Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

Starting new behaviors to improve our health can be a challenge. Too often, our health care system doesn't help us learn the skills we need to stay healthy.

Take the example of Alex, a 60-year-old man who just learned he has Type 2 diabetes.

He must watch his diet and get regular exercise. He will need to visit his doctor to prevent problems with his eyes, feet, and kidneys, which can be affected by this disease. Alex will also need to check his blood sugar levels and he may need daily pills or shots.

Alex wants to do the right things to stay healthy. That's good news, because research shows that people who are involved in their health care are more likely to feel better.

But Alex didn't understand the instructions for his care until he had to put them into practice each day. He didn't ask questions—or get answers—for several months. He didn't know whom to contact.

This happens often. It's a major reason why patients have a hard time managing their health condition.

It's also why more health care organizations, especially primary care offices, offer self-management support programs.  

Self-management, or self-care, programs help patients by—

  • Involving the whole care team in planning, carrying out, and following up on patient visits.
  • Planning patient visits that focus on preventing problems and working to stay healthy, rather than responding to problems after they occur.
  • Working with patients to achieve their health goals.
  • Providing information that is easy to understand and use.
  • Making referrals to community-based programs to follow an exercise plan, quit smoking, or take other healthy steps.
  • Connecting with patients by email, phone, text messages, and mailings to help them stay healthy and achieve their goals.

Self-care support programs are becoming more popular because they represent some of the key goals of patient-centered medical homes

A medical home may sound like a house or building. But it's actually a national movement to redefine and improve how primary care services are delivered. Members of a medical home can include doctors, nurses, social workers, pharmacists, and physical therapists. Working together, they help coordinate their patients' care in health clinics, hospitals, and medical offices.

Medical homes can make primary care more accessible, so more health issues can be addressed and managed. This can reduce the risk that a medical problem will get worse and require a hospital visit.

A medical home also can help coordinate other services. For example, Alex may need to a see a doctor who specializes in diabetes care. The medical team can arrange the visit, make sure he is prepared, and share test results with Alex and his care team.

Today, many primary care practices are putting together the comprehensive services they need to qualify as a medical home. As of January, nearly 5,200 practices had been recognized as meeting the standards of a medical home.

These developments can be traced to the Affordable Care Act, which put a high priority on creating better access and payment for primary care services. As one example, 500 Federal health clinics are part of a demonstration project that uses medical home principles to coordinate and improve care for up to 195,000 Medicare patients.

Private insurers also embrace the medical home model. More than 4 million Blue Cross Blue Shield members in 39 States are taking part in some version of a patient-centered medical home initiative, according to recent report (PDF File, Plugin Software Help). Many other insurers have similar programs.

An excellent short video for patients on self-management support is available here.

I'm convinced that self-management programs and medical homes will help patients like Alex—and all of us—take better care of ourselves.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Self-Management Support
www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/index.html

Self-Management Support: What is Self-Management Support? (video)
www.orau.gov/ahrq/sms_what.html

Patient-Centered Medical Home: What is the PCMH?
http://pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483/what_is_pcmh_

National Committee on Quality Assurance
Patient-Centered Medical Home
http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx

Center for Medicare & Medicaid Innovation
Federally Qualified Health Centers Advanced Primary Care Demonstration
http://innovation.cms.gov/initiatives/FQHCs/index.html

Patient-Centered Primary Care Collaborative
Benefits of Implementing the Primary Care Patient-Centered Medical Home
http://www.pcpcc.net/files/benefits_of_implementing_the_primary_care_pcmh_0.pdf [Plugin Software Help]

Introduction to the Patient-Centered Medical Home
http://www.emmisolutions.com/medicalhome/acp/  

Current as of March 2013
Internet Citation: New Primary Care Focus Helps Patients Take Better Care of Themselves. March 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/030513.html