Family-Centered Medical Home Overview

What is a Medical Home?

A medical home is an approach to providing comprehensive primary care that facilitates partnership between patients, physicians, and families. The American Academy of Pediatrics (AAP) believes that every child deserves a medical home, where care is accessible, continuous, comprehensive, patient- and family-centered, coordinated, compassionate, and culturally effective. Over the past year the AAP has been at the forefront of numerous initiatives to promote the adoption and spread of the patient- and family-centered medical home.

In the pediatric population, a medical home should include:

  • Patient- and family-centered partnership: A medical home provides patient- and family-centered care through a trusting, collaborative, working partnership with families, respecting their diversity, and recognizing that they are the constant in a child’s life.
  • Community-based system: The medical home is an integral part of the community-based system, a patient- and family-centered coordinated network of community-based services designed to promote the healthy development and well being of children and their families. As such, the medical home works with a coordinated team, provides ongoing primary care, and facilitates access to and coordinates with, a broad range of specialty, ancillary, and related community services.
  • Transitions: The goal of transitions is to optimize life-long health and well-being and potential through the provision of high-quality, developmentally appropriate, health care services that continue uninterrupted as the individual moves along and within systems of services and from adolescence to adulthood.
  • Value: Recognizing the importance of quality health care, appropriate payment for medical home activities is imperative.  A high-performance health care system requires appropriate financing to support and sustain medical homes that promote system-wide quality care with optimal health outcomes, family satisfaction, and cost efficiency.

In March 2007, the AAP joined with the American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and the American Osteopathic Association (AOA) to publish the Joint Principles of the Patient-Centered Medical Home PDF. This consensus statement describes seven principles of a medical home, which include: personal physician, physician-directed medical practice, whole-person orientation, coordinated care, quality and safety, enhanced access, and appropriate payment.

For additional information on medical home, please visit the Medical Home Literature and Medical Home Media pages.

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Why is a Medical Home Important Now?

It provides the best patient- and family-centered care…
A medical home provides the best patient- and family-centered care in the best way, by appropriately utilizing limited resources with adequate payment for practice activities.

It's a remedy to high health care costs…
The federal government recognizes that the total health care costs for people with chronic disease account for more than 70% of the nation’s health care expenditures. Providing care in a medical home is thought to reduce the total cost of care. The Tax Relief and Health Care Act of 2006 provides funds for a Medicare Medical Home Demonstration Project, launched in 2010.

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How is the AAP Involved in Advocating for Medical Homes?

The AAP is at the forefront of numerous initiatives to promote the adoption and spread of the patient- and family-centered medical home.

We provide support for implementation of medical home activities…
In July 2008, the AAP was honored to receive a five-year cooperative agreement grant from the federal Maternal and Child Health Bureau (MCHB) to support the National Center for Medical Home Implementation (NCMHI), administered by the AAP Division of Children with Special Needs. This agreement solidifies the continuation of a collaborative relationship with the MCHB to achieve appropriate community based service systems via access to medical homes for all children, especially children and youth with special health care needs, and their families. Some of the many activities carried out by the NCMHI was the development of the Building Your Medical Home toolkit and the EQIPP: Medical Home for Pediatric Primary Care course.

We advocate for equitable payment for care…
The AAP and the other primary care specialty societies recognize that implementation of the medical home requires a new approach to payment. The AAP was involved in the development and valuation of codes for care management that have been used — along with several other CPT codes — to facilitate payment within the Medicare Medical Home Demonstration Project, which started in January 2009. The AAP has also brought together leaders to develop a strategy to achieve payment of services in the medical home.

We help practices gain recognition as medical homes…
The National Committee for Quality Assurance (NCQA) developed the Physician Practice Connections® (PPC®) Recognition program to identify and recognize physician practices that use information systematically to enhance the quality of patient care. In order to assure that the PPC® addressed the needs of children, the AAP developed recommendations for concrete changes to the PPC. With most of the AAP recommendations approved, the NCQA launched a new version of its PPC® program in January 2008, titled the Physician Practice Connections® Patient Centered Medical Home™ (PPC®-PCMH™) Recognition program, emphasizing the systematic use of patient-centered, coordinated care management processes.

