Thirteen years ago, Family Practice Management published “Family Physicians Should Be Paid for Managing.”¹ It argued that the family physician's ability to manage health care wisely should be rewarded by payers. The idea wasn't exactly new in 1994, but it wasn't exactly spreading like wildfire either. It's back today, though hardly recognizable in its new trappings, seated on a cushion of evidence and carried on the shoulders of several primary care organizations, including the AAFP. The 2007 version of care management is the patient-centered medical home.

What's a medical home? There seem to be a variety of answers to the question, but my sense is that it is a well-trained personal physician (ideally a family physician) operating in a technologically sophisticated, quality-driven, safety-conscious, team-based, physician-directed practice and providing or coordinating all needed care. You can get a better understanding from Leigh Ann Backer's cover story. The good news is that providing a medical home for your patients might get you several dollars per patient per month on top of discounted fee for service. The bad news is that the political road from the idea to the reality of the medical home is likely to be long, rough and guarded by various champions of the status quo.

If your practice is the kind of medical home I described above, it's one of the few. That's the kind of practice that the TransforMED demonstration project is laboring to produce (the latest in our series of articles featuring tips from TransforMED appears in this issue), and it's what the Ideal Medical Practice (IMP) project is working toward (see the article by L. Gordon Moore, MD, and John H. Wasson, MD, for more on that initiative). It's what might loosely be called the “new model” practice, and it turns out that the new model requires new ways of thinking about practice and a new practice culture, not just new technology and greater efficiency.

So, if reading the cover story makes you yearn for the kind of practice you can call “home,” keep learning, keep trying new things and keep tabs on TransforMED, the IMP project and other such efforts. We'll help. But also watch for medical home initiatives from the AAFP; do what you can to help shape them and help move them forward. We may make it home yet.