Using Outreach & Enabling Services to Support the Goals of a Patient-Centered Medical Home. Oscar C. Gomez, CEO Health Outreach Partners Health Resources Services Administration Office of Rural Health Policy All-Grantees Meeting August 3, 2010* Washington, DC. Presentation Agenda .
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Oscar C. Gomez, CEO
Health Outreach Partners
Health Resources Services Administration
Office of Rural Health Policy
August 3, 2010* Washington, DC
Outreach brings primary care services to underserved and/or marginalized community members to where the live, work, and congregate. Outreach improves patient follow-up, long-term case-management, and reduces health needs. Outreach activities may include, clinical assessments, patient follow-up and referrals, health education, patient navigation and advocacy, and organizing community events such as health fairs. HOP’s Outreach Reference Manual, 2007
Enabling Services are non-clinical services that are provided to primary care patients that promote, support and assist in the delivery of health care and facilitate access to quality patient care.
Physician directed medical practice
Whole person orientation
Care is coordinated and integrated
Quality and safety (includes patient and family participation)
The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians developed these joint principles and issued them Feb. 2007
Eligibility assistance and financial counseling
Access and communication
Patient tracking and registry functions
Patient self-management support
Testing and tracking
Performance reporting and improvement
Advanced electronic communications
Outreach/Enabling services staff are part of the TEAM!
Outreach/Enabling services focus on the whole-person approach
Defines health broadly
Managing acute and chronic care
Integrating behavioral services into primary care.
Effective outreach/enabling services require the coordination and integration of care
Outreach/Enabling services understand the context of family and community
The Outreach Program will:
The Whole Person
Coordination and Integration of Care
Health Outreach Partners
405 14th St. Ste. 809
Oakland, CA 94612