2. The Advanced Medical Home

3. ACP Attributes of Advanced Medical Home Evidence-based care/clinical decision support Chronic care model approach for all patients Patient/family centered integrated care plan Enhanced access via telephone/email Quality indicators/performance feedback Information technology to promote quality and safety

4. Business Proposition Primary care practices designated as advanced medical home if they conform to practice standards more specific than general principles of primary care Practices with this designation receive higher reimbursement Expectation is that advanced medical homes will save money by reducing specialty and ED visits as well as hospitalizations

5. ACP Proposed Solutions Tied to Enhanced Reimbursement Patient care without patient in the office –Coordinating care role of primary care physician –Enhanced secure telephone/email consultation –Remote monitoring of clinical data Accountability –Quality improvement –Achievement of evidence based performance

6. Payer Reaction to Medical Home Medicare has legislative mandate for demonstration project and is making a corresponding CPT code Private insurers and large self-employed companies developing their own pilots

7. NCQA Accreditation as a Medical Home Written standards for access/communication Uses data to demonstrate meeting access standards Charting tools to organize clinical data Uses data to identify diagnoses in practice Implements at least 3 evidence-based guidelines Tracks abnormal test results Tracks referrals Actively supports patient self-management Measures and reports physician performance

8. Is a Medical Home Dependent on Insurance Coverage More than half of Medicaid beneficiaries nationwide have interruptions in coverage Community variation in availability of safety net resources

9. Interruptions in Insurance Coverage Associated with –Lower rates of primary/preventive care –Higher rates of hospitalization for ambulatory care sensitive and psychiatric conditions –Advanced stage breast cancer and lower rates of survival

10. Todays Presentations How can communities support and evaluate the impact of medical homes? Can safety net clinics provide an adequate medical home in the absence of continuous insurance coverage?