Talking the Legislative Talk: The Patient-Centered Medical Home
===============================================================

* Jerry Kruse

Recent commentaries in *The Annals of Family Medicine* summarize evidence that care delivered by an adequate workforce of family physicians in the context of a pervasive network of Patient-Centered Medical Homes is a powerful mechanism to improve healthcare outcomes and lower costs in the United States. These commentaries also describe characteristics of systems of healthcare and medical education which pose barriers to the development of such a workforce and the delivery of such care.1–3

Over the past 15 months, members of Congress have abruptly given greater attention to this message. On September 28, 2006, the Patient-Centered Medical Home (PC-MH) was the focus of testimony to the Subcommittee on Health of the House Energy and Commerce Committee, which has principle jurisdiction over Medicare physician payment policy. Subcommittee chair, Rep Nathan Deal of Georgia, expressed support for legislation that creates incentives (such as per-member, per-month care coordination fees and lower out-of-pocket expenses for patients) that support practices that establish lasting relationships between patients and physicians in the context of a PC-MH. His committee’s consensus support has touched off a series of pilot tests of the PC-MH, and Representative Deal himself has been characterized as a “champion, advocate, and defender” of the PC-MH as a centerpiece concept for healthcare reform.

Senator Dick Durbin of Illinois is sponsor and Sen Richard Burr of North Carolina is cosponsor of legislation, The Medical Homes Act of 2007, in which the PC-MH is the focal point and which contains specific language to authorize Medical Home Demonstration Projects. The following comment by Senator Durbin is representative of a greater awareness among legislators of the importance of the PC-MH: “At a time when both healthcare costs and chronic illnesses are on the rise, we need a better way to provide care that is accessible, comprehensive, coordinated, and cost effective,” said Durbin. “The Medical Homes Act of 2007 would make federal funding available for states to provide care to our nations most vulnerable—low income children and families. The Medical Home model can reduce costs and improve quality of healthcare services for every person in America.”

It is now time for all family physicians to act on this groundswell of support in Congress for the PC-MH. On March 5, 2007, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association published a document entitled *Joint Principles of the Patient-Centered Medical Home.* This document articulates both evidence-based principles of the effective PC-MH and a vision for care that will improve outcomes through quality improvement initiatives and health information technology. In dialogue with legislators, family physicians should use the term Patient-Centered Medical Home when describing their practice, and should clearly convey the elements contained in this document. The document and a commentary can be found in *The American Family Physician.*4,5

Family physicians can best seize this great opportunity by regular communication with their senators, representatives, and state legislators. This is accomplished when family physicians develop lasting personal relationships with legislators and become the legislators’ customary source of advice for healthcare issues. Family physicians must articulate compelling stories about care in the context of the PC-MH, and must also provide concise information in communication with legislators. One example of concise information which describes the PC-MH, provides a bibliography of its effectiveness, and can be used in discussions with legislators is a brochure entitled *Primary Care: A Miracle of Modern Medicine.*6 Useful information is also provided in a scientific review7 and by The Commonwealth Fund.8

The importance of a common language and unified voice cannot be overemphasized. As legislators are poised to implement healthcare reform, they should clearly understand the meaning of the words Family Physician, Family Medicine, and Patient-Centered Medical Home. These words should be heard over and over again as we advocate for legislation that supports a system of accessible, effective healthcare for all Americans, and rewards research and educational programs that promote such a system.

*   © 2007 Annals of Family Medicine, Inc.

## REFERENCES

1.  Kruse J. Family medicine legislative advocacy: our powerful message. Ann Fam Med. 2005;3(5):468.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMy81LzQ2OCI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vNS82LzU2Ni5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Kruse J. Saving Medicare: “It’s the workforce, stupid”. Ann Fam Med. 2006;4(3):274.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzI3NCI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vNS82LzU2Ni5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.  Freeman J, Kruse J. Title VII: Our loss, their pain. Ann Fam Med. 2006;4(5):465.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC81LzQ2NSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vNS82LzU2Ni5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

4.  Kellerman R, Kirk L. Principles of the patient-centered medical home. Am Fam Physician. 2007;76(6):774.
    
    [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=17910291&link_type=MED&atom=%2Fannalsfm%2F5%2F6%2F566.atom) 
    
    [Web of Science](http://www.annfammed.org/lookup/external-ref?access_num=000249645400007&link_type=ISI) 

5.  Kruse J. Improving care with the patient-centered medical home. Am Fam Physician. 2007;76(6):775.
    
    [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=17910292&link_type=MED&atom=%2Fannalsfm%2F5%2F6%2F566.atom) 

6.  UCSF Center for Excellence in Primary Care. [http://www.ucsf.edu/cepc](http://www.ucsf.edu/cepc).
    
    

7.  Starfield B, Shi L: The medical home, access to care, and insurance: a review of the literature. Pediatrics. 2004;113(5 Suppl):1493–1498.
    
    [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=15121917&link_type=MED&atom=%2Fannalsfm%2F5%2F6%2F566.atom) 
    
    [Web of Science](http://www.annfammed.org/lookup/external-ref?access_num=000221195600006&link_type=ISI) 

8.  Beal AC, Doty MM, Hernandez SE, Shea KK, Davis K. Closing the divide: how medical homes promote equity in health care: results from The Commonwealth Fund 2006 Health Care Quality Survey. The Commonwealth Fund. June 2007. [http://www.commonwealth-fund.org/publications/publications\_show.htm?doc\_id=506814](http://www.commonwealth-fund.org/publications/publications_show.htm?doc_id=506814).