The American Academy of Pediatrics defines the medical home as a model of delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. 

Deloitte Consulting, in their recently published paper The Medical Home: Disruptive Innovation for a New Primary Care Model, states a Medical Home "is not a house, hospital or other building. Rather, it is a term used to describe a health care model in which individuals use primary care practices as the basis for accessible, continuous, comprehensive and integrated care. The goal of the medical home is to provide a patient with a broad spectrum of care, both preventive and curative, over a period of time and to coordinate all of the care the patient receives."

The Blue Cross Blue Shield Association has defined the "Patient Centered Medical Home (PCMH) "as "a healthcare setting that is a collaborative partnership between the patient and personal physician.  Patients who choose to receive care in this setting have the benefit of a medical home, overseen by a trusted primary care physician of their choice, to help them through today's complex medical system.  Explaining the role of specialists, suggesting appropriate and compassionate treatment options, answering questions about illnesses, and coordinating the care ordered by specialists are cornerstones of the PCMH.  The PCMH encompasses care for all stages of life including acute and chronic care, preventive services and end-of-life care."

• American Academy of Pediatrics
• American Academy of Family Practice
• American College of Physicians
• American Osteopathic Association

The Patient Centered Primary Care Collaborative is a coalition of more than 40 major employers, consumer groups, organizations representing primary care physicians, and other stakeholders who have joined to advance the patient-centered “medical home.”  Various health plans are members of the coalition.

The Blue Cross Blue Shield Association has launched pilot demonstration medical home projects involving 27 of its member plans.

Bridges to Excellence (www.bridgestoexcellence.org) is a non-profit coalition-based organization created to encourage quality of care by recognizing and rewarding health care providers who demonstrate that they deliver safe, timely, effective, and patient-centered care. BTE works with large employers, health plans, providers and has partnered with organizations including the Leapfrog Group and the National Business Coalition on Health. 

• Personal physician – Each patient has an ongoing relationship with a Primary Care Physician (PCP), as well as clinician health coaches
• Physician-directed primary care professional organization – A physician leads a team of health coaches who collectively take responsibility for the ongoing care of patients. The day-to-day operation of the practice is focused on managing population-based outcomes and maximizing individual patient adherence to a distinct, customized self-care management program that leverages information technology. 
• “Whole person” orientation toward adherence, not compliance, incorporating holistic methods with conventional allopathic interventions
• The primary care team is responsible for providing all of the patient’s health care needs and 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, with strong consideration for the individual’s value system, personal preferences and level of engagement in decision making. 
• Monitored, coordinated and integrated care using electronic medical records and personal health records – Sharing information among medical homes and other providers in the local and regional care system is indicative of an advanced medical home model.
• Measured and managed adherence to evidence-based practices by the care team and the patient 
• Evidence-based medicine and clinical decision-support tools guide decision making. 
• Physicians in the practice accept accountability for continuous quality improvement by voluntarily engaging 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 used to appropriately support optimal patient care, performance measurement, patient education, and enhanced communication.
• Patients and families participate in quality improvement activities at the practice level.
• Enhanced accessibility: care anywhere, anytime – Care is available via open scheduling, expanded hours and new communications options
• Emphasis on physician incentives for improvements in self-care management – Physician reimbursements appropriately recognize the added value provided to patients who have a patient-centered medical home. 

• reflect the value of physician and non-physician staff patient-centered care management work that falls outside of the face-to-face visit.
• pay for services associated with coordination of care both within a given practice and between consultants, ancillary providers, and community resources.
• support adoption and use of health information technology for quality improvement;
• support provision of enhanced communication access such as secure e-mail and telephone consultation;
• recognize the value of physician work associated with remote monitoring of clinical data using technology.
• 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).
• recognize case mix differences in the patient population being treated within the practice.
• allow physicians to share in savings from reduced hospitalizations associated with physician-guided care management in the office setting.
• allow for additional payments for achieving measurable and continuous quality improvements.

Bridges to Excellence has launched the BTE Medical Home Program, which rewards physicians that demonstrate they have adopted really qualifying systems and processes of care, and are using those systems to deliver positive results in the management of their patients – in particular patients with chronic conditions. Program components include:

• Doctors can receive an annual bonus payment of $125 for each patient covered by a participating employer, with a suggested maximum yearly incentive of $100,000.
• Recognized physicians will be awarded a BTE Medical Home distinction in addition to the other Program recognitions because they have demonstrated that they have adopted and are effectively using advanced systems of care to produce good results for their patients.
• Physicians who achieve a Level 2 or Level 3 in BTE’s Physician Office Link (POL) Program as well as a Level 2 in two other BTE programs – Diabetes Care Link, Cardiac Care Link or Spine Care Link – will achieve BTE Medical Home recognition.

• While various health plans, such as the Blue Cross Blue Shield Association, are promoting Medical Home initiatives, it is important to note that the concept is ideally meant to be applied independent of a particular health plan such as an HMO, instead changing an entire practice. This means Medical Homes would deliver the primary care coordinated model for all types of patients. 
• Dr. Paul Grundy, IBM’s director of health care technology and strategic initiatives, is quoted in a recent Business Insurance article discussing the new Patient-Centered Primary Care Collaborative that IBM helped found, stating that "the medical home does not serve as a gatekeeper but rather as a gateway to the health care system." 
• There are many more attributes attached to the current Medical Home model, many embracing new technology, and requiring health information technology infrastructure, along with a commitment to evidence based medicine and quality of care standards throughout a practice.
• Medical Home initiatives are being advanced in particular with various state Medicaid and Children with Special Needs programs. Given the access problems these populations face, and the resources targeted portions of their populations require, such initiatives have become instruments of policy to achieve desired levels of access and care.

In summary - the medical home concept links primary care coordination with centralized electronic medical records and new concepts in evidence based medicine and standards of care. The medical home concept also advocates changes in primary care reimbursement that compensate doctors for care coordination and technology infrastructure, and or  quality incentive compensation in addition to standard reimbursement.

13 Specialty Health-Care Organizations Join Major Primary Care Physicians Groups To Endorse Joint Principles Of Patient-Centered Medical Home
Medical News Today, April 17, 2008
http://www.medicalnewstoday.com/articles/104410.php 

'Medical home' concept embraced by IBM, other employers 
Business Insurance, March 12, 2008
http://www.financialweek.com

Bridges to Excellence Launches Medical Home Program
Press Release, January 31, 2008
http://www.bridgestoexcellence.org/Content/ContentDisplay.aspx?ContentID=119 

Blue Cross And Blue Shield Companies Join Primary Care Physician Groups, National Employers And Consumer Groups To Explore New Approach To Patient Care
Press Release, October 17, 2007
http://www.bcbs.com/news/bcbsa/blue-cross-and-blue-shield-14.html 

Joint Principles of the Patient-Centered Medical Home
AAFP-AAP-ACP-AOA, March 2007
http://www.medicalhomeinfo.org/Joint%20Statement.pdf 

Patient Centered Primary Care Collaborative
Web Site
http://www.pcpcc.net 

• P4P Web Summit, May 8th, 2008
• Predictive Modeling Web Summit, June 5th, 2008
• The Medical Home: A New Primary Care Model, June 26, 2008
• Care Management Web Summit, November 6th, 2008
• CD-ROMs of past events
• Upcoming Events

Discounts: 
MCOL Paid Members get 50% off HealthcareWebSummit events; 10% off MCOL products; 5% off all other products through the Managed Care Store and special discounts for selected conferences