Page 2 - State Medicaid Director
The health home service delivery model is an important option for providing a cost-effective,
longitudinal “home” to facilitate access to an inter-disciplinary array of medical care, behavioral
health care, and community-based social services and supports for both children and adults with
chronic conditions. While there is still much to learn, we expect that use of the health home
service delivery model will result in lower rates of emergency room use, reduction in hospital
admissions and re-admissions, reduction in health care costs, less reliance on long-term care
facilities, and improved experience of care and quality of care outcomes for the individual.
Health homes can play a particularly pivotal role in improving the health care delivery system
for individuals with chronic conditions. Consistent with the intent of the statute, we expect
States that provide this optional benefit, and the health home providers with which the State
collaborates, to operate under a “whole-person” philosophy – caring not just for an individual’s
physical condition, but providing linkages to long-term community care services and supports,
social services, and family services. The integration of primary care and behavioral health
services is critical to the achievement of enhanced outcomes.
Health Homes and Medical Homes
To provide context about the genesis of the health home model, we are providing background in
this letter on the medical home model. While Congress defined the term “health home” in
section 2703 of the Affordable Care Act, the medical home model provides instructive history on
the evolution of the health home model. In 1967, the American Academy of Physicians (AAP)
Standards of Child Health Care envisioned the medical home as: “one central source of a
child’s pediatric records to resolve duplication and gaps in services that occur as a result of lack
of communication and coordination.” In 1992, the AAP applied the medical home term to
medical care that is accessible, continuous, comprehensive, family-centered, coordinated, and
compassionate; and in 2002, AAP further characterized care in a medical home as accessible,
continuous, comprehensive, family-centered, coordinated, compassionate, and culturally
effective. The Future of Family Medicine Project expanded on the concept in 2004 when it
called for every American to have a personal medical home. The American Academy of Family
Physicians (AAFP) developed a related policy statement the same year, and the American
College of Physicians (ACP) introduced the advanced medical home in 2006. The AAFP and
ACP teamed with the AAP and the American Osteopathic Association to draft and disseminate
Joint Principles of the Patient-Centered Medical Home. According to the principles, patient-
centered medical homes should have these characteristics: a personal physician; physician-
directed medical practice; whole-person orientation; coordinated care; quality and safety;
enhanced access; and adequate payment.
In 2007, the Commonwealth Fund defined medical home as “a healthcare setting that offers
patients a regular source of care, enhanced access to physicians and timely, well-organized care.”
Other definitions of a medical home include the use of chronic disease management, electronic
health records, web-based information, and open access to scheduling. The Patient-Centered
Medical Home (PCMH) is a model for care, provided by physician-led practices, that seeks to
strengthen the physician-patient relationship by replacing episodic care based on illnesses and
individual’s complaints with coordinated care for all life stages, acute, chronic, preventive, and