States Add Medical Home Concept to Health-Related Bills

Three months after they were published, the "Joint Principles of the Patient-Centered Medical Home," (3-page PDF; About PDFs) which were developed by the AAFP, American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association, took center stage in legislation signed by Colorado Gov. Bill Ritter.

In developing the principles, the nation's primary care physicians provided a universal definition for the personal medical home on which legislators, regulators and private sector payers could base their policies. Colorado was the first state to go on record as advocating those principles.

The new Colorado law, S.B. 130, (5-page PDF; About PDFs) calls on the state to ensure medical homes for children enrolled in the Colorado medical assistance program or basic health plan and appropriates funds to implement the law's provisions.

"The best medical care for infants, children and adolescents is provided through a medical home … that is consistent with the Joint Principles of a Patient-Centered Medical Home," the new law says.

Jeffrey Cain, M.D., of Denver, the Colorado AFP's representative to the 2010 All Colorado Kids Covered Initiative that helped write the bill's language, said that the joint principles were instrumental to the bill's passage.

"It sets the definition of what a medical home has to do, not what it is," said Cain. "We didn't say, 'You have to be this kind of a doctor,'" to qualify as a medical home. As a result, the proposal won the support of the medical society, pediatricians, mental health professionals and those who work with children and adults with special needs.

"The bottom line is: 'What is the best patient care?'" noted Raquel Alexander, C.A.E., EVP of the Colorado AFP. "There were a lot of health care providers who wanted to be called a medical home because of what's happening in health care reform."

Noting that "medical care provided through emergency departments, walk-in clinics and other urgent-care facilities is often more costly and less effective than care given by a physician with prior knowledge of the child and his or her family," the law defines a medical home as one that ensures provision of:

Much of the bill grew from proposals put forth in "All Colorado Kids Covered: A Roadmap to Coverage by 2010," (12-page PDF; About PDFs) a report produced by the 2010 All Colorado Kids Covered Initiative, to which the Colorado AFP contributed. Other members of the initiative included children's advocacy groups, churches, the Colorado Department of Public Health and Environment, the Colorado Coalition for the Medically Underserved, the Denver Medical Society, and the Colorado Hospital Association.

"As part of that initiative, it was very important to separately define medical home for children," said Alexander. "We all recognized the value of the medical home in health care for children. There was no argument on accepting the national definition. We said, 'Anyone can call themselves a medical home if they agree to provide the following services.'"

Twelve other states -- California, Connecticut, Florida, Idaho, Iowa, Louisiana, Maryland, Mississippi, Rhode Island, Texas, Washington and West Virginia -- have enacted legislation to encourage medical homes for children, according to the National Conference of State Legislatures. Some focus on children with special needs, while others extend the concept to all children.

Several state legislatures, including Indiana, Kansas, Wisconsin, West Virginia, Michigan, Massachusetts and Louisiana, have introduced Medicaid and health care access legislation this session that expands the medical home concept to patients of all ages, according to Diana Ewert, AAFP senior manager of state government relations. Those bills have taken their cue from the Community Care of North Carolina program, in which all members of the Medicaid population have a medical home, she said.

Although the idea of a medical home is gaining adherents, without a common definition of a medical home, the concept's growing popularity could pose problems, according to Greg Martin, AAFP state government relations analyst.

"There's a widespread recognition of the terminology now," said Martin. "But what that means is its definition is floating around a bit, and it's not consistent by any means." Varying descriptions of what constitutes a medical home highlight the need for a consistent definition of medical home -- as is found in the joint principles.

For example, in Louisiana, S.B. 1, known as the Health Care Reform Act of 2007 (9-page PDF; About PDFs) -- a bill that has been approved by the state senate -- calls for establishing medical homes for Medicaid beneficiaries and low-income uninsured citizens. The medical home, according to the bill, is a "health care delivery system that is patient and family centered and is guided by a personal primary care provider who coordinates and facilitates preventive and primary care that improves patient outcomes in the most cost-efficient manner possible."

A Massachusetts proposal, S.B. 682, would establish a three-year medical home demonstration project that includes care management and medical home fees for participating physician practices. Under the proposal, a medical home is a "primary care practice that utilizes a comprehensive approach to providing patient-centered care that is accessible, continuous and coordinated" and that includes "preventive and ongoing health services." However, the bill also stipulates that "participating physicians may be specialists or subspecialists for patients requiring ongoing care for specific conditions, multiple chronic conditions such as severe asthma, complex diabetes, cardiovascular disease and rheumatologic disorder, or for those with a prolonged illness."