Building a Medical Home

Building a Medical Home usually means adding on to the foundation of an existing primary care practice. Many of the components will already be part of your practice – becoming a Medical Home then involves reinforcing the infrastructure, enhancing skills, focusing on office systems and improving quality, and integrating partnerships with families and collaborations with other healthcare providers.

Though the term "medical home" has been used in pediatrics for over 40 years, the concept evolved in the last 15-20 years to emphasize the comprehensive care, coordination of services, accessing resources, and partnering with families of children and youth with special health care needs (CYSHCN). More recently, adult-oriented specialists have embraced medical home as an ideal model of care, particularly for adults with chronic conditions (see the Joint Principles of the Patient-Centered Medical Home ( 37 KB) ). With this expanded view, employers, government agencies and legislators, some insurers, and many others have recognized the potential benefits of a broad implementation of the model. As of the end of 2008, over 40 states have some form of legislation to support or mandate "medical home," usually as part of a larger attempt at health care reform and often focused on care provided to Medicaid recipients. Numerous pilot or demonstration projects are underway to test the value of medical home and to learn how best to implement it. There is considerable optimism that these will lead to changes in compensation for primary care that will support the added infrastructure and services that are needed to build and sustain medical homes.

A precise definition of a medical home has yet to evolve, but a number of organizations and legislatures have provided definitions for their own use. A "definition" that is being increasingly adopted is framed by an approach to "credentialling" medical homes by the NCQA Patient-Centered Medical Home Recognition Program program and other national organizations. Practices are scored on 9 PPC standards that include 30 scoring elements, of which 10 are "must pass." Summary scores determine the qualifying level, from "not recognized" through Level 3. As used to date, Levels 2 and 3 are required to be considered a medical home. See NCQA PCMH Content & Scoring Summary ( 37 KB) for details.

This section will provide detailed information needed to understand what medical home is all about (see also About Medical Home), how to provide medical home care, and where to find to tools to help:

• About Children and Youth with Special Health Care Needs (CYSHCN)
• Care Coordination
• Optimal Coding
• Medical Home Training and Resources

Future pages will offer more information on partnering with families, medical home pilot projects, funding mechanisms, credentialling, and ongoing quality improvement. Please let us know what you're most interested in - use the Feedback button at the top of the page.