BACKGROUND This white paper was prepared to disseminate the learnings from the REACH Healthcare Foundation Medical Home Initiative to the broader health community as primary care practic
PARTICIPANTS
Cabot Westside Health Center www.saintlukeshealthsystem.org/locations/cabot-westside-medical-and-dental-center
Cabot Westside Health Center is a not-for-profit safety net clinic affiliated with Saint Luke’s Health System Cabot recently celebrated its 100 year anniversary, serving Kansas City residents since 1906
Cabot offers comprehensive healthcare services, including adult, family, pediatric medicine, and general dentistry As a provider for the Women, Infants, and Children (WIC) nutrition program, Cabot ensures essential nutritional support for its community In 2012, Cabot cared for over 7,900 unique patients, facilitating more than 25,000 visits, predominantly serving a Hispanic population, with over 90% identifying as Hispanic and 65% speaking only Spanish While most insurance plans are accepted at Cabot Westside, the facility dedicates over 30% of its budget to providing care for uninsured patients, highlighting its commitment to accessible healthcare.
Saint Luke’s Health System has integrated PCMH transformation into its strategic plan, aiming to achieve designation across all outpatient facilities soon Notably, Cabot Westside Health Center achieved the prestigious NCQA PCMH Recognition, Level 3, in December 2011, highlighting its commitment to delivering high-quality, patient-centered care.
In 2013, Cabot Westside Health Center was acquired by a Samuel U Rodgers Health Center (also a participant in the REACH Medical Home Initiative), which operates several clinic locations in Missouri
Children’s Mercy West www.childrensmercy.org
Children’s Mercy West, also known as the Cordell Meeks, Jr Clinic, has been providing primary care to approximately 7,500 patients since its opening in 2007 As a division of Children’s Mercy Hospitals and Clinics, the clinic offers comprehensive outpatient and hospital-based healthcare services The organization features a team of 600 pediatricians and researchers across more than 40 subspecialties, dedicated to delivering high-quality clinical care, advancing pediatric research, and educating future pediatric subspecialists Additionally, the clinic supports research and teaching efforts aimed at improving children's health and serving the community.
Children’s Mercy West was an early adopter of the Patient-Centered Medical Home (PCMH) model, implementing team-based care ahead of other outpatient clinics within the Children’s Mercy system In recognition of their efforts, the clinic achieved Level 3 NCQA PCMH Certification in February 2012, demonstrating their commitment to providing coordinated, patient-centered care.
Duchesne Clinic www.duchesneclinic.org
The Duchesne Clinic, an affiliate of the Sisters of Charity of Leavenworth Health System, is dedicated to providing patient-centered medical care aligned with the Medical Home model Supported by a network that includes hospitals and clinics across Kansas, Montana, Colorado, and St John’s Hospital in Santa Monica, CA, the organization aims to establish the Duchesne Clinic as a primary medical home Their overarching goal is to expand this model to other clinics within the system, ensuring coordinated and comprehensive healthcare for all patients.
Services at Duchesne clinic include general primary care, well woman care, chronic disease management, and medication assistance Demographics reveal a patient population of 2,244 unduplicated patients in 2010, providing over 12,000 patient visits
Our clinic relies heavily on dedicated volunteer specialists, including internists, gynecologists, cardiologists, surgeons, ENT doctors, and psychiatrists, who provide essential healthcare services With a team of 25-30 experienced physicians working flexible schedules, we ensure comprehensive medical care to meet the diverse needs of our patients.
Health Partnership Clinic of Johnson County www.hpcjc.org
Health Partnership Clinic serves a diverse patient population of approximately 3,000 unique users and facilitated over 10,000 patient visits in 2010 Notably, 50% of their patients are immigrants from regions including Mexico, India, Russia, and Central and South America The clinic is experiencing substantial growth, with a 40% increase in new patients, reflecting its expanding role in providing healthcare to underserved communities.
Health Partnership Clinic, formerly a free healthcare provider, became a Federally Qualified Health Center in 2012, expanding access to comprehensive medical services The clinic relies heavily on dedicated volunteer primary care providers and specialists, ensuring quality care for the community Recognized for its excellence, HPC earned Level 1 NCQA Patient-Centered Medical Home (PCMH) Recognition in January 2011, which was elevated to Level 3 in June 2012, demonstrating its commitment to high-quality, patient-centered care.
Kansas City CARE Clinic (formerly Kansas City Free Health Clinic) www.kccareclinic.org
Kansas City CARE Clinic has a proven track record of serving the uninsured in the Kansas City metropolitan area, providing nearly 50,000 visits in 2012 to a primarily adult population of 15,000 The clinic offers comprehensive services such as general medicine, behavioral health, and dental care, making it a vital healthcare provider As a primary contractor for federally funded HIV care programs, KC CARE Clinic plays a critical role in supporting HIV patients and is actively involved in clinical research trials for HIV and hepatitis C The organization operates with a dedicated staff of 105 employees and over 1,200 volunteers, ensuring extensive service delivery and community impact.
