Defining & Recoginizng a Medical Home

Definition: The Medicaid Medical Home Task Force has recommended that the state’s definition of a medical home specify that medical home providers (1) are available on a 24/7 basis, (2) coordinate care with other providers serving a patient, and (3) address both physical and behavioral health needs.

Recognition: The Task Force has suggested using the National Committee for Quality Assurance (NCQA) as a starting point for developing recognition criteria.  They recommended maintaining the three-tier structure of NCQA recognition, but unlike NCQA recognition, favor recognizing non-physician providers (nurse practitioners and physician’s assistants) as medical home leaders.

According to Iowa’s 2008 Health Care Reform Act (House File 2539), a patient-centered medical home provides for the “coordination and integration of care, focused on prevention, wellness, and chronic care management, using a whole person orientation through a provider-directed medical practice.”

For the IowaCare program, FQHCs will likely be allowed to begin participating provided they commit to achieving NCQA recognition within one year.

Definition: The Joint Principles of the Patient-Centered Medical Home (modified to include nurse practitioners).
Recognition: National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home (NCQA PPC-PCMH) plus additional state criteria.

Definition: SB 855/HB 929 defined a patient centered medical home as: “a primary care practice organized to provide a first, coordinated, ongoing, and comprehensive source of care to patients to:

1. foster a partnership with a qualifying individual;
2. coordinate health care services for a qualifying individual; and
3. exchange medical information with carriers, other providers, and qualifying individuals.”

Recognition: National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home (NCQA PPC-PCMH).

Definition: The state has reached consensus on a draft medical home definition for Montana:

"In Montana, a patient centered medical home is health care directed by primary care providers offering family centered, culturally effective care that is coordinated, comprehensive, continuous, and, when possible, in the patient’s community and integrated across systems. Health care is characterized by enhanced access, an emphasis on prevention, and improved health outcomes and satisfaction. Primary care providers receive payment that recognizes the value of medical home services."

Recognition: National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home (NCQA PPC-PCMH) recognition is being explored.

Definition: The Joint Principles of the Patient-Centered Medical Home.
Recognition: National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home (NCQA PPC-PCMH).

Definition: The Joint Principles of the Patient-Centered Medical Home.  Adds that "The physician-led care team, which also may include roles for nurse practitioners or physician assistants, is responsible for providing all the patient's health care needs and, when needed, arranges for appropriate care with other qualified physicians."

Recognition: National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home (NCQA PPC-PCMH).

Definition: The Joint Principles of the Patient-Centered Medical Home.
Recognition: State-developed recognition tool. Please see: http://www.ohca.state.ok.us/pdf/Physician_Addendum.pdf

Definition: The Joint Principles of the Patient-Centered Medical Home.
Recognition: National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home (NCQA PPC-PCMH).

Definition: From the RFP: “HHSC has identified a set of six core competencies that a primary care practice must address in order to be a health home. The six core competencies include; patient access, quality improvement, patient/family centeredness, population approach to care, coordinated and clinically managed care, and team-based comprehensive care.”  These core competencies are grounded in the Joint Principles.

Recognition: From the RFP: “HHSC will use the Medical Home Implementation Quotient (MHIQ) assessment tool results from TransforMED to measure each pilot project’s progress in attaining the six core competencies.”  HHSC will not require practices to complete the MHIQ’s health information technology (HIT) or practice management modules.