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Implementing a medical home

ACP Senior VP Robert Doherty
ACP Senior VP Robert Doherty

By Christopher Guadagnino, Ph.D.

A wholesale change in the way that primary care is organized, delivered and reimbursed is being promoted by three primary care specialty societies, being tested in Pennsylvania and New Jersey, and gaining clout in the form of a federal demonstration project.

The American College of Physicians (ACP), the American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) have each called for significant practice redesign to improve patient-centered, preventive care, while the ACP and AAFP warn that such reform is needed to redress a perilous future for primary care: a worsening shortage of physicians entering primary care, inequities and inefficiencies in the health care delivery and reimbursement system, and care fragmentation that threatens to escalate costs and impede quality improvement.

The three specialty societies are calling for systemwide implementation of a concept known as medical home, entailing a set of fundamental changes in doctor-patient relationship and care delivery infrastructure, accompanied by reimbursement reform to support those changes.

Central to the medical home approach is the premise that truly patient-centered care requires a fundamental shift in the relationship between patients and their primary care physicians, who must help their patients navigate a fragmented health care system by forging a much higher level of personalized care coordination and access – e.g., taking the time to learn their health-related needs beyond an acute care episode, making the practice’s resources more readily available to them, identifying key medical and community resources to meet their needs, and following up closely to ensure those needs are met. Fundamental to the model is a population-based approach to care management, ideally facilitated by an electronic medical record infrastructure, to identify patients with chronic care and other special needs, and facilitate more proactive care management than is typically seen in the current system.

Selected physician practices in Pennsylvania and New Jersey are implementing the medical home concept as participants in the AAFP’s nationwide demonstration project called TransforMED, while the Pa. and New Jersey chapters of the AAP are also supporting medical home implementation in their states. A Medicare medical home demonstration project was mandated by Federal legislation passed in December, which includes care coordination and quality improvement payment components on top of fee-for-service reimbursement – a feature deemed by the three specialty societies to be essential to the success of the model.

Medical Home Rationale and Features

The three national specialty societies have been independently developing the medical home concept and are nearing a consensus on its essential features.

The concept originated with pediatricians, who see children frequently during their early years and are particularly well-positioned to provide comprehensive medical, developmental and behavioral care to their patients. The AAP in 1977 adopted a policy statement which declared that quality medical care is best provided when all the child’s medical data are together in one place, while in 1992 it offered a definition of medial home: primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. In 2002, the AAP fleshed out specific attributes of a medical home, e.g., that care should be physically and financially accessible to patients; facilitated by effective communication; and should extend beyond basic medical care to include educational, developmental, psychosocial and other needs.

The AAP’s National Center of Medical Home Initiatives for Children with Special Needs is currently offering mentorship guidance, educational resources and networking opportunities for physicians, communities and states to create access to medical homes on the state and local level.

In 2002, the leadership of seven national family medicine organizations initiated the Future of Family Medicine project, which was staffed by the AAFP and sought transformation of the discipline by promoting an integrated set of best practices rooted in the core values of continuing, comprehensive, compassionate and personal care for every American, who should have a personal medical home that serves as a focal point through which they receive acute, chronic and preventive medical care services.

The AAFP has launched a proof-of-concept medical home demonstration project called TransforMED with the participation of 36 family medicine practices around the country – including one each in Pa. and New Jersey – each of which have agree to implement a set of best practices identified by AAFP. The project will measure impacts of the model on patient satisfaction, quality of care, and practice efficiency and economics.

In January 2006, the ACP declared that the U.S. health care system is facing a collapse of primary care medicine: few new physicians are going into primary care and many of those currently in practice are leaving the field or are planning to retire in the near future; health care costs are continuing to grow faster than the economy; the Medicare Hospital Insurance Trust Fund will soon be insolvent and funding the remainder of the Medicare program is being accomplished through cutbacks in services, decreasing reimbursements to physicians, and passing premium increases along to beneficiaries; physicians are pressured to see more patients in less time, and are inundated with administrative paperwork and regulatory requirements; they have added pressure to stay current with an overload of information in a medical environment that is increasingly more technical and complicated; they struggle to keep their practices afloat in the face of declining revenues and increasing costs; and trusting relationships with patients have suffered as physicians and patients struggle with the financial and bureaucratic complexities of public and private insurance coverage issues.

