Texas HHSC approved Summary of Service Coordination

Children’s Comprehensive Care (CCC) summarizes the responsibilities of both the medical home (CCC) and the MCO (Managed Care Organization) for the delegation of service coordination tasks. Prior to the MCO committing to reimbursing the medical home for service coordination tasks, they wanted HHSC to approve the arrangement.

Complex Care Program Brochure

Part of a ‘new to program’ packet sent to new complex care program patients/families several weeks ahead of their first complex care program clinic visit.

Complex Care Program Welcome Letter

Part of a ‘new to program’ packet sent to new complex care program patients/families several weeks ahead of their first complex care program clinic visit.

HRSA Meeting Presentation Slides for the SPNS initiative Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations

On June 27, 2017, the grant recipients of the Special Projects of National Significance (SPNS) funded initiative Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations convened a day-long meeting to present results to staff from the U.S. Department of Housing and Urban Development (HUD), Health Resources & Services Administration (HRSA), and Substance Abuse and Mental Health Services Administration (SAMHSA). They presented the strategies that collectively led to more than 1,300 people nationwide being served over the five-year initiative.

Medical Home SPNS demonstration sites: one-page overview

We have created a one-page overview of the medical home model used in the initiative Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations, both for the initiative overall and for each individual site.

PubMed article: Role of Patient Navigators in Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations

Through interviews and focus groups, clinic and program staff from nine organizations nationwide provided insights about the role of patient navigators in building a medical home for people living with HIV who are homeless/unstably housed and co-diagnosed with substance use and/or mental health disorders. Results of this qualitative research are presented in this peer-reviewed article which will be published in the Journal of Public Health Management Practice and is available online ahead of print publication. Researchers identified ten key responsibilities of patient navigators as part of the HIV care team that seeks to engage this population in care and treatment. The article concludes that patient navigators may be a key component in creating an effective patient-centered medical home for this population.