Medical Home

Indicator Definition
Children (ages 0 – 17 years) who have a regular primary health care provider
and have made a preventive care visit to that provider at least once during the
past 12 months.

Children with a regular source of primary health care in Colorado4

Children with a regular source of primary health care by income in Colorado5

Indicator Significance
Children with a “medical home” have a place in which they can receive comprehensive, family-centered and coordinated health care. This promotes healthy development and allows minor problems to be identified and treated before they become serious. Especially important for children are age-appropriate screenings and immunizations. Without a regular source of primary health care, children are nine times more likely to be hospitalized for preventable problems. Uninsured children are 13 times more likely to lack a regular source of primary care.¹

Colorado Specifics
Colorado ranks 28^th among states for children with a reported regular source of primary health care. The proportion of children who had a personal doctor declined from 87 to 52 percent between 2004 and 2006. In 2007, however, the number of children with a medical home increased by 10 percent from the previous year. Children who live in families with incomes below the federal poverty level ($20,650 for a family of four in 2007) are almost three times more likely to lack a personal doctor than children in families at or above 400 percent of the federal poverty level.

Promising Initiatives
In Colorado
The Colorado Children’s Healthcare Access Program (CCHAP) seeks to ensure that every child in Colorado has a high quality medical home. CCHAP encourages and enables pediatricians and family physicians in private practice to devote 10 – 20 percent of their practices to children enrolled in Medicaid or Child Health Plan Plus (CHP+). To date, CCHAP has expanded to 52 private pediatric practices in metro Denver. CCHAP is also establishing a demonstration program with the Department of Health Care Policy and Financing to provide higher reimbursement and incentives to physicians that provide comprehensive care to publicly-insured children. Three years ago, only 20 percent of private pediatric practices in the Denver area accepted Medicaid or CHP+ children; today the number has increased to almost 50 percent. CCHAP envisions expanding to the rest of the state over the next two years.²

Elsewhere
The Integrated Mental Health Primary Care Program (IMP) in New York has helped close the gap between primary care and mental health services. Both adults and children are treated by a bilingual staff in eight primary care sites serving in the New York Presbyterian Hospital Ambulatory Care Network. It is the first and largest program of its kind in New York City, incorporating mental health exams into regular child health care. IMP attempts to destigmatize treatment of mental health by placing it within the same environment as a primary care physician. Physicians are trained how to identify psychiatric disorders and to effectively refer patients to an appropriate psychiatrist or psychologist, making access to mental health care immediate.³ 

Children with a regular source of primary health care⁶

Text

1. Campaign for Children’s Health Care. “No Shelter from the Storm: America’s Uninsured Children”; September 2006.
   
   “Regular Doctor Visits a Healthy Practice.”
   
   Kaiser Family Foundation. “Children’s Coverage and SCHIP Reauthorization”; May 2007.
   
   
2. Colorado Children’s Health Care Access Program.
   
   Colorado Health Institute. “A Conversation with Steve Poole,” CHI HealthTalk; July-August 2007.
   
   
3. New York-Presbyterian. “Innovative Health Care in a Primary Health Care Setting Available through New York Presbyterian”; June 24, 2005.
   

Charts

4. Source: Child Health Survey, 2004–2007, Colorado Department of Public Health and Environment.
   
5. Source: National Survey of Children’s Health, 2003, National Center for Health Statistics, Centers for Disease Control and Prevention.
   
6. Source: National Survey of Children’s Health, 2003, National Center for Health Statistics, Centers for Disease Control and Prevention.