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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 11: Medical Home

MCH Best Logo young parents holding and looking at their baby

Strategy. Provider Alliance and Mid-Level Providers

Approach. Use a provider alliance and mid-level providers to create a “one-stop” medical home model to provide community outreach and coordination of services.

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Overview. Initial research has shown promise in use of a provider alliance (primary care and subspecialty organizations were operationally linked) for the delivery of a coordinated continuum of health services. The alliance created a “one-stop” medical home which enrolled children and families in health programs for which they qualified, attached families to medical homes, provided primary care to children, referred families to specialty services as needed, provided clinic-based health education to families, and provided case management support in order to empower families to navigate the health care. This model utilized mid-level providers (e.g., physician assistants or similar staff) in pediatric primary care and sub-specialty settings to speed availability. Parents were slightly more satisfied with services received from a physician assistant in comparison with the physician sub-specialists in clinics.1

The Role of Title V: Title V programs can serve as the organizing group to set up the provider alliance or provide resources for such an alliance to work effectively (e.g., develop lists of specialty providers to primary care providers, managed care organizations, or hospital systems). For states who struggle with a lack of subspecialty providers, it might be advantageous to focus on one of the key components of this strategy: health assessment and medical treatment: providing clinic-based health education to families; a fast-track referral system between primary and sub-specialty sites; and non-clinical case management (assessment/screening, referrals, service coordination, individualized planning, coaching, monitoring, and third-party advocacy to maintain a continuum and regular source of care).

Evidence. Emerging Evidence. The study supporting this intervention provides data indicating that the intervention may be effective. However, the study includes limited research documenting effects and requires further research to confirm effects. Access the peer-reviewed evidence through the MCH Digital Library (link coming soon). (Read more about understanding evidence ratings).

Target Audience. Provider/Practice.

Outcome. Increased new patient rates, reported increase in sub-specialty access, and parent reports of less difficulty getting health care (primary care and specialty care). For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. There are currently no ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. However, there are 5 ESMs that measure satisfaction with services provided through a medical home model of care. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Use a provider alliance and mid-level providers to create a “one-stop” medical home model,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of patients referred to sub-specialty providers in the provider alliance.
  • Number of sub-specialty providers in a medical home who are mid-level providers.
  • Number of patients who receive clinic-based health education by a PCP and/or non-clinical case management by a community health worker within the “one-stop” medical home model.  

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of referred patients who received sub-specialty care from a physician assistant or other designated professional in the provider alliance.
  • Percent of sub-specialty providers who are mid-level providers.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of visits by children/adolescents to mid-level providers for sub-specialty care.
  • Number of parents/caregivers who report a decreased waiting time due to the fast-track referral system.
  • Number of parents/caregivers who report satisfaction with subspecialty care received by their child through the Pediatric Integrated Care Survey (PICS).
  • Number of parents/caregivers who report increased support from community health workers to navigate the health care system.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of subspecialty care visits conducted by mid-level providers.
  • Percent of parents/caregivers who report satisfaction with sub-specialty care received by their child from a mid-level provider through the Pediatric Integrated Care Survey (PICS).
  • Percent of children/adolescents who are attached to a regular source of care due to the one-stop medical home model.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Tataw, D. B., Bazargan-Hejazi, S., & James, F. (2011). Health services utilization, satisfaction, and attachment to a regular source of care among participants in an urban health provider alliance. Journal of Health and Human Services Administration, 34(1), 109-141.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.