The state of California will be implementing section 2703 of the Affordable Care Act in 2017.  Section 2703 defines the Health Homes Program (HHP) for Medicaid members in our state.  Most of us have heard the term, the Patient Centered Medical Home, and although Health Homes is new, the origins of the Health Homes Program goes back several decades.

The “Medical Home” was first defined by the American Academy of Pediatrics in 1967. The Standard of Child Health Care envisioned “one central source of a child’s pediatric records to resolve duplication and gaps in service that occur as a result of lack of communication and coordination.”  A few years later, the AAP issued a policy statement, “The Medical Home” (Pediatrics 1992;90:774), that proposed the pediatric practice as an Accessible, Continuous, Comprehensive, Family-centered, Coordinated and Compassionate place for the care of infants, children and adolescents to provide:

• Preventive care and immunizations
• Health screening and assessments of growth and development
• Patient and parental counseling about health and psychosocial issues
• Care over an extended period of time to enhance continuity
• Interaction with school and community agencies so that health needs are met
• Centralized records and enhanced communication

In 2002, the AAP added Culturally Effective to the definition and recommended that the care be “delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care.”

The key concepts of the medical home as envisioned by the AAP are preventive care, screening, counselling, continuity over time, interaction with the community and enhanced communication.  Two years later, the American Academy of Family Physicians, in the Future of Family Medicine project continued the evolution of the health home when they proposed the “Personal Medical Home” to provide continuous healing relationships, care customized to patient needs and values, the free flow of information, cooperation among clinicians and safe, timely, effective and equitable patient centered care.

The Patient Centered Medical Home (2006) was a joint statement by the AAP, AAFP, ACP and the AOA that added whole person orientation, coordinated care, quality and safety to the medical home. The Department of Health Services and the CMS Federal Work Group became involved and added coordination of medical and social services across the lifespan in 2008. Then, in 2009, in recognition that patients primarily receiving behavioral health care are often disconnected from medical care, SAMHSA added the integration of community based behavioral health care and medical care into the medical home definition.

All of these refinements came together with the Affordable Care Act in 2010.  Section 2703 of the ACA created the Medicaid Health Home program to coordinate the full range of physical and behavioral health services, community support services and long term supportive care with enhanced coordination of medical and behavioral health in a whole person philosophy of care.  The guiding principles and goals for the health homes program are to:

• Improve care coordination
• Strengthen community care linkages
• Offer team based care including community health workers
• Improve health outcomes for members with high risk chronic diseases
• Integrate physical and behavioral health issues
• Integrate palliative care into primary care delivery
• Recognize and respond to trauma informed care needs
• Improve medical care to homeless members
• Improve integration and treatment of patients with substance abuse disorder

PHC will be implementing the HHP program for our members in 2017.  PHC has been providing intensive care management in many of our FQHCs through an Intensive Out-Patient Care Management (IOPCM) program since 2012.  All of these IOPCM sites will transition to the health home concept next year.  Health Home sites will work to provide a multi-disciplinary approach for our members with increased use of health navigators and improved connections with community based resources to enhance the care of our most challenging health plan members