Walking in the footsteps of patients and staff at Cambridge Health Alliance

Today we walked in the footsteps of patients and staff at Union Square Family Health Center, part of Boston's Cambridge Health Alliance (CHA). Medical Director Kirsten Meisinger MD introduced us to the work of the Center, whose patients include many who are undocumented immigrants without health insurance.

CHA is aiming toward an accountable care organisation structure including patient-centred medical homes/neighbourhoods with high-functioning teams accountable for improving the health of a panel of patients; and clinical integration across the health continuum including specialty/ED/inpatient integration (requiring strategic partnerships and IT integration). The financial redesign required includes global payments and managing waste/inefficiency, achieved through negotiation (although it is acknowledged that this is complex and the playing field may not be level).

Care delivery is based on a model of inreach and outreach by a team, including panel management, health coaching, emails and phone calls, and patient visits. Plan care meetings determine the division of tasks and activities; with clinical leadership provided by the doctor, and other performance management generally led by nurse managers.

It was noted that sequentially moving through the 10 Bodenheimer building blocks without an overarching quality improvement strategy, and focusing primarily on complex care may compromise the success of patient-centred medical homes.