The ACP released a set of policy papers touting a comprehensive strategy to redesign how primary care is taught, delivered and financed – including a national workforce policy for internal medicine, critical changes in undergraduate and graduate medical education and training, and reforms in physician payment and delivery systems – which it said must include paying physicians on a risk-adjusted, bundled and prospective basis for providing patient-centered care through a medical home, instead of paying doctors solely on the volume of services billed. The ACP called for a new model of patient care – the advanced medical home – which it said is based on the premise that the best quality of care is provided through patient-centered, physician-guided, cost-efficient, longitudinal care, designed to strengthen and support the patient-physician relationship.

The medical home concept envisioned by the AAP, AAFP and ACP is essentially the same, and the AAFP and ACP last July issued a consensus statement of Joint Principles of the Patient-Centered Medical Home, and are close to having the AAP and American Osteopathic Association sign on to the statement, according to Doug Henley, M.D., AAFP’s Executive Vice President.

Seven features define medical home, according to the joint statement:

· Personal physician. Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.

· Physician-directed medical practice. The personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.

· Whole person orientation. The personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals, including care for all stages of life, acute care, chronic care, preventive services and end of life care.

· Care is coordinated and/or integrated across all domains of the health care system (including hospitals, home health agencies, nursing homes and consultants); facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it.

· Quality and safety practice infrastructure including evidence-based medicine and clinical decision-support tools; continuous performance measurement and improvement with recognition by an appropriate non-governmental entity; active patient participation in decision-making and feedback; and information technology to support these activities.

· Enhanced access to care through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician and office staff.

· Payment appropriately recognizes the added value provided to patients. Payment should: reflect the value of physician and non-physician staff work that falls outside of the face-to-face visit, including remote monitoring of clinical data using technology, and enhanced communication access such as secure e-mail and telephone consultation; reimburse for care management and coordination services without reducing payments for face-to-face visits; support adoption and use of health information technology for quality improvement; recognize case mix differences in the practicepatient population; allow physicians to share in savings from reduced hospitalizations associated with their care management; and allow for additional payments for achieving measurable and continuous quality improvements.

“’Care that is managed and coordinated by a personal physician with the right tools will lead to better outcomes’ is the basic premise of the medical home concept,” according to Robert Doherty, ACP’s Senior Vice President of Governmental Affairs and Public Policy. “Many patients no longer have a single physician or a single site of care. Everyone should have such a relationship with a physician: managing their whole care – not just acute disease – with the appropriate tools and systems,” he adds.

A medical home is much more than a disease management program, most of which typically involve third party companies that hire case workers with little or no relationship to the physician’s practice and “historically have left the physician out of the equation, other than to sign a lot of forms, and have not necessarily led to better care or lower costs,” says Henley. The medical home re-inserts the physician back into the equation to manage chronic diseases by coordinating care, communication and information-sharing among all the physicians and non-physician that a patient may see across medical specialties and community resources, he notes.

The medical home is based on the chronic care management model, and is particularly helpful for patients with multiple chronic conditions, whose care can be especially fragmented as they see multiple specialists without having someone closely monitor how that care comes together, says Doherty. But the medical home is applicable to everyone, as even healthy patients can benefit from a single site of integrated health care; there are a variety of age-appropriate medical screenings needed throughout a person’s life; and anyone can develop a chronic condition – deserving the best system in place to intervene early and manage it, says Henley.

Medical Home Impacts

There is a large body of evidence that patients with personal primary care physicians have better outcomes for lower costs, says Doherty, who cites a Dartmouth Health Atlas report that higher ratios of primary care physicians to Medicare population, and primary care physicians to non-primary care are positively associated with fewer ICU and hospital admissions, lower mortality rates, and decreased health care utilization and spending.

Even a very basic medical home model can achieve cost savings and quality enhancement, says Henley, who cites North Carolina’s Primary Care Case Management Medicaid program, in which every patient is matched with and given 24/7 access to a primary care physician, along with locally-based disease management and nurse educator support that is integrated with the physician practice. For an additional annual cost to the state of $15 million to $20 million – some of which goes to per-patient-per-month care coordination fees to physicians on top of their Medicaid fee-for-service reimbursement – the program has improved the outcomes of diabetes and asthma care, while saving the state between $200 million and $220 million per year in health care costs, adds Henley.

