Medical Home Monitor
Medical Home Monitor
May 19, 2008
Vol. I, No. 2

Medical Home Monitor Archives

Medical Home Q&A:
Medical Home

Medical Home Monitor

Q: How can a physician practice measure improvement outcomes resulting from the medical home?

A: In a primary care practice, quality improvement and many of the advanced medical home metrics must be done through process improvement. The practices set goals up front and measure their performance over time against those goals. We generate reports through either the electronic record that they’re using or with an electronic disease registry. (Dr. Lonnie E. Fuller Jr., medical director for Pennsylvania's Medicaid ACCESS Plus PCCM-DM Program.)

For more information on this topic, please visit:

AMA Submits Recommendations for Medicare
Medical Home Demo

Responding to a request from the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA) Specialty Society Relative Value Scale Update Committee (RUC) has submitted recommendations on the CMS Medicare medical home demonstration project that begins January 1, 2009. The RUC recommends G code descriptors for reporting of Tier 1 (entry level), Tier 2 (typical) and Tier 3 (optimal) medical homes, as well as tier-specific physician time and work relative values (RVU), staff competencies and time, and medical supplies and equipment (including EMRs). The demonstration project was mandated by the Tax Relief and Healthcare Act of 2006, which also required that CMS seek the RUC’s advice in valuing the project.

To download a copy of the recommendations, please visit:

HealthSounds Podcast: Communication, Case Managers Vital to Medical Home Success

Provider toolkits, patient diabetes action plans and case managers were integral components in Community Care of Eastern North Carolina's diabetes medical home project, which saved North Carolina $231 million in healthcare costs in 2005 and 2006. Roberta Burgess, nurse case manager for Community Care Plan through Heritage Hospital in Tarboro, N.C., provides details in this audio interview.

To listen to this complimentary HIN podcast, please visit:

Free Medical Home Assessment Tool Helps Medical Practices Gauge Progress

Medical practices working on becoming medical homes now can measure their progress with a free Medical Home Implementation Quotient (MHIQ) assessment tool from TransforMED, a practice redesign initiative affiliated with the American Academy of Family Physicians (AAFP). The MHIQ online program guides users through eight modules, each asking between 13 and 30 questions about a practice's progress in areas such as access to care and information, practice management, team-based care, point of care, continuity of care, patient safety and more.

For more information, please visit:

The Medical Home's Effect on Unnecessary ED Utilization

Medical homes figure prominently in emergency department (ED) redirection proposals from seven of 20 states recently granted $50 million in CMS funds. These states, which received funding for ED redirection programs for Medicare beneficiaries, join hospitals and health plans nationwide that are working to reduce reliance on EDs for non-emergent care. HIN conducted a non-scientific online survey in July 2007 and discovered how 220 organizations including hospitals, physician organizations, health plans and more respond to the issue of non-emergent ED use.

To download this complimentary white paper, please visit:

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