Innovative, collaborative care models such as the patient-centered medical home depend on making connections not just within the practice but throughout the health care system and broader communities. The 10 "essential" tools for making these connections have been identified in a recent publication from the Patient-Centered Primary Care Collaborative (PCPCC). An announcement of the report was featured in ModernHealthcare.com.
According to the PCPCC, while medical homes offer the possibility for a coordinated and patient-focused continuum of care, in order to be truly effective, these models need to pay careful attention to making "population health connections." These connections touch on technologies that assist the system's health care professionals, patients, and the community at large. The PCPCC report identified 10 "essential" population health IT tools: Electronic health records, patient registries, a health information exchange, risk stratification systems, automated outreach, referral tracking, patient portals, telehealth/telemedicine capabilities, remote patient monitoring, and advanced population analytics.
The patient-centered medical home concept has been an area of focus at APTA for some time. APTA has engaged in advocacy to ensure that physical therapists (PTs) have a voice in the development of medical home models, and has supported the development of the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services. In addition, APTA offers a series of videos on collaborative care models, including a presentation on the PT's role in the medical home.
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