PCMH program adds capabilities to address health care disparities in the LGBTQ+ community

By: Debbie Reinheimer

physician talks with patient in office

For the first time, the Patient-Centered Medical Home Interpretive Guidelines include capabilities focused on LGBTQ+ inclusion. Because PCMH practitioners play a vital role in delivering foundational patient-centered care, it is imperative to add policies and processes that support LGBTQ+ inclusion and address health disparities and equity issues.

An estimated 4 percent of Michigan adults identify as part of the LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer and other non-binary gender identities and sexual orientations) community. Members of this community may face barriers to health care and other health care disparities such as higher rates of alcohol, tobacco and substance use, obesity and eating disorders.

In 2016, the LGBTQ+ community was identified as a “health disparity population” by the National Institute on Minority Health and Health Disparities. The community faces challenges with access to health care and low utilization of health services due to the population not feeling comfortable or safe sharing gender or sexual identity with health care providers.

The need for increased education

Members of the LGBTQ+ community face several barriers to care, including exclusion from a partner’s health insurance, provider-related discrimination, psychosocial barriers (e.g., fear of disclosing sexual orientation and gender identity or illegal behaviors) and poor matches between the needs of LGBTQ+ people and the kinds of services that are available.

A 2017 Center for American Progress survey showed that once people experience discrimination in some form, they’re more likely to avoid doctor’s offices. Among LGBTQ+ people who had experienced discrimination in the year before the survey, more than 18% reported avoiding doctor’s offices out of fear of discrimination.

“The Patient-Centered Medical Home was designed to ensure that all Michiganders have access to high quality, equitable care.  These findings reaffirm how important it is to ensure that LGBTQ+ patients feel safe, feel heard, and have equal opportunities to obtain the best possible clinical outcomes,” said Tom Leyden, director II, Value Partnerships at Blue Cross Blue Shield of Michigan.

Incorporating PCMH capabilities

To address these issues, Blue Cross added capabilities to the PCMH program that includes training on LGBTQ+ health care issues and how to create more inclusive processes.

One capability asks practices to include in their patient registry “advanced patient demographics to enable them to identify vulnerable patient populations” so they can identify and address disparities in care. Gender identity and sexual orientation are included in those demographics.

Another capability encourages practices to be inclusive and trained on specific needs of LGBTQ+ patients. For example, PCMH practices could offer training to staff on specific needs of LGBTQ+ patients and use inclusive language on their forms and procedures.

The PCMH Interpretive Guidelines document includes these additional sources to help PCMH practices build inclusive capabilities:

Improving-the-Health-of-LGBT-People.pdf (lgbtqiahealtheducation.org)

Building-PCMH-for-LGBT-Patients-and-Families.pdf (lgbtqiahealtheducation.org)

“As a physician I really like the idea of having a home for our patients. It gives our patients the feeling that we are here for them, where diverse patients can feel safe to talk about their needs and concerns,” said John Duhn, D.O., with Spectrum Health Medical Group. “It’s crucial for patients to have a place where they feel safe to present their full self. PCMH can help patients feel like they are a part of the team and we can support each other. We are engaging and finding more providers who are able to help with this population.”

For more information on the PCMH program and its capabilities, contact [email protected]