Even before the passage of the Affordable Care Act – otherwise known as healthcare reform – the concept of medical homes was the subject of prolonged debate as a theoretical model of care. But what, exactly, is a medical home?
What Is a Medical Home?
For the most part, a medical home is not a physical care location. Rather, it is a care practice model that encompasses a network of providers delivering patient-centered preventive and primary care. The goals of the medical home concept are to reduce costs while improving quality outcomes and efficiency in care delivery.
Officially referred to as Patient Centered Medical Homes (PCMHs), the nation’s Agency for Healthcare Research and Quality (AHRQ) defines medical homes as incorporating five principles.
- A patient-centered model of care that takes into account the entire person, the full range of their care needs, and the preferences of the patient and his/her family.
- An interdisciplinary approach, which incorporates all clinicians and care providers across the full spectrum of the patient’s medical and behavioral health care needs.
- Care that is coordinated and integrated across the entire health care continuum.
- Continuous access to care, with enhanced hours of service and timely appointments, facilitated by alternative methods of communication such as email.
- A systems-based approach to quality and safety which includes the practice of evidence-based medicine and measurement of patient experience, and that the medical home organization participates in population health and management.
Growth of Medical Homes
While the concept of medical homes has been around since the 1960s, it has most recently seen a surge in growth and support through provisions in the Affordable Care Act, which establishes demonstration projects to expand the practice, along with state legislatures promoting the use of the model for Medicaid beneficiaries.
- Specifically, healthcare reform established the Federally Qualified Health Center (FQHC) Advanced Primary Care Demonstration under the Centers for Medicare and Medicaid Services’ (CMS) Innovations Center.
- The purpose of the demonstration is to illustrate how the medical home model can improve the quality of patient care, promote better health, and lower Medicare costs.
- The three-year demonstration includes 469 participants and manages the Medicare Part A and B care for 195,000 patients.
Requirements to Be a Medical Home
To be recognized as an FQHC, an organization must, among other things, serve an underserved area or population, provide comprehensive services, and receive grants under Section 330 of the Public Health Service Act.
Those participating in the demonstration are required to help patients manage chronic conditions and be actively engaged in care coordination practices that are recognized by the National Committee for Quality Assurance. If they are able to meet these conditions, the FQHC is paid a nominal monthly care management fee for each eligible Medicare beneficiary receiving primary care services.
Who Is On Board?
In addition to the FHQC demonstration, the vast majority of states (43) have established policies that promote the medical home model for some Medicaid beneficiaries. While activities vary state to state, efforts have included the establishment of pilot projects, reformed Medicaid payment structures, investments in and encouragement of the adoption of electronic health records and information technologies.
While Accountable Care Organizations (ACOs) are not specifically medical homes, there are many shared goals between the two initiatives in providing integrated patient care across the full healthcare continuum, such as improving clinical outcomes, reducing preventable hospitalizations, improving the patient experience and driving down costs.