"Medical Homes" Included in Healthcare Reform Proposals

This morning I attended a Campaign for Mental Health Reform congressional briefing, “The Integration of Mental Health and Health: Evidence from the Medical Home.” CHADD is a Campaign member. All five congressional committee draft healthcare reform legislative proposals contain financial incentives for creating and expanding “medical” or “healthcare” homes.

CHADD endorses the concept and experience of a “medical home” (clinical home/healthcare home) for children with special healthcare needs as defined, implemented, and advocated over the past decade by the American Academy of Pediatrics. Medical homes as defined by AAP are about a single medical practice taking ownership/responsibility to coordinate interventions for children with special needs, whether those children have either complex needs or a variety of needs.

The essential elements of a medical home for children with special healthcare needs are:
• Personal physician in a culturally and linguistically competent physician-directed medical
practice who provides continuous and comprehensive care;
• A focus on the “whole” child, youth, and family with coordinated care/services/supports;
• A family-driven partnership that ensures a coordinated network of community-based services where both physicians and families share accountability for quality improvement through a performance measurement system;
• A focus on transitions to ensure no disruptions of services as children and youth
progress through normal stages of growth and development;
• Privacy-protected, family-driven electronic medical records for communication with youth and families, and consultation between treating professionals.

One of the briefing speakers was Ted Epperly, MD, the president of the American Academy of Family Physicians. I asked the other speakers (a psychiatrist with the Carter Center Mental Health Program, a psychiatrist with the Missouri Department of Mental Health, and a PhD health and disease management director of prevention programs) if they agreed with Dr. Epperly’s policy and practice objective that every American have a “trusted relationship with a personal physician”? They did. All emphasized the need for a full interdisciplinary team. All agreed that the practice should be fully integrated and “patient-centered.” All agreed that the physician should be the “quarterback” of the team and have the ultimate accountability. All agreed that physician assistants, nurse practitioners, and various mental health professionals were essential to the team. All agreed that this was the goal. All agreed that this is not practice today, but we are moving toward it. All agreed that the electronic medical record was a methodology to help achieve this objective.

There are many different models of “medical homes,” involving different types of professionals based on the age and health situation of the consumer. CHADD supports adapting the AAP model for children with special needs to other populations, including adults.

Clarke

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