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The Role of Colorado Public Health Agencies in Building a Medical Home Team System
Colorado is going beyond established definitions of a Medical Home and identifying it as a
teaming approach to health care. Colorado is also building a Medical Home System, which is
the infrastructure to support a Medical Home Team Approach for all families.
Families and Providers Use a Medical Home Team Approach
The Colorado Medical Home Initiative (CMHI) of the Colorado Department of Public Health and
Environment (CDPHE) asserts that a Medical Home is a team approach to health care, guided by
quality standards. A Medical Home Team Approach requires all professionals involved in a child’s care
to operate as a team; families to be critical members of that team through education and mentoring;
and that all team members understand the importance of quality, coordinated medical, mental and oral
health care.
A Medical Home Team Approach Requires Infrastructure
A Medical Home System is the state and local infrastructure (personnel, processes, procedures and
materials) that supports providers and families to implement the practice-level Medical Home standards
for a Medical Home Approach. Often there are local and state systemic issues, such as lack of
specialists, access to insurance and uncertainty of local resources that prohibit providers from offering
a Medical Home Approach. A Medical Home System overcomes these barriers.
What is the Public Health Role in Building a Medical Home Team System?
CDPHE and local public health agencies have the role of providing the “Core Public Health Functions”
of assessment, policy development and assurance through the “Ten Essential Services of Public
Health”. These services can be applied to building a Medical Home Team System. The ten essential
services of public health are:
1. Develop policies and plans that support individual and community health efforts
2. Inform, educate and empower people about health issues
3. Mobilize community partnerships to identify and solve health problems
4. Enforce laws and regulations that protect health and ensure safety
5. Link people to needed personal health services and assure the provision of health care
when otherwise unavailable
6. Evaluate effectiveness, accessibility, and quality of personal and population-based health
services
7. Assure a competent public health and personal health care work force
8. Research for new insights and innovative solutions to health problems
9. Diagnose and investigate health problems and health hazards in the community
10. Monitor health status to identify community health problems
Title V programs in CDPHE have applied some of the essential services to building a Medical Home
System for children. The Title V Children with Special Health Care Needs Unit established the Colorado
Medical Home Initiative (CMHI) by convening key stakeholders to build the state level infrastructure of
a Medical Home System including Medical Home practice standards, web site development and tools
for technical assistance.
The CMHI has the following objectives to develop a medical home system:
1. Develop a strategic plan for the CMHI state level structure and infrastructure of the
Advisory Board, Steering Committee and Task Forces to support local implementation of
a Medical Home System in 2008 and 2009.
2. Join with Colorado Statute 194 implementation and the Public Health Alliance of Colorado
to apply the core public health functions and the essential public health services to the
development of a local pediatric Medical Home System in collaboration with local public
health agencies in two to three select communities in 2008 and 2009.
3. Garner state and federal grant funding to assist public health
agencies to develop a pediatric Medical Home System and measure its impact on the
quality and cost effectiveness of health care services in 2008 and 2009.
Local public health agencies are already providing the essential services to support a Medical Home
System in many ways by identifying local systems barriers and providing direct consultation/technical
assistance to personal health care providers. For example, local agencies have reported procedural
difficulties with access to public insurance through the electronic enrollment system and have provided
gap-filling services to families to resolve these issues. Local public health agencies identify shortages
of health care providers and the need for coordination of health care between behavioral, medical and
oral health care. Local public health agencies often offer consultation to providers regarding new
insurance policies or legislation; technical assistance to providers for the provision of immunizations;
tool kits for programs, such as Women Infant Children (WIC); and information on smoking cessation
techniques and resources.
The public health system in Colorado is well positioned for a more comprehensive application of the
essential services to building a Medical Home System for children. The recent passage of the Public
Health Statute will standardize the delivery of these essential services across all public health agencies
in the state. The creation of the Public Health Alliance of Colorado, which is a collaborative assemblage
of ten public health organizations, has helped to strengthen public health in Colorado by building
capacity within participating organizations as well as connecting its members. Through the Alliance and
the annual Colorado Public Health Association conference, education, networking and inter-community
Medical Home System mentorship can evolve. Mobilizing community partnerships is an area of
expertise for public health and can be leveraged in many ways to address health care barriers.
Extracting the consumer voice through family leaders has also proven to be an effective tool within the
Title V CDPHE programs to build effective systems.
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