Table 2.

Strategies for Caring for Socially disadvantaged Patients under Current System

STRATEGY	BENEFIT	LIMITATIONS
Improve billing coding	Higher reimbursement for longer visits. Code for counseling based on time.	Costs of communication across language, culture and health literacy not covered. More time needed for documentation
Schedule more frequent visits	Spreads care out over more visits, allowing for more focused visits.	Greater financial and time costs to the patient
Refer patient for care coordination, navigation, language translation	Provides key resources not widely available in primary care	Requires separate funding e.g. Ryan White for HIV, ACS for cancer
Pay-for-performance	Focuses on improve performance for selected measures	Fails to consider additional difficulty and costs of improving quality among socially disadvantaged populations. Neglects unmeasured, but important tasks
Limited capitation	Allows for care to be based on patient needs rather than based on visits	Requires consideration of actual costs of delivering high quality care. Not widely available
Patient coaching	Improvement in patient self-efficacy and skills	Requires staff training Not currently reimbursed
Patient registry	Allows identification of patients in need of intervention. Extends care out of visit	Requires electronic infrastructure and staff training. Not directly reimbursed
Pre-visit team huddles	Allows for pre-visit team planning	Requires change in routine and few extra minutes before visits
Standing orders	Minimize potential bias and decompresses visits.	Requires identification of patients in need of intervention and physician delegation.
Resource list including low-cost medications and community agencies	Allows easy access to key resources for socially disadvantaged patients	Time required to develop and maintain lists
Physician training in PCMH including key communication skills	Provides more efficient and optimal use of visit time Physician better equipped to work with activated patients Improved team function	Not widely offered in either medical undergraduate or graduate training
Recruitment of diverse staff	Improves cultural diversity of team	May require extra recruitment effort