Five safety-net clinics in Louisiana, Mississippi, Alabama, and Florida all Gulf Coast States are participating in the “Community Centered Health Home (CCHH) Demonstration Project”. The Louisiana Public Health Institute is directing the project and aims to expand Patient-Centered Medical Homes (PCMH) to the CCHH concept.
According to the CDC www.cdc.gov article published on their website authored by Daphne Miller, MD and Eric T. Baumgartner MD, titled “Lessons from the Community-Centered Health Home Demonstration Project”, PCMHs can also improve health conditions in their surrounding communities http://dx.doi.org/10.5888/pcd13.160262.
The PCMH structure increases patient access to secondary prevention and screening services, such as mammograms, blood pressure screening, but the PCMH structure can also provide lifestyle and chronic disease self-management education.
The CCHH approach takes the PCMH structure a step further by acknowledging that socioeconomic and environmental factors greatly influence behavior and disease risks. This means that broader influences must be targeted in tandem with efforts directed toward the individual’s health.
CCHH clinics are taking advantage of the collaborative team structure and all team members understand how environmental and social factors shape people’s health so it is important for each team member to play a key role in addressing those factors.
For example, asthma can be triggered by substandard housing conditions or toxic environmental exposures plus diabetes and obesity can be caused by the scarcity of healthful foods and to unsafe streets and parks.
To make the CCHH concept successful, clinicians will need to share information with other agencies and advocate for policies and programs to change the physical and social environment. So far, staff members with information technology expertise have pooled clinical data and blended it with data from outside agencies. The next step is to do a geospatial analyses to help identify the root causes of disease patterns in a community.
Today, CCHH sites are forming partnerships with public health and other organizations dedicated to improving community conditions that influence health. In addition, they are co-locating with social services, providing information on insurance enrollment programs, plus sources for legal assistance.
However, additional research is needed to find ways to fully support this new approach. This research should not focus only on outcome indicators, but on the quality of care and costs, along with information on the number and quality of partnerships in which the clinic is a stakeholder. In addition, new national, state, and local policies are needed to finance this population health approach.