What Makes a Primary Care Office a Medical Home?

The American Academy of Pediatrics has identified the following elements of a medical home (Medical Home Policy Statement, Pediatrics, July, 2002):

Accessible

Family-Centered

Continuous

Comprehensive

Coordinated

Compassionate

Culturally Effective

All primary care practices provide many of the services described above. The information and materials presented in this web site are to support those practitioners who are interested in enhancing the current level of services in their practice by "building a medical home step-by-step." (Cooley & McAllister, 2001)

Benefits of a Medical Home

A number of health outcomes have been linked to the strength of primary care. There is good research evidence that having a regular primary care physician results in improved problem identification and diagnosis, improved compliance, fewer hospitalizations and lower cost, and increased satisfaction with care (Starfield, 1998). Recently developed tools such as the Medical Home Index and the Medical Home Family Index (Center for Medical Home Improvement, 2001) will be used to show that strong medical homes improve a variety of child, family and practice outcomes including increase in family and physician satisfaction with care.

History

The medical home concept has grown from a demonstration project in Hawaii to become a national priority of the American Academy of Pediatrics (AAP) and the United States Maternal and Child Health Bureau (MCHB). In 1985, the Hawaii legislature provided funds for a demonstration project headed by Dr. Cal Sia linking infants at high psychosocial risk with medical homes. The project was based on a comprehensive Child Health Plan adopted by the Hawaii Medical Association and the Hawaii Chapter of the American Academy of Pediatrics (AAP) that stressed the importance of providing child health care through a "medical home" that would provide comprehensive services and focus on the whole child in the context of the family and the community (Sia & Breakey, 1985). The essentials of the "medical home" included:

National Resources

Current resources include the National Center for Medical Home Initiatives for Children with Special Needs; the training program, "Every Child Deserves a Medical Home," developed by the AAP, MCHB, Family Voices, Shriners Hospitals for Children and the National Association of Children's hospitals and Related Institutions (NACHRI); the National Medical Home Mentorship Network; MCHB grants that support statewide implementation of medical homes (including our Oregon Medical Home Project); AAP's Community Access to Child Health (CATCH) grants that focus on medical home activities in local communities and community pediatric residency programs (Anne E. Dyson Initiative in Pediatric training).

Barriers to Strengthening the Medical Home

The barriers to building a medical home include limited time and personnel resources in the primary care office, limited reimbursement for care coordination activities and misconceptions by health care professionals about the requirements of a medical home. Some physicians wonder how they could possibly do all of the things a medical home requires when they already have a very busy office practice. In a medical home, however, health care providers work more efficiently by:

(Cooley & McAllister, 2001)

Coding, Billing and Reimbursement

Reimbursement can be improved by using appropriate coding and billing procedures and by developing programs that adequately compensate primary care offices for care coordination activities. Information on coding and billing procedures for CSHN and reimbursement for care coordination activities is available from several sources:

Some states have developed pilot projects to reimburse physicians for care coordination services. Information on these programs is also available on the National Center's web site. In Oregon, a subcommittee of the Oregon Medical Home Project's advisory group will study this issue and make recommendations to appropriate agencies and organizations as well as the State government.

In addition, information on current grants and other funding opportunities is presented on the web site of the Center for Children with Special Needs, Children's Hospital and Regional Medical Center, Seattle. These resources include funding opportunities for interested primary care providers for example, CATCH grants from the AAP.