135.158 - MEDICAL HOME PURPOSES -- CHARACTERISTICS.
135.158 MEDICAL HOME PURPOSES -- CHARACTERISTICS.
1. The purposes of a medical home are the following:
a. To reduce disparities in health care access, delivery, and
health care outcomes.
b. To improve quality of health care and lower health care
costs, thereby creating savings to allow more Iowans to have health
care coverage and to provide for the sustainability of the health
care system.
c. To provide a tangible method to document if each Iowan has
access to health care.
2. A medical home has all of the following characteristics:
a. A personal provider. Each patient has an ongoing
relationship with a personal provider trained to provide first
contact and continuous and comprehensive care.
b. A provider-directed medical practice. The personal
provider leads a team of individuals at the practice level who
collectively take responsibility for the ongoing health care of
patients.
c. Whole person orientation. The personal provider is
responsible for providing for all of a patient's health care needs or
taking responsibility for appropriately arranging health care by
other qualified health care professionals. This responsibility
includes health care at all stages of life including provision of
acute care, chronic care, preventive services, and end-of-life care.
d. Coordination and integration of care. Care is coordinated
and integrated across all elements of the complex health care system
and the patient's community. Care is facilitated by registries,
information technology, health information exchanges, and other means
to assure that patients receive the indicated care when and where
they need and want the care in a culturally and linguistically
appropriate manner.
e. Quality and safety. The following are quality and safety
components of the medical home:
(1) Provider-directed medical practices advocate for their
patients to support the attainment of optimal, patient-centered
outcomes that are defined by a care planning process driven by a
compassionate, robust partnership between providers, the patient, and
the patient's family.
(2) Evidence-based medicine and clinical decision-support tools
guide decision making.
(3) Providers in the medical practice accept accountability for
continuous quality improvement through voluntary engagement in
performance measurement and improvement.
(4) Patients actively participate in decision making and feedback
is sought to ensure that the patients' expectations are being met.
(5) Information technology is utilized appropriately to support
optimal patient care, performance measurement, patient education, and
enhanced communication.
(6) Practices participate in a voluntary recognition process
conducted by an appropriate nongovernmental entity to demonstrate
that the practice has the capabilities to provide patient-centered
services consistent with the medical home model.
(7) Patients and families participate in quality improvement
activities at the practice level.
f. Enhanced access to health care. Enhanced access to health
care is available through systems such as open scheduling, expanded
hours, and new options for communication between the patient, the
patient's personal provider, and practice staff.
g. Payment. The payment system appropriately recognizes the
added value provided to patients who have a patient-centered medical
home. The payment structure framework of the medical home provides
all of the following:
(1) Reflects the value of provider and nonprovider staff and
patient-centered care management work that is in addition to the
face-to-face visit.
(2) Pays for services associated with coordination of health care
both within a given practice and between consultants, ancillary
providers, and community resources.
(3) Supports adoption and use of health information technology
for quality improvement.
(4) Supports provision of enhanced communication access such as
secure electronic mail and telephone consultation.
(5) Recognizes the value of provider work associated with remote
monitoring of clinical data using technology.
(6) Allows for separate fee-for-service payments for face-to-face
visits. Payments for health care management services that are in
addition to the face-to-face visit do not result in a reduction in
the payments for face-to-face visits.
(7) Recognizes case mix differences in the patient population
being treated within the practice.
(8) Allows providers to share in savings from reduced
hospitalizations associated with provider-guided health care
management in the office setting.
(9) Allows for additional payments for achieving measurable and
continuous quality improvements. Section History: Recent Form
2008 Acts, ch 1188, §45
Referred to in § 135.157