Medical Home
Case for Change
The Medical Home concept was originally introduced in 1967 by the American Academy of Pediatrics. Since then, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association have taken these original ideas and developed joint principles that describe the patient-centered medical home. Approximately 333,000 physicians are represented by these organizations that support this new model of care.
The American College of Physicians describes the Patient Centered Medical Home (PCMH) as, “A team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcomes. The PCMH practice is responsible for providing for all of a patient’s health care needs or appropriately arranging care with other qualified professionals. This includes the provision of preventive services, treatment of acute and chronic illness, and assistance with end-of-life issues. It is a model of practice in which a team of health professionals, coordinated by a personal physician, works collaboratively to provide high levels of care, access and communication, care coordination and integration, and care quality and safety.”1
Research conducted in other countries shows that a focus on primary care results in healthier populations, a longer lifespan, increased patient satisfaction with patient care and lower costs.2 One of Iowa’s many strengths is a strong primary care base. Physician leaders in Iowa agree that the concepts of Medical Home have the potential to align well with our current healthcare system and provide opportunities for improving patient outcomes.
This toolkit will:
- Describe the components of a patient-centered medical home
- Describe the business model for medical home
- Provide information on how to become a medical home
- Provide information about medical home projects happening around the country
Sources:
- http://www.acponline.org/advocacy/where_we_stand/medical_home/what.htm
- http://www.pcpcc.net/content/patient-centered-medical-home
Tool Kit
What is Medical Home?
- American Academy of Family Physicians
This site provides questions and answers to several patient-centered medical home questions.
- American College of Physicians
This policy monograph titled, “The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care” discusses the healthcare system today and proposes new ideas for delivering and financing care.
- Joint Principles of the Patient-Centered Medical Home
This document describes the patient-centered medical home, as defined by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association.
- National Committee for Quality Assurance
The 2007 Annual Report focuses on the patient-centered medical home, and the tool developed by NCQA that identifies practices that deliver care in accordance to this new model of care.
- Wisconsin Academy of Family Physicians
This site includes background information on medical home, including a video that shows how we can lower the cost of healthcare and have a healthier outcome for all patients.
This site provides questions and answers to several patient-centered medical home questions.
This policy monograph titled, “The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care” discusses the healthcare system today and proposes new ideas for delivering and financing care.
This document describes the patient-centered medical home, as defined by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association.
The 2007 Annual Report focuses on the patient-centered medical home, and the tool developed by NCQA that identifies practices that deliver care in accordance to this new model of care.
This site includes background information on medical home, including a video that shows how we can lower the cost of healthcare and have a healthier outcome for all patients.
Who supports the Medical Home concept?
- The PCMH care model is supported by the major primary care physician groups, including:
- American Academy of Pediatrics
- American Academy of Family Physicians
- American College of Physicians
- American Osteopathic Association
as well as 13 additional specialty health care organizations.
- Patient-Centered Primary Care Collaborative
The Patient-Centered Primary Care Collaborative is a coalition of major employers, consumer groups, organizations representing primary care physicians, and other stakeholders who have joined to advance the patient centered medical home.
- American Academy of Pediatrics
- American Academy of Family Physicians
- American College of Physicians
- American Osteopathic Association
The Patient-Centered Primary Care Collaborative is a coalition of major employers, consumer groups, organizations representing primary care physicians, and other stakeholders who have joined to advance the patient centered medical home.
Business Case for Medical Home
- American College of Physicians
A detailed look at the business model for the PCMH, and a way to re-align payment incentives to support the PCMH.
- Annals of Family Medicine
This report titled, “Financing the New Model of Family Medicine”
estimates the savings that could be realized if every American had a medical home.
- “Contribution of Primary Care to Health Systems and Health.” Barbara Starfield, Leiyu Shi, and James Macinko. The Milbank Quarterly, Vol. 83, No. 3, 2005 (pp. 457–502).
In this report Barbara Starfield illustrates the value of the medical home by reviewing the evidence for better outcomes and lower costs with primary care physicians.
- Patient Centered Primary Care Collaborative
This site details the evidence on the effectiveness of the patient-centered medical home on quality and cost.
A detailed look at the business model for the PCMH, and a way to re-align payment incentives to support the PCMH.
This report titled, “Financing the New Model of Family Medicine” estimates the savings that could be realized if every American had a medical home.
This site details the evidence on the effectiveness of the patient-centered medical home on quality and cost.
How do I become a Medical Home?
- The National Committee on Quality Assurance (NCQA) is one of the organizations that has developed, in conjunction with the primary care physician groups, a recognition program which recognizes practices as a patient-centered medical home.
- PPC-PCMH Fact Sheet
This document lists the aspects of care measured, and why practices should apply.
- PPC-PCMH Overview
This document lists the standards and guidelines.
- PPC-PCMH Pricing Fee Schedule
This document lists the fee schedule for obtaining the survey tool license and application fees for NCQA review and recognition.
- Click here to order any of the materials listed above
- Program Video Tutorial
The video walks you through how to apply for recognition
- TransforMED
Medical Home IQ is a web-based self-assessment tool for primary care practices seeking to become Medical Homes. This tool also allows you to estimate how a practice might score on NCQA’s recognition program.
