a higher incidence of chronic conditions, which could be treated more effectively through more timely clinical preventive services (e.g., culturally and linguistically relevant diabetes health education). Other disparities can be prevented through cancer screening programs and immunizations.

Public health agencies can provide direct support to HCHMs and they can improve the health of the population by working collaboratively with employers, schools, the faith community, and nonprofit agencies. They also provide a variety of programs and activities that are designed to reach the entire population.

Nebraska SHIP Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

For this SHIP goal, several activities were planned for implementation:

• Analyze health data from clinics with healthcare home models, and recommend best practices.
• Implement health education and promotion programs to compliment clinic services.

Several clinics are already operating healthcare home clinics and tracking various health indicators such as Hemoglobin A1c and cholesterol levels. These clinics receive additional funding from BlueCross BlueShield of Nebraska, Medicaid, and Federally Qualified Health Centers (FQHCs). By developing a pilot project and collecting comparable data among selected clinics, it will be possible to identify best practices and to identify the roles of local and state health departments in tracking the data and connecting patients with appropriate community health promotion programs.

The Health Care Home Model has some very unique characteristics and places patients at the center of the health care system and includes the following:

•  A physician-led, team-based coordination of care process that focuses on the patient and his/her family.
•  A care model that is holistic – including the patient’s physical, mental, and socioeconomic health status.
•  A care model where each patient is assigned a provider and care team that oversees and implements continuity of care that is delivered through access to a spectrum of health care delivery services, including home health, hospital inpatient care, specialists, rehabilitation facilities, and long-term care facilities.
•  A focus on providing high-quality care, especially to patients with chronic disease/conditions, including a documented monitoring process using patient registries.
•  24/7 access to care.

There are several elements of the health care home model. These elements include 1) patient tracking and registry, 2) access to care, 3) care management, 4) patient self-management support, 5) test tracking, 6) referral tracking, 7) performance reporting improvement, and 8) advanced electronic communication.