The medical home approach goes further by equipping primary care physicians with tools such as patient registries to promote a population-based approach to care management – sorting patients by chronic disease and condition and targeting specific interventions to specific populations, and by coordinating a team of caregivers and community support for focused, comprehensive and effective quality improvement, says Melinda Abrams, M.S., Senior Program Officer of Child Development and Prenatal Care Program, and Patient-Centered Primary Care Program Director of the Commonwealth Fund.

U.S. and international studies of the medical home model, analyzed by Johns Hopkins University School of Public Health researcher Barbara Starfield, M.D., MPH in a 2004 Pediatrics article, indicate that a relationship with a medical home is associated with better health on the individual and population levels, with lower overall costs of care and with reductions in hospitalization and specialty referral disparities between socially disadvantaged and advantaged populations.

There is also a body of research evidence showing that patients’ perception of their care affects their clinical outcomes, for example, hypertension and diabetes patients who report they have received collaborative patient-centered care fare better and are more likely to adhere to a medication regimen, says Abrams. A better patient experience is also associated with fewer medical malpractice claims, she adds.

The enhanced access component of the medical home has the potential to accommodate many non-emergent patients who otherwise would have gone to the emergency room after normal business hours, or to a community health center that might be crowded and resource-depleted, or to a non-physician at a retail-based health clinic, says ACP President Lynne Kirk, M.D. Not to be confused with a gatekeeper model, a medical home reduces barriers and facilitates the ability for patients to get the right care at the right time, she notes. The medical home could provide the level of service offered by concierge or retainer-based medical practices, but could make it available to all persons, without the high fee typically associated with that type of practice, Kirk adds.

The ACP hopes to track the impact of medical home demonstration projects on physician workforce capacity, which Kirk says could take various forms: a practice’s overall patient capacity could be reduced because of the additional care coordination activities; patients might require fewer physician office visits because of enhanced care management or group visit innovations; the supply of physicians could increase if the medical home model attracts more residents to primary care specialties, and physician training programs incorporate medical home concepts into their curriculum.

Significant obstacles remain in the way of realizing the promise of medical homes, including its time-consuming care coordination services that remain unreimbursed by insurers, and the fundamental tenet of the model that people have a regular source of care, says Abrams. Thirteen percent Americans did not have a usual source of care in 2005, for a variety of reasons including lack of insurance coverage, frequent job changes and relocations; while more than half of Americans report that they have been seeing their doctor for less than five years, she adds. Medical home implementation can begin to address that obstacle, as patient-centered care research has shown that patients with fewer communication problems in their encounters with their physician are less likely to change their physician, says Abrams.

Federal Clout

A major boost to the medical home concept came last December when President Bush signed a law that among other things authorized a Medicare medical home demonstration project. The three-year project, for which specific implementation regulations still need to be worked out, will select from as many as eight states physician practices that will be required to:

· Implement a cross-discipline plan for ongoing medical care developed in partnership with patients and including all other physicians, medical personnel or agencies furnishing care to the patient.

· Use evidence-based medicine and clinical decision support tools to guide decision-making at the point of care.

· Use health information technology that may include remote monitoring and patient registries, to monitor and track the health status of patients, and to enhance the convenience of their access to health care services.

· Use education and support systems to encourage patients to engage in self-management of their health.

Participating physicians will continue to receive fee-for-service Medicare payments, and will be eligible for two additional payments: a care management fee for each patient under their care – to be determined through the relative value scale update committee process, and an additional bonus fee based upon Medicare part A and B quality improvement and cost reduction that is attributable to the medical home intervention (to be determined by comparison to a baseline).

Doherty says the demo project specifications lay down some important markers for the medical home concept: that physicians should be paid a care coordination component, that they should be allowed to share in the savings the model produces, and that the savings calculations break down the silos of Medicare Parts A and B – making the important acknowledgement that an increase in Part B physician spending can bring about significant reductions in Part A hospital costs, says Doherty.