- PPC-PCMH Fact Sheet
This document lists the aspects of care measured, and why practices should apply. - PPC-PCMH Overview
This document lists the standards and guidelines. - PPC-PCMH Pricing Fee Schedule
This document lists the fee schedule for obtaining the survey tool license and application fees for NCQA review and recognition. - Click here to order any of the materials listed above
- Program Video Tutorial
The video walks you through how to apply for recognition
Medical Home IQ is a web-based self-assessment tool for primary care practices seeking to become Medical Homes. This tool also allows you to estimate how a practice might score on NCQA’s recognition program.
Medical Home Projects
- Centers for Medicare and Medicaid Services - Medicare Demonstration Project
- Details for Medicare Medical Home Demonstration Project
- Section 204 of the Tax Relief and Health Care Act of 2006
- Frequently Asked Questions about the Medicare medical home demonstration project (see page 6)
- The Commonwealth Fund
Building Patient-Centered Medical Homes: An Evaluation of a Multipayer Demonstration in Rhode Island.
- New Hampshire Citizens Health Initiative
Launched from a comprehensive review of pay-for-performance initiatives and trends in the summer of 2006, the Reimbursement Workgroup has ratified goals, objectives and tasks associated with a fundamental shift in primary and specialty care reimbursement in New Hampshire.
- Patient Centered Primary Care Collaborative
“The Patient-Centered Primary Care Collaborative is a coalition of major employers, consumer groups, and other stakeholders who have joined with organizations representing primary care physicians to develop and advance the patient centered medical home. The Collaborative believes that, if implemented, the patient centered medical home will improve the health of patients and the viability of the health care delivery system. In order to accomplish our goal, employers, consumers, patients, physicians and payers have agreed that it is essential to support a better model of compensating physicians.”
- TransforMed
“TransforMED is focused on practice redesign and affiliated with the American Academy of Family Physicians (AAFP). TransforMED is studying and implementing transformed models of high performance practices that meet the needs of both patients and practices.”
- Details for Medicare Medical Home Demonstration Project
- Section 204 of the Tax Relief and Health Care Act of 2006
- Frequently Asked Questions about the Medicare medical home demonstration project (see page 6)
Building Patient-Centered Medical Homes: An Evaluation of a Multipayer Demonstration in Rhode Island.
Launched from a comprehensive review of pay-for-performance initiatives and trends in the summer of 2006, the Reimbursement Workgroup has ratified goals, objectives and tasks associated with a fundamental shift in primary and specialty care reimbursement in New Hampshire.
“The Patient-Centered Primary Care Collaborative is a coalition of major employers, consumer groups, and other stakeholders who have joined with organizations representing primary care physicians to develop and advance the patient centered medical home. The Collaborative believes that, if implemented, the patient centered medical home will improve the health of patients and the viability of the health care delivery system. In order to accomplish our goal, employers, consumers, patients, physicians and payers have agreed that it is essential to support a better model of compensating physicians.”
Success Stories
- Community Care of North Carolina
Community Care of North Carolina is a working example of a PCMH. The program shows excellent quality and cost outcomes through disease management, evidence-based clinical practice, and an emphasis on a physician-led team approach. Community Care of North Carolina is the state’s Medicaid program. Two independent evaluations of this program indicate it has saved the state $195 to $215 million in 2003 and between $230 and $260 million in 2004 when compared to historical fee-for-service.
- TransforMED's Lessons Hit Home
This article features Dr. Don Klitgaard, from Myrtue Medical Center in Harlan, Iowa, and his experience with the TransforMED demonstration project.
Community Care of North Carolina is a working example of a PCMH. The program shows excellent quality and cost outcomes through disease management, evidence-based clinical practice, and an emphasis on a physician-led team approach. Community Care of North Carolina is the state’s Medicaid program. Two independent evaluations of this program indicate it has saved the state $195 to $215 million in 2003 and between $230 and $260 million in 2004 when compared to historical fee-for-service.
This article features Dr. Don Klitgaard, from Myrtue Medical Center in Harlan, Iowa, and his experience with the TransforMED demonstration project.
Mentors
Please contact IHC if your organization would like to contribute materials to this tool kit.
Resources
- American Academy of Family Physicians
The Future of Family Medicine: A Collaborative Project of the Family Medicine Community.
- “DIAGNOSIS: Doctor's Office Rebellion PRESCRIPTION: Put the patient first.” Charlotte Huff. AmericanWay.
- “Home Sweet Medical Home.” Chris Dimick. Journal of AHIMA, August 1, 2008.
- “Medicare, Graduate Medical Education, and New Policy Directions.” John Iglehart. New England Journal of Medicine, 359;6 August 7, 2008.
- “Old-fashioned Docs Inspire New Medical Homes.” Julie Appleby. USA TODAY.
- Patient-Centered Primary Care Collaborative
Additional resources, related articles and references regarding medical home.
- Robert Wood Johnson Foundation
A study about how care coordination teams may improve patient outcomes.
The Future of Family Medicine: A Collaborative Project of the Family Medicine Community.
Additional resources, related articles and references regarding medical home.
A study about how care coordination teams may improve patient outcomes.