Medical Home

How It Works

The medical home is not a physical entity to which children with special health needs can seek medical attention. Rather, the medical home is a concept that defines ideal principles to maximize the health and wellness of children and youth. As defined by the AAP, a medical home must provide care that meets the following criteria:

Accessible. Care is provided in the child’s community and is both physically and financially accessible.
Family Centered. Care is provided in an environment of mutual respect and shared decision making between families, youth, and physicians.
Continuous. Care is provided from infancy to young adulthood.
Comprehensive. Care is directed by a well-trained physician and availability of care is ensured, 24 hours a day. Preventative, primary, and tertiary care needs are met.
Coordinated. Care among multiple providers is coordinated through the medical home.
Compassionate. Care emphasizes that the well-being of the child and family is primary concern and empathy is demonstrated.
Culturally effective.

History

The AAP introduced the medical home in 1967, which focused initially on a central location for a child’s medical record. In the 1980s, redefining the medical home led to the current concept of a medical home. In 1992 the AAP issued its first policy statement defining the medical home. There have been subsequent revisions of the policy statement. The American Academy of Family Physicians and the American College of Physicians have embraced this concept as a optimal model of providing medical services and have issued their own policy statements on the medical home.

Policy Update

Provision of high quality medical care that encompasses the seven principles of a medical home has gained significant support on the community and national level.

One barrier to the penetration of this medical model centers around reimbursement for physicians and related services. To this end, House bill 2351, HealthCARE Act of 2007, section 201, provides waiver authority for states to implement policies that are consistent with the medical home. Included in this section of the bill is a reimbursement method that is called the Patient Centered Medical Home Reimbursement Methodology. This method recognizes the value of clinical time associated with family education, coordination of care between specialists, and telephone communications, as well as other aspects of providing care to CSHCN.

While the outlays for medical services provided in this model may be significant, there are also potential savings that have not been calculated. To this end, Section 505 of Senate bill 1364, Healthy Kids 2007 Act, includes as provision to establish a Medical Home Demonstration Project (MHDP). The demonstration project will evaluate savings resulting from increased cost efficiencies and decreases in inappropriate emergency room utilization and duplication of health care services.

Links

American Academy of Pediatrics, National Center for Medical Home Initiatives for Children with Special Needs

References

American Academy of Pediatrics, National Center for Medical Home Initiatives for Children with Special Needs. Available at: http://www.medicalhomeinfo.org/