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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Overall.

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Strategy. Policies to Promote Medical Home

Approach. Develop policies to promote the medical home model for children and adolescents

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Overview. National, local, and systems level health care policies affect the ability for children and adolescents with and without special health care needs to access health care. Medical home policies particularly affect children and adolescents receiving Medicaid. Studies have shown that when states move from a Medicaid fee-for-service delivery model to a primary care case management model there is an increase in the number of children and adolescents who receive a well-child visit and who have one primary care provider.[1]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Inventory and analysis of developed policies
  • Data on alignment with national initiatives and recommendations (re: National Survey of Children's Health)
  • Internal program evaluation data on policy impact

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of community partner engagement sessions, public hearings, and community forums conducted by Title V agencies to gather input and feedback on proposed medical home policies. (Measures the level of community and community partner involvement in policy development)
  • Number of training sessions, technical assistance encounters, and resources provided by Title V agencies to healthcare providers, payers, and systems to support the implementation of medical home policies. (Measures the capacity building efforts to facilitate policy adoption and compliance)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of Title V agency staff and leadership who have received training and demonstrate competency in developing and advancing evidence-based medical home policies. (Measures the internal capacity and readiness of Title V agencies to lead policy change efforts)
  • Percent of proposed medical home policies that are aligned with national standards, best practices, and guidelines for high-quality, patient-centered care. (Measures the quality and evidence base of policy development efforts)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of cross-sector partnerships and collaborations established by Title V agencies with Medicaid, managed care organizations, professional associations, and consumer support groups to advance medical home policies. (Measures the level of multi-community partner engagement and alignment in policy development and implementation)
  • Number of policy briefs, reports, and presentations developed by Title V agencies to educate policymakers, legislators, and the public on the value and impact of medical home policies for children and adolescents. (Measures the support and communication efforts to build broader support for policy change)
  • Number of children and adolescents with special health care needs from communities who experience improved health outcomes as a result of medical home policies and practices. (Measures the impact of policies on advancing health outcomes)
  • Number of states, health systems, and payers that adopt and spread successful medical home policies and models based on the evidence, tools, and technical assistance provided by Title V agencies. (Measures the potential for policy replication, scalability, and sustainability)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of medical home policies developed by Title V agencies that explicitly prioritize resources to address the needs of children and adolescents from communities with access challenges. (Measures the focus and intentionality of policy development efforts)
  • Percent of medical home policies and implementation plans that are informed by family and youth voices, experiences, and priorities. (Measures the level of family and community engagement in policy design and implementation)
  • Percent reduction in gaps for key child and adolescent health indicators (e.g., immunization rates, developmental screening, chronic condition management) between populations served by medical homes supported by Title V policies and those served by traditional, fragmented care models. (Measures the impact of policies on advancing health and closing health gaps)
  • Percent of children and adolescents served by medical homes who experience improved access to safe housing, healthy food, and high-quality education, as a result of policy-driven investments in community-based supports and services. (Measures the impact of policies on addressing upstream factors influencing child and adolescent health and well-being)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Hill, S. C., & Zuvekas, S. H. (2021). Patient-Centered Medical Homes and Pediatric Preventive Counseling. Academic Pediatrics, 21(3), 488-496.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.