The PCMH & Diabetes

The Patient Protection and Affordable Care Act (ACA), also known as Obamacare, has been a significant driver in forcing healthcare providers to take a closer look at the health of their communities. While most politicians and the media have primarily focused on the seminal achievement of the legislation, expanding health insurance and market reforms, there are numerous provisions within the sweeping health reform bill. One of the most exciting advents of the new law is the Accountable Care Organization (ACO). ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services.  Yet ACOs will find that successful care coordination will fall well beyond the delivery of health care services to reducing access barriers.   Using geographic information systems (GIS), we developed a methodology and set of maps to identify communities with high access barriers, such as transportation, provider shortages, language barriers, and poor access to healthy foods.  We model these and other barriers by examining the relationships to ambulatory care sensitive condition (ACSC) hospitalization rates. Certain conditions like asthma and diabetes are ACSC that is, hospitalization is largely preventable by timely and appropriate primary healthcare. High rates for these conditions serve as indicators of need for primary care.  Although the results are preliminary, we identify the characteristics of communities where the combination of health professional shortages and transportation barriers contribute to missed opportunities for patients to obtain healthcare and result in increased use of hospital (in-patient and emergency department) resources for non-urgent care