ESSAY — Volume 13 — August 4, 2016

Local and state health partnership models, such as accountable care organizations and accountable communities for health, are being tested, and large health care organizations are embracing a “health in all policies” approach, which emphasizes multisector collaboration to improve population health (2,3). These innovations are encouraging, but there are no concrete strategies for how primary care clinics, and safety-net clinics in particular, can participate in this larger effort (4). We propose that the medical home model — a system of primary care designed to meet the needs of individual patients by delivering coordinated and accessible services — offers a ready framework for community clinics to offer primary prevention to individuals and to improve health at the population level.

Five safety-net clinics in 4 US Gulf Coast states (Louisiana, Mississippi, Alabama, and Florida) are participating in the Community Centered Health Home Demonstration Project, directed by the Louisiana Public Health Institute, to expand from a patient-centered medical home (PCMH) to what is being called a community-centered health home (CCHH) (5). The CCHH model provides a framework for primary care – and health care organizations in general – to address individual health needs while systematically addressing community conditions that affect individual health. This article describes the experience of clinics in the Gulf Coast states in creating a CCHH by building on the 3 established characteristics of a successful PCMH: 1) an explicit vision for how to serve a population, 2) engaged and visible leaders, and 3) effective clinical teams (6).

All demonstration clinics had an established social mission, and yet the broadening of their focus from individual patient needs to the community’s needs changed their approach to illness and injury prevention.

To read more of the Essay authored by Daphne Miller, MD and Eric T. Baumgartner, MD, MPH, please click here.