How physician practices could share personnel and resources to support medical homes

To become a medical home, providing patients with comprehensive, coordinated primary care, practices need to meet multiple requirements. These include some form of round-the-clock access for patients; managing chronic or complex conditions; carrying out timely, clear communication between providers and patients; and engaging in continuous quality improvement. The recently enacted health reform law reinforces these requirements. Although most primary care practices are small, we show how they, too, can meet the requirements by sharing services--for example, by using a shared nurse-staffed service to provide medical advice evenings and weekends--and by receiving help through various "extension" centers.