MINNEAPOLIS, January 16, 2008—The American Academy of Family Physicians has been busily promoting the concept of the medical home, a key part of the health care reform bill espoused by the Minnesota Medical Association.

In the past three months the academy:

• supported a voluntary designation program that would recognize physician practices as patient-centered medical homes
• asked that legislation on Capitol Hill more clearly define the phrase "medical home," and
• convinced the Council of State Governments to implement and fund patient-centered medical home pilot projects.

The voluntary designation program would be administered by the National Committee for Quality Assurance (NCQA), and would recognize physician practices as patient-centered medical homes, a development designed to promote comprehensive and coordinated care.

Program criteria are based on a series of requirements, including patient registries, care management programs, electronic prescribing and follow-ups on tests, among other measures.

The AAFP seeks to define the medical home as group-based, not based on individual physicians. The physician is not a home, they insist. Only a physician practice can earn the designation of "patient-centered medical home." 

Senate bill 2376 would create a medical home demonstration program for certain beneficiaries enrolled in Medicaid and the State Children’s Health Insurance Program (SCHIP).

Under the legislation, Medicaid and SCHIP beneficiaries without a regular source of care would be assigned to medical homes with primary care physicians who would be responsible for managing and coordinating their care. The legislation also would create local medical management committees to establish standards and measures for patient-centered medical homes.

The legislation gives the medical management committees the authority to define the patient-centered medical home, but it does not require them to base the definition on any national standard, creating the possibility that differing definitions of the medical home may emerge.

Similarly, the legislation also should require the medical management committees to base their performance standards for the medical home on the list determined by the Physician Consortium for Performance Improvement, those endorsed by the National Quality Forum and those chosen for primary care implementation by the Ambulatory Care Quality Alliance.

Pediatrician George Schoephoerster, M.D., president-elect of the MMA and a leading proponent of the medical home idea in Minnesota, said that the principle of the medical home is the same between the MMA, AAFP, and groups including the American Pediatric Association, the American College of Pediatricians, and the American Osteopathic Association. He also credited NCQA (National Committee for Quality Assurance) for providing leadership on the medical home.

"The principles are the same, though the constituencies are different," Schoephoerster said. "Specialty groups see the medical home as promoting patient-centered care. Groups like the MMA are committed because of the opportunity to lower cost and improve quality."

Dave Renner, director of state and federal legislation for the MMA, remarked that the MMA is very comfortable with actions taken by the AAFP on the medical home.

"The medical home model is directly tied to what we've been working to achieve with the Healthy Minnesota proposal, and which the Legislature will be looking at this session as it grapples with the problem of health care reform," Renner said. He said the MMA congratulates the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Physicians.

"The concept of the medical home is one of patient-centered health care that results in lower cost and better care," Renner said.  "Those are difficult ideas to disagree with."

Annals of Family Medicine article