In theory, assigning a medical home—accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective healthcare—to every individual should pay off in more effective, patient-centric care. In practice, however, establishing medical homes can be time-consuming and challenging, especially for those with chronic conditions and in high-disparity and underserved populations.

Congress passed legislation in late 2006 that adds financial weight to the idea of the patient-centered medical home, which has its roots in pediatrics. By funding the Medicare Medical Home Demonstration as part of the Tax Relief and Health Care Act of 2006, Congress authorized the payment of a “care coordination fee” to participating physicians in eight states who manage patients with multiple chronic conditions.

The Medical Home: Pathway to Patient-Centric Primary Care addresses the value and challenges of medical homes from the viewpoints of organizations already trying to establish medical homes for their populations. Covered in this 40-page special report are funding and implementation hurdles, successful methods for identifying members and redesigning office practices to move toward an advanced medical home model.

Part of the Medical Home Compilation, a three-volume series with medical home case studies from APS Healthcare, the Commonwealth of Massachusetts, Community Care of North Carolina, Horizon Blue Cross Blue Shield of New Jersey, the Pennsylvania Medicaid Access Program and United Healthcare -Save 20% when you order the Medical Home Compilation Series.

This report also summarizes the results of a 2006 HIN e-survey that identified opportunities for educating the healthcare industry on medical homes. More than half of survey respondents were either unfamiliar with medical home terminology or confused it with a physical structure.

In The Medical Home: Pathway to Patient-Centric Primary Care, HIN's accomplished panel of contributing authors furnish details on the following:

• Enhancing chronic care programs through medical homes and modifying this approach for other populations;
• Building partnerships that foster a community care model;
• Commentary and suggestions from early adopters of medical home models who responded to the 2006 e-survey;
• The role of health coaches, case workers and the patient in the establishment of a medical home;
• How to triangulate interventions to achieve best-practice outcomes;
• Funding, identification and program launching strategies; and
• Reallocating resources to optimize program success.

Throughout this 40-page report, these respected thought leaders detail their findings:

• Elizabeth Reardon, consultant with the Office of Community Programs, Commonwealth Medicine, a division of the University of Massachusetts Medical School;
• Anne Hernandez, director of operations of APS Healthcare;
• Dr. George Rust, senior consultant for APS Healthcare and interim director of the National Center for Primary Care at Morehouse School of Medicine.

Table of Contents

• Survey Identifies Medical Homes Knowledge Gap
  • The Medical Home’s Pediatric Roots
  • Targeted Populations
  • Medical Homes Increase Patient Satisfaction and Improve Outcomes
  • Early Adopters Share Strategies for Success
  • The Role of the Primary Care Provider
• An Overview of Medical Homes, the Hub of Healthcare
  • Key Components of Medical Homes
  • Enhancing Chronic Care Programs Through Medical Homes
  • Modifications for Other Populations
  • Challenges to Medical Homes
  • Tools and Resources
• APS Healthcare Helping to Establish Medical Homes for Members
  • Georgia Disease Management Program
  • Strong Partnership Leads to Community Care Model
  • Why Members Don’t Use Medical Homes
  • Health Coaches Can Guide Members to Medical Homes
  • Bringing Best Practice Perspectives Where They’re Needed Most
  • The Value of a Primary Care Home
  • Primary Care Homes and High Disparity Populations
  • Usual Care Does Not Provide the Best Outcome
  • Triangulate Interventions to Achieve Best-Practice Outcomes
• Q&A: Ask the Experts
  • Funding Medical Homes and Implementing Measures
  • Successful Methods for Identifying People and Initiating Care Management
  • Redesigning the Office to Move Toward an Advanced Medical Home
  • The Trend Toward Retail Clinics
• Glossary
• For More Information
• About the Authors

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