The Medical Home encompasses five functions and attributes.
The primary care medical home is accountable for meeting the large majority of each patient’s physical, oral, and mental health care needs. This includes prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. This integrated healthcare team might include physicians, advanced practice nurses, physician assistants, nurses, dentists, hygienists, pharmacists, nutritionists, social workers, behavioral health counselors, educators, case managers and care coordinators.
The primary care medical home provides primary health care that is relationship-based with an orientation toward the whole person. Partnering with patients and their families requires understanding and respecting each patient’s unique needs, culture, values, and preferences.
The primary care medical home coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. FHN functions most effectively as a medical home when patients/families provide a complete medical history and information about care obtained outside the practice.
The primary care medical home delivers accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication such as email and telephone care.
Quality and Safety
The primary care medical home demonstrates a commitment to quality and quality improvement by ongoing activities such as using evidence-based medicine and clinical decision-support tools to guide shared decision making with patients and families.