1. A review of the literature
Medical home
A review of the literature

2. Medical home beginnings
American Academy of Pediatrics (AAP)
1967, Children with special health care needs (CSHCN) (Berenson et al., 2008; Backer, 2007)
1992 position paper, an “approach to providing comprehensive primary care.”
(Association of American Medical Colleges, The Medical Home Position Statement, 2008)
2002, AAP operationalized the medical home concept
Accessible
Continuous
Comprehensive
Family-centered
Coordinated
compassionate
Culturally effective
(Joint Principles of the Patient-Centered medical home, 2007

3. The American health Care System
“medically homeless” individuals
Difficult to navigate
Does not encourage continuity of care and care coordination
Information systems do not “talk” to each other
(Association of American Medical Colleges, The Medical Home Position Statement, 2008)

4. Evolution of the Medical home Concept
2004, Future of Family Medicine Project called for every American to have a “personal medical home.” and the American Academy of Family Physicians (AAFP) developed a similar policy
2006, American College of Physicians promoted- “advanced medical home”
2007, AAFP; ACP; AAP; AOA produced Joint Principles of the Patient Centered Medical Home
(Backer, 2007)

5. Medical home principles
Personal physician
Physician directed
Holistic
Coordinated
Quality and safety
Enhanced access
Adequate payment
(Backer,2007)

6. (Joint Principles of the Patient-Centered Medical home, 2007)
Medical home Defined
“A physician-directed practice that provides care that is accessible, continuous, comprehensive and coordinated, and delivered in the context of family and community.”
( Berenson et al., 2008)
“An approach to providing comprehensive primary care for children, youth and adults. A health care setting that facilitates partnerships between individuals patients, and their personal physicians, and when appropriate, the patient’s family.”
(Joint Principles of the Patient-Centered Medical home, 2007)

7. Why a medical home? Access to basic primary care services
Fragmentation in health care delivery
Quality of care
Cost of care
(Berenson et al, 2008)

8. A Regular source of care
Having a regular source of care is a better predictor of receiving care than just having insurance
Access to a particular physician
Earlier diagnoses
More accurate diagnoses
Reduced ER use
Fewer hospitalizations
Lower costs
Fewer unmet medical needs
Increased patient satisfaction
(Proser, 2005)

9. Medical Home Success Community Care of North Carolina
North Carolina Department of Health and human Services
Physician-directed networks
3,500 physicians in 100 counties
Primary care physicians, pharmacists, health departments, social service agencies, community support
Medical Home framework
Medicaid Patients
Savings in Medicaid costs
$60 mill- 2003; $120 mill- 2004; $231 mill-2005 and 2006 (
medicine/ northcarolina.html)

10. Medical home concept needs
Better definition
Information on how various conditions and “degrees of acute and chronic illness” will be handled
More research
Implementation
Measurement
(Association of American Medical Colleges, The Medical Home Position Statement, 2008)
Evidence in support of the medical home concept has been drawn form primary care and case management approaches aimed at improving care coordination and prevention.
Discuss reimbursement issues
Discuss low number of primary care physicians in comparison to specialists
Discuss doctors choosing not to participate in Medicaid.