Doherty says ACP plans to meet with the Centers for Medicare & Medicaid Services to discuss the project’s details and reimbursement structure, and would also like to see the medical home incentive structures applied to other programs, such as the State Children’s Health Insurance Program (SCHIP), and Medicare’s upcoming Physician Quality Reporting Initiative – in which physicians receive bonuses for reporting quality outcome measures starting this July. ACP would like CMS to revise that program and create tiered payment incentives for physician practices that acquire effective case management systems such as patient registries and electronic medical records, adds Doherty. ACP would also like the CMS to create incentives for states to put all Medicaid patients into medical homes – which Doherty says the Medicaid Commission recommended be done without the need for federal waivers.

The ACP is in discussions with employers and payors around the country about creating medical home pilot projects – with reimbursement enhancement components – to evaluate impacts of the medical home model, says Doherty. The ACP is also in the middle of a two-year pilot project – the Center for Practice Innovation – which is sharing programs, tools and lessons learned with 34 physician practices around the country to develop, test and disseminate practice redesign strategies for patient-centered and physician-guided models of care. The practices are testing clinical, operational and financial changes, including revamping clinical chart forms, implementing electronic medical records, reallocating functions among staff to promote more efficient office practices, and implementing practices such as group visits and electronic communication with patients.

State Level Implementation

Pilot practices for AAFP’s TransforMED national demonstration project were chosen from over 500 applicants, ranging in size from practices with seven or more physicians to solo practices, and although some have several medical home tools such as electronic health records in place already, others are starting from scratch, according to Terry McGeeney, M.D., MBA, President and CEO of TransforMED. The project launched last June and half of the 36 selected sites are undergoing facilitated implementation of the TransforMED model – receiving discounted software technology, training and consultation from experts in the areas of practice redesign and change management – while half are undergoing self-directed implementation, but have been very active on the project’s electronic message boards – arranging meetings and exchanging shared learnings, McGeeney notes.

Both groups will be compared to a control group not engaged in implementing the medical home model, and all demo sites will undergo assessment of patient satisfaction, physician and staff satisfaction, clinical process and outcome measures, and potential economic impact on practice revenues and physician income. A final report is expected in early 2009.

TransforMED’s specific goals, which McGeeney says involve more complex practice redesign features than the medical home concept, include having all practices:

· Implement electronic medical records.

· Operationalize patient registries and population management.

· Redesign medical office space – for example, to facilitate group visits.

· Expand open scheduling for office visits.

· Reduce medical errors.

· Improve coding and billing processes.

· Implement the medical team concept – including specific collaborative relationships with nurse managers and a tighter communication relationship with specialists.

· Realize and analyze process efficiencies – for example, how lab data is used, and how prescription refill requests are handled before being acted upon.

· Retain appropriate point-of-care services – for example, performing simple biopsies, lab work or X-rays in the office rather than referring them out and requiring a patient to go elsewhere for them.

· Work out call arrangements to reduce unnecessary ER utilization.

Reimbursement enhancements are not part of the TransforMED demo, and the project is studying the extent to which office efficiency enhancements can secure financial viability of the new practice model, while Henley notes that AAFP is also working with some large employers – including IBM – and insurance carriers to develop medical home pilots with blended reimbursement models.

As New Jersey’s TransforMED participant, Robert Eidus, M.D., a solo physician of Cranford Family Practice in Cranford, New Jersey, has implemented several practice redesign features. To help facilitate patient access, he has reserved open slots on his patient schedule, particularly during high-demand times such as Mondays and the months of December, January and February. He offers “E-visits” which, for a $30 fee (compared to a typical $15 to $20 insured co-pay) patients can fill out a structured interview form about their symptoms – such as diabetes, hypertension, bronchitis and sinusitis – and get a same-day response to inquiries, which could include general advice, a prescription or a request to schedule an office visit, if needed.

This summer, Eidus plans to offer group visits for diabetic patients, which will include interdisciplinary support of a physician, nurse practitioner, nutritionist and peer interaction. Shared medical visits have been shown to improve outcomes of diabetics, and can also be used for any chronic condition and for well child visits, says Eidus.

Eidus uses electronic health record and drug prescribing systems with evidence-based decision support databases to flag recommended office visit intervals and screening tests for patients with chronic conditions, compare their outcomes to national benchmarks, link the practice to the commercial laboratory it uses, check for possible adverse drug interactions for a patient, and help alert specific patients to any black box warnings that might be issued for their drugs.

