Health Affairs, 27, no. 5 (2008): 1218 doi: 10.1377/hlthaff.27.5.1218 © 2008 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Medical Home

PROLOGUE

The Medical Home

As with most things, it turns out that what’s old is actually new again. Robert Berenson and colleagues write that the American Academy of Pediatrics introduced the phrase in the 1960s, describing a way to improve the care of children with special needs. Four decades later, the concept has been resurrected to describe a new model for primary care—not just for kids, but for everybody. As such, it’s been promoted by four primary care specialty societies, including the American Academy of Family Physicians. Yet Jaan Sidorov suggests in a Perspective that the model might not be ready for prime time.

In the current lexicon, the medical home has now become a "patient-centered" one—primary care that, while "physician-directed," is focused on the family and community. Yet some proponents emphasize the "patient-centered" component; in a medical home, your doctor might even call or e-mail you 24/7! Others explain that the "home" would really be a "system" complete with electronic health records and real-time information flows, while still others see a primary focus on coordinating and managing chronic disease care. Then there’s the question of who pays for medical homes, and how much. Clearly, part of the vision is doling out more dough to underpaid primary care providers for things that don’t currently earn them peanuts—such as coaching patients on how to manage their own illnesses.

Since there’s no succinct notion of what "it" is, it seems a good idea to test it—which is what Medicare, assorted Blues plans, and other payers are now doing in various demonstrations. That’s good, write Berenson and colleagues—but in the meantime, they caution that some consensus should be forged on what medical homes are and what they might reasonably be expected to deliver. The Geisinger system, as described by Ronald Paulus and colleagues, offers a real-world example of how medical homes more broadly might function. Without such consensus, enthusiasm for this promising if relatively unformed health policy idea might wane—especially as people figure out how far U.S. health care is from the idealized vision. After all, as Diane Rittenhouse and colleagues observe, even many large medical groups today lack the key components of medical homes.

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