From the CEOs

Strategies to Achieve Medical Home Implementation

By Mike R. Fraser, PhD      

It is a pleasure to introduce this issue of Pulse, featuring the work of our members, and share the pages with colleagues and friends from the American Academy of Pediatrics, one of AMCHP’s long-standing and most important partners. This issue of AMCHP Pulse features the topic of medical home. The “medical home” concept is powerful: it is about building systems and supporting practices to be more efficient, more effective, and more comprehensive. It is also simple – nothing makes more sense than a coordinated, family and patient-centered approach for providing care. Why then do 42 percent of U.S. children not experience care within a medical home? What do we need to do to get every child access to a medical home? 

If our goal is 100 percent access to a medical home, our first strategy should be partnership building. Effective medical homes are not necessarily physical structures but rather specific approaches to comprehensive, coordinated care. Medical homes involve and network pediatricians, family physicians, families, state maternal and child health leaders, community stakeholders, specialists, and key agencies in supporting the health of children, including children with special health care needs. The only solution to fixing uncoordinated care is stepping back, untangling the different systems and silos that make coordination difficult, and then partnering to braid activities in support of patients and their families. Creating braided systems is a hallmark of Title V and a strength that state maternal and child health leaders bring to these critical partnerships. This issue exemplifies the importance of partnership, as highlighted by the inspiring comments from Drs. Alden, Palfrey and Sloyer that introduce it. 

Our second strategy should be programmatic. We need to share what is working, replicate best practices and encourage innovation where feasible throughout the states. That is core to the work we do at AMCHP and is the theme of this issue. Also note that AAP’s National Center for Medical Home Implementation is a tremendous resource for all of us and will help us accomplish our programmatic goals. AMCHP is also seeking best practices for our Innovation Station that we can share with state and local health departments that build on the great work of AAP’s National Center, the work of state Title V programs, and other program partners. 

Our third strategy includes public policy change that supports medical home development and implementation. Passage of health reform offers the opportunity to do just that and includes many opportunities to move and expand medical home programs in the states. We need to continue to work with AAP and other key partners to identify the policy levers that will move medical home implementation further and continue to evaluate what families, states, and providers need to ensure that all children have access to a medical home.  

AMCHP is committed to supporting the medical home concept, and working to support the Title V role in medical home implementation and expansion. As you can see from the content of this issue, there is a lot going on across the country on medical home. We want to continue to share and support this great work, and work with you to reach our goal of all kids having access to comprehensive, coordinated, and culturally appropriate care in a family-centered medical home.


Medical Home: The Standard Care for All 

Errol R. Alden, M.D., FAAP
Executive Director/CEO, American Academy of Pediatrics 

The American Academy of Pediatrics has a long history of collaboration with the HRSA Maternal and Child Health Bureau and Title V. Indeed, it was through the collaboration of MCHB, Family Voices, and the AAP that the initial concept of “medical home” for children with special health care needs was developed. Medical homes have since expanded to include acute, preventive and chronic care. More recently, the AAP in collaboration with the American College of Physicians, the American Osteopathic Association and the American Academy of Family Physicians developed the Principles of the Patient Centered Medical Home in 2007. Over the last 30 years, medical homes have moved from a remarkable, visionary concept to becoming the standard of care for all of us — children and adults. 

As documented in the 2004 AAP Policy Statement on The Medical Home, medical care of infants, children and adolescents should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective. The 2007 Joint Principles also address the personal physician, whole person orientation, care coordination, quality of care, enhanced assess and appropriate payment. Our pediatric preamble stresses the importance of family-centeredness in a community based system of care. The medical home and the physician must be known to the child and family, in a partnership of mutual responsibility and trust. According to the policy statement, “With the collaboration of families, insurers, employers, government, medical educators, and other components of the health care system, the quality of life can be improved for all children through the care provided in a medical home.” 

A medical home operates within or develops, then utilizes, a seamless system of care for children, youth and their families. The unique role that state Title V and the AAP chapters can play is in the development of appropriate systems of care which may include other health care providers, specialists and subspecialists, interdisciplinary partners, hospitals and healthcare facilities, public health and the community. Title V has years of expertise in the evaluation and development of systems of care. The collaboration among pediatricians, Title V, and families garners the strength to make the changes necessary to optimize the care of the children within the medical home.  

There are still challenges in the full implementation of medical homes. Some of these challenges include: the appropriate definition of medical home; appropriate payment for services; health information technology and interoperability; family knowledge and involvement; knowledge of community resources and services; measurement and performance standards; and subspecialty involvement including co-management. 

With the recent historical passage of health care reform legislation, the stage is truly set and the timing is critical for collaboration with our partners in disseminating and implementing medical homes. There is a great opportunity for pediatricians and Title V to capitalize on the current momentum to enhance the spread of “medical homeness.” With the aim of improved health outcomes for children and youth, the goal is simple — and possible: all children must have access to appropriate, quality health care within medical homes.