Why is Medical Home Important?

Since the 1960s, the medical home has evolved from a place to store medical records for children with special health care needs to the standard of care for all children and youth, particularly those with special needs.

Over the last 40 years, multiple national, state, and local organizations have conducted and published research that shows evidence in support of the pediatric medical home approach to care. These studies show an association between access to and utilization of pediatric medical homes to improved health outcomes for the population, increased satisfaction for children and families, and decreased cost of care.

The implementation of the Affordable Care Act in 2010 further encouraged the uptake of the pediatric medical home model by individual practices, large health care organizations, hospitals, states, and public and private payers.

Research shows that the medical home model is associated with a reduction in health care costs. This is evident in part through decreased utilization of unnecessary services such as visits to the emergency department and in-patient hospitalization stays.^1,2 For the pediatric population, evidence shows an association between access and utilization of a medical home to the following:

• Decreased hospitalizations, including days spent at the hospital^3,4,5
• Decreased visits to the emergency department^5,6,7
• Less out-of-pocket spending from families, particularly those with public insurance⁸
• Lower Per Member Per Month (PMPM) costs⁷
  

View the "References" section of this Web page for bibliography.

Access to a pediatric medical home is associated with increased quality of care, improved health outcomes, and decreased unmet medical needs for children and youth, including children and youth with special health care needs. Research shows that access to and utilization of a pediatric medical home is associated with the following:

• Increased provision of preventive services for children, such as the following:

• Increased likelihood of having anticipatory guidance provided⁹
• Increased likelihood of being seen by a primary care clinician within the last year⁴
• Increased rates of childhood immunizations^10,11
• Increased rates of well-child visits¹⁰
• Increased likelihood to have had height, weight, and blood pressure checked⁹

• Decreased amount of outpatient sick visits¹⁴
• Decreased rate of inappropriate use of antibiotics^7,15
• Improved health outcomes and health status¹⁶

^{View the "References" section of this Web page for bibliography.}

Family-centered care is a key component of the medical home model. For pediatric populations, family-centered care is particularly important, given that families are the primary caregivers for children and youth. Research has shown that access to a clinical practice that is implementing family-centered care has positive impacts on family satisfaction. Research findings include the following:

• Increased family satisfaction and positive parental experiences¹⁷
• Increased ability for families' to meet day-to-day demands of parenthood¹⁸
• Decreased missed workdays for families¹⁹
• Decreased parental worry, increased family feedback⁴

^{View the "References" section of this Web page for bibliography.}

1. Nielson M, Gibson A, Buelt L, Grundy P, Grumbach K. The Patient-Centered Medical Home's Impact on Cost and Quality: Annual Review of Evidence 2013-2014. The Patient-Centered Primary Care Collaborative Publication, January 2015.
2. Nielsen M, Langner B, Zema C, Hacker T, Grundy P. Benefits of Implementing the Primary Care Patient-Centered Medical Home: A Review of Cost & Quality Results. The Patient- Centered Primary Care Collaborative Publication, 2012.
3. Gordon J, Colby H, Bartelt T, Jablonski D, Krauthoefer M, Havens P. A Tertiary Care-Primary Care Partnership Model for Medically Complex and Fragile Children and Youth with Special Health Care Needs. Arch Pediatr Adolesc Med. 2007;161(1):937-944.
4. McAllister J, Sherrieb K,  Cooley C. Improvement in the Family-Centered Medical Home Enhances Outcomes for Children and Youth With Special Healthcare Needs. J Ambulatory Care Manage. 2009; 32(3):188-196.
5. Mosquera R, Tyson J. An Enhanced Medical Home Providing Comprehensive Care to High-Risk Chronically Ill Children: A Randomized Control Trial. Pediatric Academic Societies Annual Meeting. Washington DC. 2013
6. Long W, Auchner H, Sege R, Cabral H,  Garg A. The Value of the Medical Home for Children Without Special Health Care Needs. Pediatrics. 2012; 129:87-98.
7. Raskas R, Latts L, Hummel J, Wenners D, Levine H, Nussbaum S. Early Results Show WellPoint's Patient-Centered Medical Home Pilots Have Met Some Goals for Costs, Utilization, and Quality. Health Affairs. 2012; 31(9);2002-2009.
8. Porterfield S, DeRigne L. Medical Home and Out-of-Pocket Medical Costs for Children With Special Health Care Needs. Pediatrics. 2011;128(5):893-900
9. Romaire M, Bell J. The Medical Home, Preventive Screenings, and Counseling for Children: Evidence from the Medical Expenditure Panel Survey. Acad Pediatr. 2010;10(5):338-345
10. Cox J, Buman M, Woods E, Famakinwa O, Harris S. Evaluation of raising adolescent families together program: a medical home for adolescent mothers and their children. Am J Public Health. 2012; 102(10):1879-85.  
11. Smith P, Santoli J, Chu S, Ochoa D, Rodewald, L. The Association Between Having a Medical Home and Vaccination Coverage Among Children Eligible for the Vaccines for Children Program. Pediatrics 2005; 116 (130); 2004 - 1058
12. Strickland B, Singh G, Kogan M, et al. Access to the Medical Home: New Findings From the 2005 – 2006 National Survey of Children With Special Health Care Needs. Pediatrics 2009; 123(e996); 2008 – 2504
13. Lewis C, Robertson A, Phelps S. Unmet Dental Care Needs Among Children With Special Health Care Needs: Implications for the Medical Home. Pediatrics. 2005;116(3):e426-32
14. Long W, Auchner H, Sege R, Cabral H, Garg A. The Value of the Medical Home for Children Without Special Health Care Needs. Pediatrics. 2012; 129:87-98.
15. DeVries A, Winnie C, Sridhar G, Hummel J, Bredbart S, Barron J. Impact of Medical Homes On Quality, Healthcare Utilization, and Costs. The American Journal of Managed Care. 2012;18(9):534-544)
16. Homer C, Klatka K, Romm D, et al. A Review of the Evidence for the Medical Home for Children with Special Health Care Needs. Peditarics. 2008; 122(4): e922 – e9
17. Hamilton L, Lerner C, Presson A, Klitzner T. Effects of a Medical Home Program for Children with Special Health Care Needs on Parental Perceptions of are in an Ethnically Diverse Patient Population. Matern Child Health J. 2013;17(3):463-9.
18. Dummond A, Looman W, Phillips A. Coping Among Parents of Children With Special Health Care Needs With and Without a Health Care Home. 2011; 26(4):266-275
19. Kuhlthau K, Bloom A, Van Cleave J, et al. Evidence for Family-Centered Care for Children With Special Health Care Needs: A Systematic Review. Academic Pediatrics 2011; 11(2): 136-143