Although he is only nine months into the TransforMED project, Eidus incorporated those electronic tools four years ago, from day one of his practice, avoiding the costs of having to retrain staff and convert paper charts to electronic format. He says the systems “are not prohibitively expensive,” and allow him to run his practice efficiently, noting that he recouped his investment in about two or three years and that his overhead costs are just under 50 percent of his practice revenue, compared to a national average of over 60 percent for primary care physicians.

Eidus is still trying to overcome structural barriers such as connectivity of electronic health information between his practice and the hospital, and the ability to get reports back in a timely way from specialists. “You need to have a close working relationship with your referral physicians,” he says.

“A lot of the work we do is not compensated,” says Eidus, who cites the finding of one study that “26 percent of a primary care practice’s overhead is related to pushing paper in order to receive payment.” He notes that TransforMED is trying to address the issue in two ways: internally by building practice efficiencies to offset time burdens; and externally by reducing patient demand that causes unnecessary overhead costs, as well as seeking additional care coordination reimbursement.

“I try to maintain as efficient an office practice as possible. The absence of additional reimbursement will limit the extent of what I can do – I would like to have a nurse practitioner and a nutritionist in my practice,” says Eidus.

Pennsylvania’s TransforMED participant, Joseph Mambu, M.D., part of Family Medicine, Geriatrics and Wellness, a two-physician practice in Lower Gwynedd, Pa., says his practice is designed along the lines of the patient-centered, team approach of the medical home model. With an outlay of about $30,000 to $40,000 per physician, his practice has just purchased an electronic medical record system to sort patients and provide appropriate interventions according to their health status and needs, e.g., diabetes, CHF, asthma, immunization schedule – something Mambu says he already does with great difficulty using paper charts.

Besides facilitating active population management and electronic prescribing, the electronic health record system is an important part of TransforMED’s vision of reimbursement reform, says Mambu. “You do the service first – show insurers you are improving performance and quality – and demonstrate that those improvements should be reimbursed,” he notes.

Mambu’s practice tries to enhance access by reserving open appointment slots every day, and staying late for an additional patient if all slots are filled. He hopes soon to activate an online patient portal for “electronic visits” to answer inquiries from patients, some of whom may not require a face-to-face visit, and he will charge a co-payment for the consultation until payors reimburse for such a service.

The practice, which includes a nurse practitioner, two registered nurses and several full time staff, has revised the way it thinks about staff meetings, and sets aside more time to discuss patient needs and coordination efforts to hook patients up with appropriate community resources, such as Meals on Wheels, hospital support groups, and the Area Agency on Aging, says Mambu.

Other statewide programs to implement the medical home model are being spearheaded by state chapters of the American Academy of Pediatrics.

Educating Physicians in Community Integrated Care (EPIC IC) is a medical home development project that was launched as a collaborative effort of the Pennsylvania Department of Health Division of Special Health Care programs (Title V), family organizations and the Pa. Chapter of the AAP. Based on the AAP’s Educating Physicians In their Communities model, EPIC IC is supporting practice design change as the key to improving the care provided to children with special health care needs, and focuses on effective community-based coordination and communication, according to its director, Renee Turchi, M.D., MPH.

Eighteen practices across Pa. have been participating in EPIC IC for two years – and 34 practices are currently signed up as participants – by implementing customized quality improvement activities after performing a self-evaluation using a shortened version of The Medical Home Index, which was developed by the Center for Medical Home Improvement at Dartmouth and rates a primary care practice across six domains: organizational capacity, chronic condition management, care coordination, community outreach, data management and quality improvement/change, says Turchi.

Each EPIC IC practice forms a team comprised of a clinician, a care coordination staff member and a parent partner, who attend regular training conferences and participate in monthly conference calls on medical home and other quality improvement topics, Turchi notes. Practices’ medical home index scores are rated annually, while the project is tracking health care utilization and time spent on care coordination – with a preliminary estimate that hundreds of unplanned hospitalizations have been prevented because of the project’s medical home interventions, Turchi adds.

The project offers practices tools to help identify children with special health care needs, a progress note template to assist providers with documentation for more complex patient encounters, a care plan to be placed in patient charts so that all staff can easily find needed information for patients, a fax back referral form to expedite communication between providers, a Tips Sheet for Parents to help parents be better prepared for their visit, and a listing of websites to help providers and parents locate national and statewide resources, says Turchi. The project is open to any interested pediatric group and, after six months of participation, practices can apply for an annual grant of $6,000 to $10,000 for care coordination and data collection activities, she adds.

