The medical home is a team based health care delivery model led by a physician or nurse practitioner that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is an approach to providing comprehensive primary care for children, youth and adults. Several key foci are important in understanding the overall concept of the medical home. First, the concept of the medical home dates back to the 1960’s and has evolved since its inception. Second, the model of care delivery is concerted effort that requires several key elements. Finally, the new health reform law will give states the opportunity to expand upon current medical home efforts. History of the Medical Home Concept The medical home is a concept first introduced by the American Academy of Pediatrics (AAP) in 1967. Originally, it was defined as the center of a child’s medical records. During the early stages of the medical home concept, the care of children with special health care needs was the primary focus. Over time, the concept was redefined as it evolved to reflect the changing needs and perspectives in health care. Efforts by Dr. Calvin C. J. Sia, a Honolulu-based pediatrician, to pursue new approaches to improve early childhood development in Hawaii in the 1980’s laid the groundwork for an Academy policy statement in 1992 that defined a medical home largely the way Sia conceived it: a strategy for delivering the family-centered, comprehensive, continuous and coordinated care that all infants and children deserve (Wikipedia, n.d. para. 2). In 2002, the Future of Family Medicine project was created to change and rejuvenate the specialty of family medicine. According to project recommendations, every American should have a personal medical home enabling access to acute, chronic and preventive services. These services should be “accessible, accountable, comprehensive, integrated, patient-centered, safe, scientifically valid, and satisfying to both patients and their physicians” (Wikipedia, n.d. para. 3). A study estimated that if the recommendations from the Future of Family Medicine were followed, health care costs would likely decrease by 5.6%, resulting in national savings of 67 billion dollars per year, with an improvement in the overall quality of the care provided. Medical homes are synonymous with better health, lower overall costs of care and reductions in disparities in health (A. Romeo RN, PhD, 2012). By 2005, the American College of Physicians had developed an "advanced medical home" model. The model involved the use of evidence-based medicine, clinical decision support tools, the Chronic Care Model, medical care plans, "enhanced and convenient" access to care, quantitative indicators of quality, health information technology, and feedback on performance. Payment reform was recognized as important to implement the model (Wikipedia, n.d. para. 5). In 2007, the AAP joined with the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA) to form the Joint Principles of the Patient Centered Medical Home. Under this collaborative effort, the characteristics of the medical home have been defined within these 7 principles: 1. Personal physician - Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care. 2. Physician directed medical practice - The personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients. 3. Whole person orientation - The personal physician is responsible for providing for all the patient's health care needs or taking responsibility for appropriately arranging care with other qualified professionals. 4. Care is coordinated and/or integrated - Across all elements of the complex health care system. 5. Quality and safety are hallmarks of the medical home - Partnerships between the patient, physicians and their family are an integral part of the medical home. Practices are encouraged to advocate for their patients and provide compassionate quality, patient-centered care. 6. Enhanced access to care - available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff. 7. Payment - Appropriately recognizes the added value provided to patients who have a patient-centered medical home. The modern medical home expands upon its original foundation, becoming a home base for any child’s medical and non-medical care. Today’s medical home is a cultivated partnership between the patient, family and primary provider in cooperation with specialists and support from the community (HRSA, n.d. para. 2).
Model of Care Delivery
The medical home relies on a team of providers, such as physicians, nurses, nutritionists, pharmacists, and social workers, to take care of a patient’s health care needs. Studies have shown that the medical home model’s attention to the whole-person and integration of all aspects of health care offer potential to improve physical health, behavioral health, access to community-based social services and management of chronic conditions (NCSL, 2012, para. 3). The model is designed around patient needs and aims to improve access to care (e.g. through extended office hours and increased communication between providers and patients via email and telephone), increase care coordination and enhance overall quality, while simultaneously reducing costs. Paramount to medical home care is health information technology (HIT) and payment reform (NCSL, 2012, para. 6). Because the medical home can be a physical or a virtual network of providers and services, HIT facilitates communication and information sharing among providers. For example, medical homes use electronic health records, which give providers instant access to patient information regardless of location. ACA’s Impact Health care reform has created new possibilities for the advancement of medical home. The new health reform law will give states the opportunity to expand upon current medical home efforts. It is critical that states create medical home programs that meet the needs of children and pediatricians, including ensuring coverage of necessary services, better coordination between state programs and pediatric primary care providers, and payment for care coordination and other services provided in a medical home. The health reform law creates a Medicaid state option to provide medical assistance in a medical home to individuals with chronic conditions. An individual may select a physician, a team of health care professionals operating with a physician, or a health team as their designated health home. The payment methodology for the program can be determined by states and may be tiered to reflect the severity or number of a patient’s chronic conditions and the specific capabilities of the health home. Payment models are not limited to per‐member per‐month structures. Those who may enroll include individuals eligible under the state plan or waiver with (1) at least two chronic conditions, (2) one chronic condition and a risk of developing a second, or (3) one serious and persistent mental health condition. Chronic conditions include, but are not limited to, a mental health condition, a substance use disorder, asthma, diabetes, heart disease and obesity. The new law also provides grants to states or state‐designated entities to establish community‐based interdisciplinary, inter‐professional health teams to support primary care practices and provide capitated payments to primary care providers (AAP, 2012. Para. 3 & 4). Conclusion
The medical home model of care is offering alternative methods of transforming the health care delivery system. Medical homes can reduce costs while improving quality and efficiency through an innovative approach to delivering comprehensive patient-centered preventive and primary care. This model is designed around patient needs and aims to improve access to care, increase care coordination and enhance overall quality, while simultaneously reducing costs. The model relies on a team of providers to meet a patient’s health care needs, allowing the patient a “one stop shopping” kind of experience. The medical home model’s focus on the entire person and the involvement of all aspects of health care offer great potential to improve overall health and wellness, access to community-based social services and management of chronic conditions.
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http://en.wikipedia.org/wiki/Medical_home#Ongoing_medical_home_projects National Conference of State Legislatures. 2012. The Medical Home Model of Care. Retrieved
from: http://www.ncsl.org/issues-research/health/the-medical-home-model-of-care.aspx Romeo, A., RN, PhD. 2012. What is a Medical Home? Retrieved from: