The Patient-Centered Medical Home

The AAP definition of “medical home”: A medical home is an approach to providing comprehensive and high quality primary care. A medical home should be the following:
  • Accessible: Care is easy for the child and family to obtain, including geographic access and insurance accommodation.
  • Family-centered: The family is recognized and acknowledged as the primary caregiver and support for the child, ensuring that all medical decisions are made in true partnership with the family.
  • Continuous: The same primary care clinician cares for the child from infancy through young adulthood, providing assistance and support to transition to adult care.
  • Comprehensive: Preventive, primary, and specialty care are provided to the child and family.
  • Coordinated: A care plan is created in partnership with the family and communicated with all health care clinicians and necessary community agencies and organizations.
  • Compassionate: Genuine concern for the well-being of a child and family are emphasized and addressed.
  • Culturally Effective: The family and child's culture, language, beliefs, and traditions are recognized, valued, and respected
Parents sitting in grass with 2 children who have 22q deletion and global developmental delay
A medical home is not a building or place; it extends beyond the walls of a clinical practice. A medical home builds partnerships with clinical specialists, families, and community resources. The medical home recognizes the family as a constant in a child's life and emphasizes partnership between health care professionals and families.

The term “medical home” was first introduced by the American Academy of Pediatrics (AAP) in 1967. In 1992, the AAP published a policy statement defining the Medical Home concept, which has evolved considerably since its inception and has been adapted as a standard of care by many other professional organizations. The Medical Home model is viewed as an ideal model of care for children and youth with special health care needs (CYSHCN) and is founded on the four following principles:

  • family-centered partnership
  • community-based system
  • transitions
  • value

As the ideas of the Medical Home and patient- and family-centered care have taken root, many practices and organizations have undergone changes to implement these concepts in a myriad of ways. Because there is growing evidence that this model fulfills the “Triple Aim (improved patient experience, increased quality, and decreased costs”), both private and public payers continue to improve compensation for the added infrastructure and services that are needed to build and sustain medical homes.

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. Many practices now seek recognition and credentialing as a certified “medical home” using programs that adhere to the Joint Principles of the Patient Centered Medical Home (PCMH), a standard recognized by multiple physician organizations. Some organizations use the terminology: Family-Centered Medical Home (FCMH). The NCQA Patient-Centered Medical Home Recognition Programis one of the most respected program for practices to evaluate and improve their medical home services and achieve recognition as a “Medical Home.”

The Medical Home team includes families and patients, clinicians, support staff, and care coordinators. This section of the Medical Home Portal provides more information needed to understand what the Medical Home is all about, how to build a Medical Home to provide optimal family-centered care, and tools to help coordinate care and advocate for children and youth with special needs. Please let us know what additional topics you are most interested in - use the Feedback button at the bottom of the page.


Information & Support

For Professionals

Medical Home Resources (AAP)
An in-depth look at the medical home model and how to implement it. Includes information about quality improvement, maintenance of certification activities to improve your medical home, and financing and payment resources; American Academy of Pediatrics.

National Resource Center for Patient/Family-Centered Medical Home
The National Resource Center, a cooperative agreement between the Maternal and Child Health Bureau (MCHB) and the American Academy of Pediatrics (AAP), provides free technical assistance and support to state Maternal and Child Health Title V / Children and Youth with Special Health Care Needs programs, pediatric clinicians, families, community members, policy makers, and others interested in implementing high quality primary care for children and youth.

NCQA Patient-Centered Medical Home Recognition Program
A program of the National Committee on Quality Assurance to "recognize" practices as Medical Homes.

Authors & Reviewers

Initial publication: February 2019
Current Authors and Reviewers:
Author: Jennifer Goldman, MD, MRP, FAAP