Choosing Your Healthcare Provider

Getting Care from a Medical Home

Summary

A medical home is a type of doctor’s practice that uses a team to focus on the “whole person.” It is sometimes called a patient-centered medical home (PCMH). The team is often run by one or more primary care physicians (PCPs), or sometimes nurse practitioners. The team coordinates all of your care needs. Coordinating care means all of the people treating you know your medical history and treatment plan. They can work together to get you the care you need and avoid providing services you don’t need.

A medical home is not a type of health plan. It is similar to other health networks that aim to coordinate patient care better, such as Accountable Care Organizations (ACOs). If the providers are in your plan’s network, there is no extra cost to get care through a medical home. Medical homes can be good for many types of patients. They may be especially helpful for patients who need ongoing care, like those with chronic health problems such as asthma, heart failure or diabetes.

One key goal of a medical home is giving “patient-centered care.” That means working closely with you and your family to make sure you have a say in your treatment.

If you do not know whether you are already in a medical home, ask your PCP. If you would like to join one, ask your insurer for a list of medical homes in the plan’s network. Or, look here for providers in your state who meet the PCMH standards of the National Committee for Quality Assurance (NCQA).

A medical home, also known as a patient-centered medical home (PCMH), is a program or type of doctor’s practice that uses a team to focus on the “whole person.” Everyone involved in your care works together to keep you physically and mentally healthy, and to develop a complete, personalized plan for your care. A medical home practice is often run by one or more primary care physicians such as pediatricians, family practitioners or internists, although some may be run by nurse practitioners. These healthcare professionals lead a team that coordinates your physical and mental health needs, such as preventive screenings, vaccinations, hospital stays and even social services.

One important goal of a medical home is “patient-centered care.” That means working closely with you and your family to make sure you have a say in your treatment. If you receive care through a medical home, you may have regular, ongoing communication from your providers, and access to someone from your care team outside of office hours. Medical homes are also committed to providing care that is comprehensive, coordinated, accessible and committed to quality and safety. They are similar to other health networks that aim to better coordinate patient care, like Accountable Care Organizations (ACOs) and “medical neighborhoods” (which can include specialists such as surgeons and oncologists). Medical homes are like ACOs, but on a smaller scale.

A medical home isn’t a type of health plan or a special kind of “home.” It’s just a different way of organizing your care. You can ask your doctor if his or her practice is a medical home, or look for providers in your state that are nationally recognized for meeting PCMH standards.

What does “coordinated care” mean?

Coordinated care means that everyone in the medical practice knows your medical history and treatment plan. In some cases, your medical information will be stored in a personal electronic health record that you and your doctors and other healthcare professionals can share, so everyone has a complete picture of your health. Ideally, your providers will know what tests and services you’ve had. That way, you won’t get the same screening twice, or have a bad reaction to a drug because a doctor didn’t know your medical history. They will also know if you’ve been getting the preventive care you need, like immunizations for the flu, or regular blood tests if you have diabetes.

Who provides my care at a medical home?

Your healthcare team is led by your primary physician, who works with other healthcare professionals, providers and specialists to coordinate your care. There may also be a designated patient care coordinator, such as a nurse or social worker, who contacts you and keeps track of the care you receive. Other members of your team could include specialists, nurse practitioners, physician assistants, behavioral health professionals, pharmacists, physical and occupational therapists, dietitians or nutritionists. Some specialists, like oncologists or surgeons, also can establish medical homes and serve as the “neighbors” for a primary care practice when a patient needs more complex care.

Who should have a medical home?

While medical homes can benefit many types of patients, they may be especially helpful for patients who need ongoing care, like those with chronic conditions such as asthma, heart failure or diabetes. Some groups with special care needs, like individuals with disabilities, the elderly, or children may also benefit from a medical home.

How much does care at a medical home cost?

There should be no extra cost for using a medical home practice, as long as your doctor is in your health plan’s network. You should still have the same premium, copayments and deductibles. The only difference is that a team of providers will coordinate your care.

Where can I find a medical home?

You may be assigned or referred to a medical home when you visit your primary care physician or emergency room. You also may visit a primary care practice without knowing that the practice is a medical home. If you would like to have your care coordinated by a medical home, ask your doctor, or look for providers in your state that meet PCMH standards by the National Committee for Quality Assurance (NCQA) here. You also can ask your insurer whether there are medical homes that would be available to you in your plan network.

Your Action Plan: Be Informed

If you would like to have your care coordinated by a medical home, find out if you already are getting care from one by asking your primary care physician. Remember, it is always a good idea to ask!
If you are not currently getting care from a medical home, ask your doctor or insurer whether there are medical homes available to you in your plan network.
You also may find providers in your state that meet medical home standards by the NCQA here.

Remember, you are your own best advocate, so ask if there is anything you do not understand!