October 14, 2019

It has been over a decade since passage of the Affordable Care Act, and policymakers are still fighting over it. The law's goals were to reduce the number of uninsured, make coverage more affordable, and expand access to care. Since its adoption, there have been near-constant attempts to repeal it or replace it with alternative reforms, or to modify the law to address other goals. But there is near-universal agreement on one aspect of the law: the need to shift the way healthcare is paid for and delivered, simultaneously reducing costs while improving health care outcomes. And this is where the Fry Foundation grantees come in. By implementing medical-home models of care, our grantees ─ individually and collectively ─ are advancing the field of primary care.

The medical-home model is an approach to primary care that is patient-centered, team-based, coordinated, accessible, and focused on patient outcomes. It helps patients ensure that their range of health needs – from primary care, specialty care and mental health care are coordinated across all health care providers. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system, particularly for low-income patients. Medical-home models shift the healthcare paradigm, encouraging doctors and care teams to meet patients where they are, from the simplest to the most complex conditions.

The Foundation has three core strategies that have been successful in helping health centers change their operating models: technical support to accelerate specific efforts such as new scheduling systems to reduce overbooking and create capacity for same-day scheduling; collaborative learning and partnerships; and staying power, enabling health centers to make improvements systematically and over time.

As grantees have implemented medical-home models, they have advanced the field by addressing critical questions which hold essential keys to improving health outcomes and reducing costs. For example, Access Community Health Center was the first health center to receive support in 2017 to tackle how to incorporate a strategy that involves doctors discussing treatment options with patients and making decisions collaboratively. This model has been shown to increase patient adherence to treatment. Access has widely shared how it shifted its medical culture with other community health centers interested in adopting shared decision-making practices.

Grantee collaboration has been a critical mechanism for advancing medical-home models, allowing grantees to share and solve common challenges, adopt each other’s best practices, and, in some cases, leverage resources.

• The Safety-Net Learning Collaborative, launched in 2012 with eight grantees, initally worked to reduce wait times at clinics and to reduce the number of patients who do not show up for appointments. The Collaborative has grown to 19 organizations. In 2016, the Collaborative launched a Leadership Institute to train entry- and mid-level health care center managers, and in 2018, it added further training, including learning groups for chief medical officers, mental health directors, chief operating officers, and CEOs.
• The Behavioral Health-Primary Care Integration Learning Collaborative started in 2017. It is large with 34 multi-sectoral organizations. In its first two years, members worked to understand each other’s practices and operations, as a critical first step to learning how they might coordinate care. While gaining knowledge about each other through learning sessions, the Collaborative split into six subgroups to tackle issues that are common in each region. Now in the third year, members agree that they are in a better position to strategically partner and start piloting strategies to coordinate work.
• This year, Access Community Health Center received a grant to pilot efforts to coordinate care for high-risk patients with serious medical, mental health, substance abuse, and social issues. It is working with four partners ─Catholic Charities, Trilogy, Sinai Health System, and Gateway Foundation.

Grantees are now looking to expand on medical-home models of care by exploring ways to go beyond their medical walls, recognizing that what happens in a patient’s home and community is critical for patient health.