title: Dual Eligibles' Experience of Care with North Carolina's Patient-Centered Medical Home.
abstract: Although individuals enrolled in both Medicare and Medicaid (dual eligibles) are among those with the nation's greatest need, at $300 billion per year, their care is also expensive and beset by quality problems. Previous research found problems associated with inadequate coordination of benefits and services; however, these studies have largely used quantitative approaches and focused on providers-few studies have explored the perspective of dual eligible patients. In an effort to improve care and reduce costs, North Carolina (NC) developed a Patient-Centered Medical Home (PCMH) model centered on a continuous relationship with a primary care provider who is responsible for coordination of services and addressing patients' health care needs by providing direct services or arranging care with other qualified professionals. This article presents the history of the NC PCMH model and describes results of an in-depth qualitative investigation of dual eligible patients' experience of care with this model. Experience of care was captured through 11 focus groups with 61 dual eligible patients. Focus groups were audio recorded and analyzed using NVivo 9 software, which supported the categorization of data into themes based on frequency and intensity of discussions. Findings indicate that dual eligible patients were generally satisfied by the care received through the NC PCMH program. However, many patients reported continuity of care issues, problems accessing necessary prescription drugs, and difficulties navigating the health care delivery system. Findings also revealed that conflicting state and federal Medicaid drug co-pay policies confused and limited access for some patients.
authors.affiliation: 1 Medicare and Medicaid Coordination Office, Centers for Medicare & Medicaid Services , Washington, District of Columbia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Grantham
authors.affiliation: 2 Department of Health Administration and Policy, George Mason University , Fairfax, Virginia.
authors.forename: Debora Goetz
authors.initials: DG
authors.lastname: Goldberg
authors.affiliation: 3 George Washington University , Trachtenberg School of Public Policy and Public Administration, Washington, District of Columbia.
authors.forename: Donna Lind
authors.initials: DL
authors.lastname: Infeld
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D009657:North Carolina; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D011320:Primary Health Care; D011787:Quality of Health Care; D014481:United States
keywords: Medicare-Medicaid; care coordination; dual eligible; patient centered medical home; primary care; quality of care