As NCQA embarked on the revision of the 2008 standards, which were released in January 2011, AAP had been an active participant in the evolution process and continually provided feedback on how to further include the patient-and-family-centered aspects of medical home into their program standards.

The NCMHI developed the Building Your Medical Home toolkit in June 2009, which is available online at no charge. The toolkit supports the development and/or improvement of a pediatric medical home. It also prepares a practice to apply for and potentially meet the 2008 NCQA PPC®-PCMH™ Recognition Program requirements. The toolkit contains a crosswalk between each of the toolkit building blocks and the2008 NCQA PPC®-PCMH™ Recognition Program 'must pass' elements. A revised crosswalk between the toolkit and the NCQA 2011 PCMH standards may be available in the near future.

We work with health care plans to further their understanding of medical homes…
Employer groups also have exhibited a strong interest in the medical home model. The AAP, along with major national employer groups, health plans, and other medical specialty societies, is a partner in the Patient-Centered Primary Care Collaborative (PCPCC). This coalition represents 50 million American workers and over 300,000 physicians. The coalition’s goals include working to stimulate additional medical home pilots by large, self-insured employer groups and fostering legislation that supports and encourages medical homes at the state and federal levels. As a member of the PCPCC, the AAP is providing leadership by serving on its Executive Steering Committee. In addition, senior AAP staff actively represents pediatric interests by participating on the advocacy, public payer, and private payer committees.

Over the past year the AAP has met with major national health plans and employer groups to discuss implementation of the medical home model. To date, the AAP has met with United HealthCare, Humana, and the BlueCross BlueShield Association. The AAP has brokered an understanding with United HealthCare that it will develop and test a separate pediatric version of the medicla home model.

We continue to play a pivotal role...
The AAP will continue to play a pivotal role in ensuring the interests of children, families, and pediatricians are “front and center” as the medical home model continues to evolve in the private and public markets. Concrete next steps include the following:

  • Collaborate with the NCQA and the other primary care medical specialty societies in identifying markets and pediatric practices that can pilot test the medical home model.
  • Continue to advocate for children as an active member of the steering committee for the PCPCC.
  • Promote the joint principles and the accompanying preamble that qualifies the pediatric attributes to health plans, employers, and policy makers.
  • Continue to work with United HealthCare, Humana, Aetna, CIGNA, WellPoint, and BlueCross BlueShield Association, and other major national and regional health plans to stake out additional major health plans that are interested in examining the medical home model.
  • Continue to advocate for firm and innovative payment mechanisms to support the medical home model, including the development and valuation of appropriate codes.
  • Develop a specific medical home implementation plan with tools for medical home activities.
  • Leverage the revised Bright Futures health supervision guidelines to build a connection to the patient- and family-centered medical home.

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How Can the AAP Support You in Advocating or Implementing Medical Home?

Practice Management Online (PMO)
PMO is a resource for AAP members and their office staff. It provides the best pediatric practice management information, tools, and resources in one easily accessible Web site. Medical home is a feature on this Web site, containing tools for implementation.

Chapter Alliance for Quality Improvement (CAQI)
This alliance helps AAP Chapters build the capacity to support the quality improvement work of medical homes.

EQIPP: Medical Home for Pediatric Primary Care
The goal of the EQIPP: Medical Home for Pediatric Primary Care course is to help pediatric health care providers create plans for improvement to address gaps identified in key activities of the medical home. Using EQIPP, pediatric health care providers will collect baseline and follow-up data and work to improve their medical home through Plan, Do, Study, and Act (PDSA) cycles. This EQIPP course will focus on the following key activities related to medical home:

  • Developing a highly functioning, multidisciplinary quality improvement team
  • Knowing and manage your patient population
  • Enhancing access to care
  • Providing family-centered care
  • Providing and document planned, proactive, comprehensive care
  • Coordinating care across all settings

Quality Improvement Innovation Network (QuIIN)
The AAP QuIIN serves as a practical working lab for pediatricians to test how improvements can be implemented in everyday pediatric practice.

AAP Chapters/Pediatric Councils
Pediatric councils serve as forums to address pediatric issues with payers involving covered services, plan policies and payer administrative procedures that impact access, quality, and cost.

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