Originally known as KC Free Health Clinic, the organization did not accept health insurance and referred patients with coverage to other primary care providers In 2012, KC Free transitioned to a fee-based model in response to healthcare reforms that shifted many patients to Medicaid coverage This new business model allows existing patients to continue receiving care at the safety net primary care facility without disruption.
Samuel U Rodgers Health Center www.rodgershealth.org
Samuel U Rodgers Health Center (SURHC), established over 40 years ago, was Missouri's first community health center and the fourth in the United States, positioning it as a pioneer in accessible healthcare As one of three federally qualified health centers (FQHC) in Kansas City, SURHC plays a vital role in providing comprehensive medical, dental, and behavioral health services Last year alone, SURHC served more than 21,000 patients across its eight locations, demonstrating its commitment to community health and wellness.
Samuel U Rodgers Health Center is dedicated to delivering high-quality care through its structured quality improvement program, which served as a strong foundation for transitioning to a patient-centered medical home In 2013, SURHC expanded its network by acquiring Cabot Westside Medical and Dental Clinics, enhancing access to comprehensive health services for the community.
Silver City Health Center www.silvercityhealthcenter.org
The Silver City Health Center was acquired by Kansas University Medical Center (KUMC) in 1996 and operated by medical residents for nearly a decade In 2006, it was purchased by Kansas University Health Partners (KUHP) and became an affiliate of KUMC, functioning as a faculty practice Notably, Silver City is recognized as a nurse-managed practice, with advanced practice nurses (nurse practitioners) delivering healthcare services to the community.
Silver City Clinic serves an active patient population of around 2,500, conducting over 7,500 visits annually With approximately 50% of patients speaking Spanish, the clinic ensures effective communication by employing bilingual medical assistants and patient service representatives This dedicated language support helps improve patient care and enhances the overall healthcare experience for the diverse community.
Our services provide comprehensive primary care, including pharmacy assistance and referral coordination to ensure seamless patient support We focus on health education and community outreach to promote prevention and early intervention Additionally, we offer tailored programs specifically designed to reduce the impact of chronic diseases, enhancing overall healthcare outcomes and patient well-being.
IDENTIFIED TECHNICAL ASSISTANCE NEEDS
CLINIC 1 CLINIC 2 CLINIC 3 CLINIC 4 CLINIC 5 CLINIC 6 CLINIC 7 CLINIC 8
E Cult and Ling Appropriate Services
F Using Data for Population Management x x x x x x x
OTHER LOCAL/REGIONAL PATIENT- CENTERED
LOCAL/REGIONAL PATIENT- CENTERED CARE
In 2011, the Missouri Medical Home Collaborative (MMHC) was launched, funded by the Missouri Foundation for Health and the Health Care Foundation of Greater
Kansas City is participating in the Missouri Medicaid Health Care (MMHC) program, overseen by MO HealthNet The initiative involves fifty clinic sites and is guided by Ballit Health consulting group Over a two-year period, the program includes nine full-day learning sessions and ongoing telephonic consultation to support healthcare providers.
This collaborative focused on transforming healthcare through Patient-Centered Medical Home (PCMH) concepts while emphasizing key areas such as Clinical Care Management and Care Coordination Additionally, it prioritized data collection and reporting to enhance healthcare outcomes The development of a sustainable payment model was also a crucial component, ensuring improved value-based care and long-term success.
Kansas Association for the Medically Underserved (KAMU) Medical Home Initiative
In 2010, KAMU launched its first learning collaborative for member clinics, primarily providing technical assistance through distance learning Building on this experience and sponsored by the Kansas Health Foundation, KAMU expanded in 2012 by launching a new collaborative with 10 additional clinics, focusing on adopting the PCMH model and achieving NCQA PCMH Recognition This initiative offered a comprehensive technical assistance approach, combining in-person workshops and webinars to support participating clinics effectively.
The Kansas Patient-Centered Medical Home Initiative (PCMHI)
In July 2011, a consortium of professional associations launched the 24-month PCMHI project to serve as a key catalyst for healthcare transformation in Kansas This initiative involves eight physician-led practices and aims to promote the adoption of the Patient-Centered Medical Home (PCMH) model The project emphasizes education and information sharing to encourage practices to transition to PCMH, ultimately improving population health and clinical outcomes.
The collaborating partners are: Kansas Chapter of the American Academy of
Pediatrics, Kansas Academy of Family Physicians, Kansas Association of
Osteopathic Medicine receives support from the Kansas Chapter of the American College of Physicians and the Kansas Medical Society, highlighting strong professional backing The initiative is primarily funded by major organizations including the United Methodist Health Ministry Fund, Sunflower Foundation, and the Kansas Health Foundation, emphasizing community and health-focused investments Additionally, Blue Cross Blue Shield has pledged payer support, ensuring financial backing and sustainability for the program's success.
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Medical Homes Promote Equity in Health Care—Results from The
Commonwealth Fund 2006 Health Care Quality Survey, The Commonwealth Fund, June 2007
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PCMH Recognition Standards: A Crosswalk Available at: http://www.safetynetmedicalhome.org/sites/default/files/NCQA-Change- Concept-Crosswalk.pdf Accessed February 20, 2014
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Management Advisor, Vol 1, Issues 7 & 8, May 9 and 23, 2005.