Medical homes can be a component within ACOs, but ACOs aren’t required to have formal medical homes, and medical homes can also exist outside of ACOs.
Unlike the old HMO gatekeepers, doctors running medical homes sometimes can get rewarded with extra payments if they meet certain standards and provide certain measures of quality care (such as keeping patients out of emergency rooms).
One key is accessibility, because many patients now have a hard time getting an appointment with a primary care doctor. Bernd Wollschlaeger, a family practice physician who operates the Aventura Family Health Center, has received a formal designation for his practice to be named a medical home. One requirement is that he offer extended hours to make it easier for working patients to see him: He’s generally in the office until 7 p.m. weekdays and for several hours on Saturdays.
“There’s a very stringent, very detailed list of requirements for a medical home,” Wollschlaeger says, particularly with providing coordinated care for people with chronic diseases, such as diabetes. “Providing quality care is the basic component.”
UM’s Ullmann says medical homes are particularly important for the uninsured, who tend to end up in expensive emergency room visits because they avoid primary care. The Miami-Dade Health Action Network, a coalition of healthcare leaders including Ullmann, is working to establish a system in which a single identification card could be used by each uninsured person in the county’s safety network providers, including Jackson and clinics that treat the poor.
The network’s idea is that such ID cards would be a major step in getting the uninsured into a medical home and an integrated system that could function like an ACO — in theory saving major sums for taxpayers.