Table 1.

Eligibility Criteria for Participation in Medical-Home Programs.^*

Medical-Home Capacities	How Capacities Are Measured in Most Current Medical-Home Certification Programs
Improved access and communication	Have written standards for key components of access and communication (4 points) and use data to document how standards are met (5). Assess language preference and communication barriers (2). (Total: 11 points)
Use of data systems to enhance safety and reliability	Use data system for nonclinical (2) and clinical (6) information to track patients’ diagnoses (4) and clinical status (6) and to generate reminders (3). Track referrals (4) and laboratory results systematically (7). Use electronic system to order, retrieve, and flag tests (6); write prescriptions (3) and check their safety (3) and cost (2); and improve safety and communication (4). (Total: 50 points)
Care management and coordination	Adopt and implement evidence-based guidelines (3) and use reminders for preventive services (4). Coordinate care with other providers (5) and use nonphysician staff to manage patient care (3). (Total: 15 points)
Support for patient self-care	Develop individualized patient care plans, which assess progress and address barriers to achieving plan goals (5). Actively support patient self-care (4). (Total: 9 points)
Performance reporting and improvement	Measure (3) and report performance to physicians in the practice (3) using standardized measures (2). Report performance externally (1). Survey patients about their experience (3). Set goals and take action to improve (3). (Total: 15 points)

^*Qualification requirements for receiving extra payments under current medical-home demonstration programs generally rely on qualification as a patient-centered medical home by the National Committee for Quality Assurance, with greater payments generally granted to practices achieving higher scores (points are shown in parentheses). Practices are expected to perform the core functions of primary care, which include first contact and comprehensive care. Primary care physicians (in family medicine, general internal medicine, pediatrics, or osteopathic medicine) are generally the focus of these programs. Whether specialty practices should be eligible to participate is controversial.