What is a Medical Home?

From American Academy of Family Physicians (AAFP), American Academy of
Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic
Association (AOA)

Joint Principles of the Patient-Centered Medical Home
February 2007

Introduction
The Patient-Centered Medical Home (PC-MH) is an approach to providing
comprehensive primary care for children, youth and adults.  The PC-MH is a health
care setting that facilitates partnerships between individual patients, and their
personal physicians, and when appropriate, the patient’s family.
The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians,
have developed the following joint principles to describe the characteristics of the
PC-MH.

Principles
Personal physician - each patient has an ongoing relationship with a personal
physician trained to provide first contact, continuous and comprehensive care.
Physician directed medical practice – the personal physician leads a team of
individuals at the practice level who collectively take responsibility for the
ongoing care of patients.

Whole person orientation – the personal physician is responsible for providing
for all the patient’s health care needs or taking responsibility for appropriately
arranging care with other qualified professionals.  This includes care for all stages
of life; acute care; chronic care; preventive services; and end of life care.

Care is coordinated and/or integrated across all elements of the complex health
care system (e.g., subspecialty care, hospitals, home health agencies, nursing
homes) and the patient’s community (e.g., family, public and private community-
based services). Care is facilitated by registries, information technology, health
information exchange and other means to assure that patients get the indicated
care when and where they need and want it in a culturally and linguistically
appropriate manner.

Quality and safety are hallmarks of the medical home:
  • Practices advocate for their patients to support the attainment of optimal,
    patient-centered outcomes that are defined by a care planning process driven
    by a compassionate, robust partnership between physicians, patients, and the
    patient’s family.
  • Evidence-based medicine and clinical decision-support tools guide decision
    making
  • Physicians in the practice accept accountability for continuous quality
    improvement through voluntary engagement in performance measurement
    and improvement.        
  • Patients actively participate in decision-making and feedback is sought to
    ensure patients’ expectations are being met
  • Information technology is utilized appropriately to support optimal patient  care,
    performance measurement, patient education, and enhanced communication
  • Practices go through a voluntary recognition process by an appropriate non-
    governmental entity to demonstrate that they have the capabilities to provide
    patient centered services consistent with the medical home model.
  • Patients and families participate in quality improvement activities at the
    practice level. Enhanced access to care is available through systems such as
    open scheduling, expanded hours and new options for communication
    between patients, their personal physician, and practice staff.
  • Payment appropriately recognizes the added value provided to patients who
    have a patient-centered medical home.  The payment structure should be
    based on the following framework: It should reflect the value of physician and
    non-physician staff patient-centered care management work that falls outside
    of the face-to-face visit.
  • It should pay for services associated with coordination of care both within a
    given practice and between consultants, ancillary providers, and community
    resources.
  • It should support adoption and use of health information technology for quality
    improvement;  
  • It should support provision of enhanced communication access such as secure
    e-mail and telephone consultation;
  • It should recognize the value of physician work associated with remote
    monitoring of clinical data using technology.
  • It should allow for separate fee-for-service payments for face-to-face visits.
    (Payments for care management services that fall outside of the face-to-face
    visit, as described above, should not result in a reduction in the payments for
    face-to-face visits).

The American Academy of Pediatrics (AAP) introduced the medical home concept in
1967, initially referring to a central location for archiving a child’s medical record.  In
its 2002 policy statement, the AAP expanded the medical home concept to include
these operational characteristics: accessible, continuous, comprehensive, family-
centered, coordinated, compassionate, and culturally effective care.   
The American Academy of Family Physicians (AAFP) and the American College of
Physicians (ACP) have since developed their own models for improving patient care
called the  “medical home” (AAFP, 2004) or “advanced medical home” (ACP, 2006).   
For More Information:
American Academy of Family Physicians
http://www.futurefamilymed.org
American Academy of Pediatrics:
http://aappolicy.aappublications.org/policy_statement/index.dtl#M
American College of Physicians
http://www.acponline.org/advocacy/?hp
American Osteopathic Association
http://www.osteopathic.org