Case Study: Yuma District Hospital Patient Centered Medical Home

Yuma District Hospital
Yuma, CO
12 Beds

The Problem 
Yuma District Hospital, located in Yuma, Colorado, is a facility that houses acute inpa¬tient health services, including 12 acute care beds, two labor/delivery/post-partum beds, surgical services and 24-hour emergency services. The hospital also has two provider-based rural health clinics, one of which is co-located in the hospital facility.

The Solution
Yuma District Hospital began work four years ago with several safety net clinics in Colorado to transform into a patient-centered medical home (PCMH). Selected by the Colorado Community Health Network to take part in a five-year demonstration project initiated and funded by Qualis Health in Washington State, the Commonwealth Fund, and the MacColl Center for Health Care Innovation at the Group Health Research Institute, these safety-net clinics focused on helping primary care safety-net sites become high-performing PCMHs. Through this initiative, the Colorado Community Health Network, a group consisting mostly of federally qualified health centers, provided technical assistance for these clinics to become PCMHs. Staff have spent three years working with consultants to get the Yuma clinics certified as a PCMHs. Yuma has developed provider teams and a process for assigning patients to those teams, and Yuma's IT department has been actively involved in creating new ways to track and monitor patients.

Because of the hospital's and clinic's efforts to adopt the PCMH model, Yuma Hospital District was invited to participate in the Medicaid Regional Care Coordination Organization managed by Colorado Access. Participating members of the PCMHs receive $2 per member per month, plus another $1 per member per month if the following goals are met: reductions in 30-day readmissions, ED visits and high-cost imaging. If the region's goals are not met, partners do not receive the additional incentive payment. Yuma will continue to be reimbursed on a fee-for-service basis for medical care provided to Medicaid patients. PCMH services include only patient care management.

Yuma patients require behavioral and social support, which they receive from a nearby health and social service agency, the North Colorado Health Alliance. A community service organization handles the nonmedical elements that influence health, like behavioral health care, arranging for transportation and helping with financial management. The alliance supplies a staff member to assist Yuma in accessing these resources.

The Result 
Introducing the medical home process helped in developing communication systems to improve patient hand-offs and data access. A huge advantage of being part of the PCMH is access to the wealth of data available to help with patient care management. After reviewing the data, Yuma identified a pool of high-risk people who could benefit from patient care management. Contracting with the North Colorado Health Alliance gives the organization access to nonclinical services that have a significant impact on the health of the patient.

Lessons Learned
Similar to other rural towns, Yuma previously had physicians that served the community on an ongoing basis. Changing to the PCMH model removed the traditional model of physician service and created a care transition system where a patient may see multiple physicians. Switching to this new model created some community dissatisfaction as patients' traditional relationship with their physician was interrupted.

Contact Information
John R. Gardner, FACHE
Chief Executive
(970) 848-4601