Wednesday, March 10, 2010

Centralizing the “Centered” Models in New Hampshire

By Laura Davie, Project Director, NH Institute for Health Policy and Practice

In my role as project director in the Institute for Health Policy and Practice, I work on multiple projects. Although these projects have different components (including populations segments being focused on, issue being addressed, partners engaged at the table), it is impossible to ignore how these project are (or, at least, should be) connected across the health systems that they span. In my work of late, I notice the word “centered” is used a lot as an important descriptor of projects being implemented across health systems. These projects include the patient-centered medical home within the health care delivery system and person-centered planning in the long-term care system. I believe that, while these two “centered” models serve different functions within their respective systems, New Hampshire will be best served when these “centered” models overlap (and the sooner, the better.)

A previous blog by Heather Staples on this site describes the NH Initiative’s Patient Centered Medical Home project (see the medical home page of the Citizens Health Initiative website for additional information). As described on the website, “[t]he patient-centered medical home concept re-centers health care on the patient’s needs and priorities by providing primary, preventive, and chronic condition care that is personalized for each patient.” In addition to patient-centered models in primary care settings, hospitals across New Hampshire are implementing patient-centered models focusing on care-coordination and care-transition. I recently attended a conference in which Dartmouth-Hitchcock Medical Center presented their “Bridges to Safe Transition” program. I won’t describe that program in detail here, and it is one of many models that exist in the hospital setting. The point is that these primary care and acute care settings models are vital to improving health outcomes. These medical system models improve communication between providers and improve education and care planning with patients. New Hampshire should continue to push for expanding these programs beyond the nine pilots currently implementing medical home and beyond the selective diagnostic cases the acute care model often focuses.

Another health system focusing on centeredness is New Hampshire’s long-term care system. This system has made great strides, and continues to transform itself into a person-centered system. One of the key elements of a person-centered system is utilizing person-centered planning. To quote my colleague, Sue Fox, at the UNH Institute on Disability, “person-centered planning means a process to develop an individual support plan that is directed by the participant and/or their representative and is intended to identify their preferences, strengths, capacities, needs, and desired outcomes or goals.” Two services available through the ServiceLink Resource Centers around the state that use elements of person-centered planning include Long-term Care Support Counselors and Caregiver Specialists. Person-centered planning addresses the social factors such access to food, transportation, and assistance with dressing or bathing on an ongoing bases. Expanding person-centered planning models in our long-term care systems needs to continue to push forward.

The expansion of patient-centered and person-centered models in their respective systems should be a priority for New Hampshire. In addition, these two models should not be considered mutually exclusive. Quite the opposite — it is the overlap of these two (and certainly other related projects) projects that place the person or patient (or whatever term being used) at the center in which the individual is really at the center. True coordination of these systems is what will facilitate improved health outcomes. While the medical system is rightfully centered on the medical aspect, a person’s ability to heal or cope with their health status is dependent upon social supports: Who can pick up their prescriptions? Do they have transportation to the follow up appointments? Did they eat the meals delivered by Meals on Wheels? The long-term care person-centered planning model develops an individual support plan identifying their preferences, strengths, capacities, needs, and desired outcomes/goals. This social support plan is the glue for the medical plan. I do believe all “centered” models will best serve New Hampshire when they overlap. I think we are on our way, but our health systems need to identify and remove system barriers that prevent them from really centralizing around the person.

Tags: Add new tag, Citizens Health Initiative, Citizens Health Intiative, Health care, health systems, healthcare, long term care, medical home, New Hampshire Health Care, ServiceLink Resource Centers, system barriers

This entry was posted on Wednesday, March 10th, 2010 at 3:54 pm and is filed under Health Reform, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.