Abstract
The medical home has been widely promoted as a model of primary care with the potential
to transform the health care delivery system. Although this model was initially focused
on children with chronic conditions, the American Academy of Pediatrics has endorsed
a generalization of the model, promoting the statement, “Every child deserves a medical
home.” Recently, other major professional and governmental organizations have embraced
this more inclusive vision, and the medical home concept has been promoted in provisions
of the Affordable Care Act. Yet, rigorous evaluations of the value of the medical
home, within pediatrics and beyond, have been limited, and the results have been mixed.
Early results from large demonstration projects in adults have generally noted modest
improvements in quality without accompanying reductions in cost. At this critical
period in health care, with widespread interest in health care delivery and payment
reform, these results present a potential threat to the medical home. Understanding
possible reasons for these early findings is crucial to sustaining the spread of the
medical home beyond its first 50 years. With this aim, we review the history of the
medical home and trends in child health, and we explore the concepts of value and
complexity as they pertain to pediatric health care delivery. We propose that, because
of the demographic characteristics and economics of child health and current policy
imperatives with regard to health care, a strong value proposition for the medical
home in pediatrics involves children with medical complexity.
Keywords
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Article Info
Publication History
Published online: April 27, 2017
Accepted:
April 9,
2017
Received:
December 13,
2016
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2017 by Academic Pediatric Association
