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Targeting appropriate patients for care management is crucial to maximizing quality of care and cost-effectiveness in Medicaid care management programs. This study examined patient characteristics predicting selection for care management pre- and postmanagement changes at the Durham Community Health Network (DHCN), one of North Carolina's Medicaid primary care management networks. From the beginning, care managers were directed to target asthmatics, diabetics, and high-volume utilizers of health care, using an array of markers to identify patients who needed management. In 2003, the state reinforced its focus on chronic disease and high utilizers, and new management at DCHN began emphasizing the use of protocols for patient targeting. This study examined the relative effects of patient demographics, diagnoses, PCP group, and health care utilization as predictors of patient selection before and after these changes. [ABSTRACT FROM AUTHOR]

The article focuses on economic and health disparities in which Durham County, North Carolina and Duke of North Carolina are striving to overcome the issue. It mentions that people who are enrolled on the Medicaid or the Children's Health Insurance Program (CHIP) are being provided by the Community Care of North Carolina (CCNC) with a care management. It states that a data system for capturing emergency departments was built by Durham Community Health Network (DCHN). It says that the Medicaid In-Home Aide Service will be implemented to evaluate the function of personal care assistants. It adds that the education of clinicians, funds and data information sharing, and reorientation of research agenda are the key steps on the development of linking system of the community.

Population health experiences have become more common in medical education. Yet, most resident population health experiences are in patient panel management and fail to connect with the rapidly growing movement of cross-sector, data-driven, and community-led initiatives dedicated to improving the health of populations defined by geography rather than insurer or employer. In this Perspective, the authors present a five-stage framework for residents' participation in the work of these initiatives. The five stages of this framework are (1) organize and prepare, (2) plan and prioritize, (3) implement, (4) monitor and evaluate, and (5) sustain. In applying this approach, residents stand to acquire new population health skills and augment the value and meaning of their work, while institutions stand to improve the health of the communities they serve, including the health of their own employees. However, a paucity of experienced role models and demanding residency schedules present significant challenges to residents effectively partnering with the community. Residencies and institutions will have to be flexible and committed to being a part of these cross-sector, data-driven, and community-led partnerships over the long term.

A 2012 Institute of Medicine report is the latest in the growing number of calls to incorporate a population health approach in health professionals' training. Over the last decade, Duke University, particularly its Department of Community and Family Medicine, has been heavily involved with community partners in Durham, North Carolina, to improve the local community's health. On the basis of these initiatives, a group of interprofessional faculty began tackling the need to fill the curriculum gap to train future health professionals in public health practice, community engagement, critical thinking, and team skills to improve population health effectively in Durham and elsewhere. The Department of Community and Family Medicine has spent years in care delivery redesign and curriculum experimentation, design, and evaluation to distinguish the skills trainees and faculty need for population health improvement and to integrate them into educational programs. These clinical and educational experiences have led to a set of competencies that form an organizational framework for curricular planning and training. This framework delineates which learning objectives are appropriate and necessary for each learning level, from novice through expert, across multiple disciplines and domains. The resulting competency map has guided Duke's efforts to develop, implement, and assess training in population health for learners and faculty. In this article, the authors describe the competency map development process as well as examples of its application and evaluation at Duke and limitations to its use with the hope that other institutions will apply it in different settings.

Evidence is accumulating that the United States is falling behind in its potential to translate biomedical advances into practical applications for the population. Societal forces, increased awareness of health disparities, and the direction of clinical and translational research are producing a compelling case for AHCs to bridge the gaps between scientific knowledge and medical advancement and between medical advancement and health. The Duke University Health System, the city and county of Durham, North Carolina, and multiple local nonprofit and civic organizations are actively engaged in addressing this need. More than a decade ago, Duke and its community partners began collaborating on projects to meet specific, locally defined community health needs. In 2005, Duke and Durham jointly developed a set of Principles of Community Engagement reflecting the key elements of the partnership and crafted an educational infrastructure to train health professionals in the principles and practice of community engagement. And, most recently, Duke has worked to establish the Duke Translational Medicine Institute, funded in part by a National Institutes of Health Clinical Translational Science Award, to improve health through innovative behavioral, social, and medical knowledge, matched with community engagement and the information sciences.

Purpose: To promote health and maintain independence, Just for Us provides financially sustainable, in-home, integrated care to medically fragile, low-income seniors and disabled adults living in subsidized housing., Design and Methods: The program provides primary care, care management, and mental health services delivered in patient's homes by a multidisciplinary, multiagency team., Results: After 2 years of operation, Just for Us is serving nearly 300 individuals in 10 buildings. The program is demonstrating improvement in individual indices of health. Medicaid expenditures for enrollees are shifting from ambulances and hospital services to pharmacy, personal care, and outpatient visits. The program is not breaking even, but it is moving toward that goal. The program's success is based on a partnership involving an academic medical center, a community health center, county social and mental health agencies, and a city housing authority to coordinate and leverage services., Implications: Just for Us is becoming a financially sustainable way of creating a "system within a nonsystem" for low-income elderly persons in clustered housing.

Background: The Future of Family Medicine Report calls for a fundamental redesign of the American family physician workplace. At the same time, academic family practices are under economic pressure. Most family medicine departments do not have self-supporting practices, but seek support from specialty colleagues or hospital practice plans. Alternative models for academic family practices that are economically viable and consistent with the principles of family medicine are needed. This article presents several "experiments" to address these challenges., Methods: The basis of comparison is a traditional academic family medicine center. Apart of the faculty practice plan, our center consistently operated at a deficit despite high productivity. A number of different practice types and alternative models of service delivery were therefore developed and tested. They ranged from a multi-specialty office arrangement, to a community clinic operated as part of a federally-qualified health center, to a team of providers based in and providing care for residents of an elderly public housing project. Financial comparisons using consistent accounting across models are provided., Results: Academic family practices can, at least in some settings, operate without subsidy while providing continuity of care to a broad segment of the community. The prerequisites are that the clinicians must see patients efficiently, and be able to bill appropriately for their payer mix., Conclusion: Experimenting within academic practice structure and organization is worthwhile, and can result in economically viable alternatives to traditional models.

Academic medical centers (AMCs) have traditionally provided primary care for low-income and other underserved populations. However, they have had difficulty developing lasting partnerships with other organizations serving the same populations. This article describes an exception to the rule, in which an academic division was created at Duke University Medical Center to develop effective collaborations with health care and social service providers in Durham, North Carolina, including both public agencies and private organizations. Together, the division and its partners have created and operate programs that improve health outcomes and access to care for those at risk. These programs share a number of characteristics: they are designed to meet the needs of the patient, not the provider; they are based in the community, not in the AMC; they bring services to people's homes, schools, and neighborhoods; they are multidisciplinary, combining health, social, and even mental health services; and, once established, they are revenue-generating and can be made self-supporting when grant funding ends. These programs are also innovative. They are designed to model and test new ways of organizing and delivering care. Preliminary indications suggest that they also strengthen the AMC's relationships with the surrounding community.