Health Care for Individuals with Intellectual and Developmental Disabilities: An Integrated DD Health Home Model

In this chapter, we present a community-based health care model for persons with intellectual and developmental disabilities (I/DD), the DD Health Home. We explore the background, rationale, and evolution of the model against the backdrop of the American health care system and efforts to reform it. The model addresses the triple aim of health care reform in America-better care, better health, and lower costs-for patients with I/DD who often do not have adequate access to health care. Building on the medical home concept, we show how a re-engineering of primary care practices to incorporate nurse practitioners and certain medical specialties achieves the triple aim for this population. We also describe research studies on the efficacy of the DD Health Home conducted on several iterations of the model over a 25-year period. We review clinical research that has informed practice patterns within the model and we present studies that highlight outcomes related to quality and satisfaction. Utilization studies are presented that show substantial cost savings in emergency room use and hospital admissions by patients served in the DD Health Home. We argue that the structure of the model and, especially, its care-coordination provisions account for such savings. Implications are examined for the model in a reformed health care marketplace.