In the practice of Laura Smals, M.D., a full-time care coordinator performs key tasks that typically pose a heavy burden for parents of children with multiple care needs, and the service has become so popular with parents that the practice is looking to hire a second coordinator. Smals, who is Medical Director of the Special Needs Program in Ambulatory Pediatrics at Saint Christopher’s Hospital for Children in Philadelphia, says the volume of special needs children in her practice has grown from 100 to over 400 in two years, without any advertising or promotion of the service.

A full-time registered nurse is dedicated entirely to linking Smals’ patients with various entities, including subspecialists, medical equipment companies, insurance companies, nursing agencies and ambulance transport, Smals says. Being part of an urban children’s hospital makes complex care coordination particularly vital, she notes, because a high percentage of her patients have disabilities, mental retardation, and other severe illnesses, and their parents are almost always Medicaid beneficiaries, who are particularly in need of social resources, assistance in understanding their benefits, and help in navigating the multiple referrals their child receives, says Smals.

Speaking anecdotally, Smals says her practice’s care coordination effort has improved the medical care of her patients, as parents who would often miss specialty visits because of the complexity of their child’s care are now making it to those visits. Parents who didn’t know they could qualify for special equipment programs, and for social and school resources, are now enrolled in those programs. Parents can more easily communicate with the practice before seeking care in the emergency department, which Smals says has resulted in fewer hospitalizations and ER visits.

Another continuity of care tool promoted by the EPIC IC project is the use of care plans – two- to three-page medical summaries of a patient’s insurance information, treatment and hospitalization history, medications, specialists, lab work, support services and medical equipment list. Families can take that list with them when their children travel or when they visit specialists or the ER, says Vicki Rote, care coordinator for the medical home activities of Roseville Pediatrics, an 11-physician practice in Lancaster, Pa. that is also participating in EPIC IC. The care plans help eliminate duplicate tests and keep patients and their caregivers up-to-date about all of the care received, she adds.

The practice also mails flyers to parents of selected patients inviting them to attend focus groups, which it convenes two or three times a year to discuss topics such as obesity, premature babies, Down Syndrome and autism, says Rote. The meetings help attendees – which include the physicians and office staff – to learn about new community resources, and to link families to “parent advisors” who offer to share their experiences on a certain topics, she adds.

Rote arranges weekly “pre-visit contacts” by calling parents of selected patients – particularly those with special needs children, or those who have asked a lot of questions in the past – to solicit their questions and concerns in advance of their office visits. That simple intervention keeps office appointments moving more efficiently by helping physicians assemble in advance the necessary information and resources for the visit, and can pre-empt many “doorknob questions,” that a parent might begin to ask while walking out of the office at the very end of the appointment, says Rote.

The practice maintains a medical home bulletin board that posts information about subjects such as upcoming conferences on pediatric topics, free transportation to medical appointments, bookstore storytimes for children with Down Syndrome, summer camps for special needs children, and palliative and respite care available in the community, says Rote.

Roseville Pediatrics is able to provide all of these services without an electronic medical record, although it plans to acquire one in the future, Rote adds.

The Pediatric Council on Research and Education (PCORE), a nonprofit arm of the New Jersey chapter of the AAP, is integrating the medical home concept into its educational projects on lead poisoning screening, post partum depression and immunization, according to Fran Gallagher, PCORE’s executive director. PCORE is working with the New Jersey Department of Health and Senior Services to develop regional presentations on the medical home approach for children with special health care needs, and to recruit physician practices for pilot projects, she notes.

PCORE plans to implement a medical home pilot project focusing on asthma management with 12 primary care practices in Trenton as part of its ongoing collaboration with Robert Wood Johnson University Hospital, and hopes eventually to involve all nine children’s hospitals in the state in the medical home management mindset, says Steven Kairys, M.D., PCORE’s medical director and Chair of Pediatrics at Jersey Shore University Medical Center. PCORE is currently organizing grand rounds presentations of the medical home model at hospitals throughout New Jersey, and would like to evolve into a project like Pennsylvania’s EPIC IC, he adds.

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