The Patient Protection and Affordable Care Act, which is also known as Obamacare, repeatedly identifies medical homes, which are also called health homes, as innovative models for ensuring the neediest patients receive the highest quality health care in the most timely and efficient ways, and at the lowest cost. Like Accountable Care Organizations, medical homes allow doctors, pharmacists, social workers, dietitians and counselors to coordinate their services for and share information about patients.
The medial home model was first codified at the federal level in the Tax Relief & Health Care Act of 2006. That law required the Centers for Medicare and Medicaid Services to fund demonstration projects "to provide targeted, accessible, continuous and coordinated care to Medicare beneficiaries with chronic or prolonged illnesses requiring regular medical monitoring, advising or treatment."
Pharmacists on Medical Home Health Teams
Section 3502 of the PPACA states that CMS can only recognize medical homes that ensure Medicare and Medicaid beneficiaries have access to an interdisciplinary health team. While the law suggests that a medical home health team may include pharmacists, it also specifies that medical home patients have access to pharmacy services.
Medical home services explicitly listed in the Obamacare law include
- Pharmacist-provided medication therapy management.
- Medication reconciliation upon admission to a hospital or long-term care facility.
- Medication reconciliation at discharge from a hospital or LTC.
- Follow-up monitoring of medication therapy outcomes and patient adherence after transitioning from a health care facility to home.
CMS regulations and guidance for Medicaid medical homes -- the agency prefers the term “health homes” -- clarify that health teams must include pharmacists. Naturally then, community, hospital and consultant pharmacists have integral roles to play within medical homes. As researchers noted in the May 2010 Health Affairs, "Pharmacists are often underused … . They perform comprehensive therapy reviews of prescribed and self-care medications, resolve medication-related problems, optimize complex regimens, design adherence programs and recommend cost-effective therapies."
Each national, and most state, pharmacist associations offer online information on how pharmacy professionals can integrate themselves into medical home health teams.
Who ‘Lives’ in Medical Homes?
Under the PPACA, medical homes are intended primarily for Medicaid beneficiaries who most require health care services. On its Medicaid Health Homes webpage, CMS explains that the "organizations should offer comprehensive care management, care coordination, health promotion, comprehensive transitional care and follow-up, patient and family support, and referral to community and social support services."
The agency also limits medical home enrollment to patients who have
- Two or more chronic conditions such as diabetes or HIV/AIDS, or
- One chronic condition and risk for a second, or
- One serious and persistent mental health condition such as addiction or schizophrenia.
The federal government normally covers half (or a little more) of the costs of the medical treatments, medications and counseling services Medicaid beneficiaries. For patients enrolled in medical homes, CMS covers 90% of those costs for the first two years the organization operates.