School of Public Health

What is a Medical Home?

October 2016

Dr. Marie Mann, senior medical advisor at the Maternal and Child Health Bureau , explains how the medical home has evolved.

The ‘medical home’ integrates disparate health systems designed to care for one body.  It is a holistic model of primary care service that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally effective.1

“It’s where the provider is not just thinking about your earache or your heart murmur or do you have diabetes,” said Dr. Marie Mann, a senior medical advisor at the Maternal and Child Health Bureau. “It’s where the clinician not only focuses on the medical condition but aims to deliver whole person care in the context of the patient and family.”

Dr. Mann, who is also the project officer for the National Center for Medical Home Implementation, explained that the family-centered principle is fundamental in a pediatric medical home.

A provider who establishes a trusting partnership with a family gains insight into the patient’s home environment as well as the family’s values and customs, and can more readily address the broad range of issues that may contribute to the child’s well-being. For example, a provider acting from a family-centered perspective might assess the family’s health literacy levels, refer a recently unemployed parent to a social worker, coordinate with an education specialist for a child who has trouble with schoolwork, or with a mental health specialist for a child struggling with social interaction.

THE EVOLUTION OF THE MEDICAL HOME

Dr. Mann is quick to point out that the medical home is not a physical space. When the American Academy of Pediatrics (AAP) first published the term in 1967 it meant a central repository for the medical records of children with disabilities and chronic conditions.2 As the term gained popularity in the medical community, it began to change shape. “Over the next two decades some of the more forward-thinking pediatricians and families said it was not sufficient to just to have centralized records,” explained Dr. Mann.  "The medical home needed to address the care this population of children should have.”

In 1992, the AAP formally proposed the concept of the medical home as a primary care model3 and expanded the definition to include all children a decade later.1 But it was in 2007 that the concept became more nationally visible. Several primary care physician organizations endorsed the concept of the patient-centered medical home as advanced care for all populations, including adults.4 “It’s gained a lot of momentum as a promising health care delivery model in the last nine years,” said Dr. Mann.

Provisions in the 2010 Affordable Care Act (ACA) made it possible for some public and private insurers to offer enhanced reimbursement rates to practices with a formal medical home designation.5

'MEDICAL HOME' AS A UNIVERSAL MEASURE FOR MCHB

For many years, MCHB's goal was that all children with special healthcare needs receive coordinated, ongoing, comprehensive care within a medical home.6 The current goal for the MCHB’s National Performance Measure (NPM) 11 is “to increase the number of children with and without special health care needs [ages 0 through 17] who have a medical home.”7

Michael Kogan, MCHB’s Director of Epidemiology and Research, co-chaired the committee that recently revised the NPMs. Kogan explained that the committee’s decision to broaden the goal was based on evidence that medical homes are beneficial for children with all levels of healthcare needs. The MCHB links this NPM to several National Outcome Measures including routine vaccinations for all children and at least one dose each of the HPV, Tdap and meningococcal conjugate vaccines for adolescents.

Kate Orville, co-Director of the Washington State Medical Homes Partnership, describes the need for medical homes, especially in pediatric care.

“States have the option of choosing to target their strategies at certain groups,” Kogan added. “Like children with special healthcare needs.”

The medical home measure is one of the most popular NPMs. Last year, forty-seven states and jurisdictions selected this the medical homes measures as a five-year programmatic focus. Children with special health care needs are less likely to recieve care in a medical home than children without.8 This disparity in access is especially prominent for children who are immigrants, of color, or from low-income families.5

THE NEW PARADIGM OF HEALTH

“There is this huge push to change the way healthcare is being done,” said Kate Orville, co-Director of the Washington State Medical Homes Partnership. “Medical homes are a big piece of that.”

The United States is paying more for healthcare than other industrialized nations but receiving it at a much lower quality.9 The ACA catalyzed the distribution of healthcare transformation grants across the country to improve systems of care. “We are trying to move away from a wasteful system where people have to divide up their bodies to receive care,” said Orville. The intent of a medical home is to address the fragmented system that simply responds to illness and create proactive connections that support prevention and wellness.

On a bulletin board next to her desk, Orville displays three short declarations: improve health, enhance patient experience, and reduce costs. This is the Triple Aim Initiative from the Institute for Healthcare Improvement.

“The medical home is a key building block of a strong primary care system and the Triple Aim,” Orville explained. “Children and other individuals with special healthcare needs and their families particularly benefit from this collaborative, proactive team-based model of care,” she added.

A pediatric medical home has the greatest potential to identify medical and health-related non-medical needs early on. This improves the lifelong health and wellbeing of patient and family.


REFERENCES

  1. American Academy of Pediatrics, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. The Medical Home. Pediatrics. 2002;110:184-186.
  2. Sia C, Tonniges TF, Osterhus E, et al. History of the Medical Home Concept. Pediatrics. 2004 May;113(5 Suppl):1473-8.
  3. American Academy of Pediatrics, Ad Hoc Task Force on the Definition of the Medical Home. The medical home. Pediatrics. 1992;90:774
  4. American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association (2007). Joint principles of the Patient-Centered Medical Home. Accessed October 2016
  5. Bachrach A, Isakson E, Seith D, et al. Pediatric Medical Homes: Laying the Foundation of a Promising Model of Care. National Center for Children in Poverty, Mailman School of Public Health, Columbia University. October 2011.
  6. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.The National Survey of Children with Special Health Care Needs Chartbook 2009–2010. Rockville, Maryland: U.S. Department of Health and Human Services, 2013.
  7. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Federally Available Data Resource Document
  8. National Survey of Children’s Health
  9. US Health System Ranks Last Among Eleven Countries on Measures of Access, Equity, Quality, Efficiency, and Healthy Lives. Commonwealth Fund. June 2014.
  10. National Center for Medical Home Implementation. Why is Medical Home Important? Updated: July 2016