A review of the literature Medical home A review of the literature

Medical home beginnings American Academy of Pediatrics (AAP) 1967, Children with special health care needs (CSHCN) (Berenson et al., 2008; Backer, 2007) 1992 position paper, an “approach to providing comprehensive primary care.” (Association of American Medical Colleges, The Medical Home Position Statement, 2008) 2002, AAP operationalized the medical home concept Accessible Continuous Comprehensive Family-centered Coordinated compassionate Culturally effective (Joint Principles of the Patient-Centered medical home, 2007 http://www.medicalhomeinfo.org/Joint%20Statement.pdf)

The American health Care System “medically homeless” individuals Difficult to navigate Does not encourage continuity of care and care coordination Information systems do not “talk” to each other (Association of American Medical Colleges, The Medical Home Position Statement, 2008)

Evolution of the Medical home Concept 2004, Future of Family Medicine Project called for every American to have a “personal medical home.” and the American Academy of Family Physicians (AAFP) developed a similar policy 2006, American College of Physicians promoted- “advanced medical home” 2007, AAFP; ACP; AAP; AOA produced Joint Principles of the Patient Centered Medical Home (Backer, 2007)

Medical home principles Personal physician Physician directed Holistic Coordinated Quality and safety Enhanced access Adequate payment (Backer,2007)

(Joint Principles of the Patient-Centered Medical home, 2007) Medical home Defined “A physician-directed practice that provides care that is accessible, continuous, comprehensive and coordinated, and delivered in the context of family and community.” ( Berenson et al., 2008) “An approach to providing comprehensive primary care for children, youth and adults. A health care setting that facilitates partnerships between individuals patients, and their personal physicians, and when appropriate, the patient’s family.” (Joint Principles of the Patient-Centered Medical home, 2007)

Why a medical home? Access to basic primary care services Fragmentation in health care delivery Quality of care Cost of care (Berenson et al, 2008)

A Regular source of care Having a regular source of care is a better predictor of receiving care than just having insurance Access to a particular physician Earlier diagnoses More accurate diagnoses Reduced ER use Fewer hospitalizations Lower costs Fewer unmet medical needs Increased patient satisfaction (Proser, 2005)

Medical Home Success Community Care of North Carolina North Carolina Department of Health and human Services Physician-directed networks 3,500 physicians in 100 counties Primary care physicians, pharmacists, health departments, social service agencies, community support Medical Home framework Medicaid Patients Savings in Medicaid costs $60 mill- 2003; $120 mill- 2004; $231 mill-2005 and 2006 (www.governor.state.nc.us/News_FullStory.asp http://www.aafp.org/news-now/government- medicine/20070306northcarolina.html)

Medical home concept needs Better definition Information on how various conditions and “degrees of acute and chronic illness” will be handled More research Implementation Measurement (Association of American Medical Colleges, The Medical Home Position Statement, 2008) Evidence in support of the medical home concept has been drawn form primary care and case management approaches aimed at improving care coordination and prevention. Discuss reimbursement issues Discuss low number of primary care physicians in comparison to specialists Discuss doctors choosing not to participate in Medicaid.