es and potentially share in the rewards for
doing so. Some medical home practices are
even eyeing at-risk payment contracts.
Volpe describes the emerging care deliv-
ery model this way: “A medical home is like
a real home,” he explains. “If you live in a
home, everyone cares about everyone else.
Everyone in the home pitches in to make
sure everyone succeeds. You migrate that
idea to the physician office. So the front
desk isn’t brusque with people and the staff
asks patients about their families, about the
daughter who just went to college.”
But the bar is set pretty high for practices
trying to earn medical home designation.
Attaining medical home status the Nation-
al Committee for Quality Assurance—the
industry’s gold standard, one recognized
by both CMS and commercial payers—re-
quires meeting not only hefty I. T. require-
ments but upending traditional staff roles
to boot. Those I. T. requirements include an
EHR as an absolute prerequisite for more
sophisticated versions of the model, with a
patient portal, data exchange, and analyti-
cal capabilities running a close second.
In many ways, the medical home is the
industry’s testing ground for a connected
industry. Physicians who embrace it say
they can meet the so-called “triple aim”
goals touted by the federal government of
better care, better access and better out-
comes.
Humble beginnings
Although versions of the medical home
date to the late 1960s (the American Acad-
emy of Pediatrics introduced the term in
1967), many point to 2008 as the year when
the idea began to gel. That’s when NCQA
launched its patient-centered medical
home recognition program, a status which
serves as the industry seal of approval. The
early iteration of the program required no
EHR, but subsequent versions did, says
Mina Harkins, assistant vice president, rec-
ognition programs, at Washington, D.C.-
based NCQA. “Primary care is the focus,
internal and family medicine,” she says.
“It’s not for specialties. We are focused on
a practice that is treating the whole per-
son with both preventive care and chronic
care.”
To date, just over 4,900 group prac-
tices—encompassing 23,000 physicians,
physician assistants and advanced nurse
practitioners—have attained NCQA recog-
nition as a medical home.
Laying the foundation
Making the medical home model work re-
quires a number of moving I.T. parts: An
EHR is foundational, but practices mov-
ing into the medical home space find they
need assorted bolt-on technologies to
succeed. That’s the case at Elmhurst (Ill.)
Clinic, a 100-physician multi-specialty
group practice. The practice garnered Lev-
el III recognition for five of its primary care
sites in 2008 (the recognition is site-spe-
cific), representing about 35 physicians,
says Donald Lurye, M.D., CEO. It uses an
EHR from NextGen. Although the medi-
cal home status only applies to its primary
care sites, being a multi-specialty group on
a common EHR platform is an advantage,
particularly when it comes to the tracking
of referrals and follow-ups with specialists
that is a key element of the model, he says.
“With a common medical record, if I send
you to the surgeon he can look up your
chart and see my concerns,” Lurye says.
“Often specialists are unclear as to why a
patient is there to see them. Here it’s much
smoother.”
Elmhurst Clinic has added on other I. T.
tools to assist with the model. It uses an
automated appointment reminder system,
from Phytel, which scours the practice’s
scheduling system and provides HIPAA-
compliant phone call reminders. The Phytel
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