Am Fam Physician. 2007 Sep 15;76(6):774-775.
An article on the medical home appeared in the September 2007 issue of Family Practice Management.
The American Academy of Family Physicians (AAFP), American College of Physicians (ACP), American Academy of Pediatrics (AAP), and American Osteopathic Association (AOA), representing about 333,000 physicians, have developed joint principles to describe the characteristics of the patient-centered medical home.
Research has shown that primary care matters in terms of access, cost, and quality. Patients who have an ongoing relationship with a primary care physician have better outcomes and lower costs. When care is managed effectively by primary care physicians in the ambulatory setting, patients with chronic diseases have fewer complications, which leads to fewer avoidable hospitalizations.1 The following principles have been adopted by each organization and form the cornerstone of advocacy in the public and private sectors:
Personal physician: each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous, and comprehensive care.
Physician-directed medical practice: the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
Whole-person orientation: the personal physician is responsible for providing for all of the patient's health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life, acute care, chronic care, preventive services, and end-of-life care.
Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient's community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange, and other means to ensure that patients get the indicated care, when and where they need and want it, in a culturally and linguistically appropriate manner.
Quality and safety are hallmarks of the medical home.
Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership among physicians, patients, and the patient's family.
Evidence-based medicine and clinical decision-support tools guide decision making. Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement. Patients actively participate in decision making, and feedback is sought to ensure that patients' expectations are being met.
Information technology is used appropriately to supportoptimal patient care, performance measurement, patient education, and enhanced communication.
Practices go through a voluntary recognition process by an appropriate nongovernmental entity to demonstrate that they have the capabilities to provide patient-centered services consistent with the medical home model.
Patients and families participate in quality-improvement activities at the practice level.
Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication between patients, their personal physician, and practice staff.
Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home. The payment structure should be based on the following framework:
It should reflect the value of physician and non-physician staff patient-centered care management work that falls outside the face-to-face visit.
It should pay for services associated with coordination of care within a given practice and between consultants, ancillary providers, and community resources.
It should support adoption and use of health information technology for quality improvement.
It should support provision of enhanced communication access such as secure e-mail and telephone consultation.
It should recognize the value of physician work associated with remote monitoring of clinical data using technology.
It should allow for separate fee-for-service payments for face-to-face visits (payments for care management services that fall outside of the face-to-face visit, as described above, should not result in a reduction in the payments for face-to-face visits).
It should recognize case mix differences in the patient population being treated within the practice.
It should allow physicians to share in savings from reduced hospitalizations associated with physician-guided care management in the office setting.
It should allow for additional payments for achieving measurable and continuous quality improvements.
Background of the Medical Home Concept
The AAP introduced the medical home concept in 1967, initially referring to a central location for archiving a child's medical record. In its 2002 policy statement, the AAP expanded the medical home concept to include these operational characteristics: accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care.
The AAFP and the ACP have since developed their own models for improving patient care called the “medical home” (AAFP, 2004) or “advanced medical home” (ACP, 2006).
For More Information
Address correspondence to Rick Kellerman, MD, at firstname.lastname@example.org. Reprints are not available from the authors.
Author disclosure: Nothing to disclose.
1. American Academy of Family Physicians. Value of Family Medicine. Accessed August 7, 2007, at: http://www.aafp.org/online/en/home/policy/familymedvalue.html.
Copyright © 2007 by the American Academy of Family Physicians.
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