OBJECTIVES:  To evaluate whether variability of healthcare utilization metrics and process of care exists in Medical Homes (MHs) depending on the extent of services offered. METHODS:  A retrospective study was conducted using the 2015 population-based healthcare database of residents in Parma Local Health Authority, Emilia-Romagna, Italy. Data were analyzed for 118,356 patients ≥ 14 years receiving care from primary care physicians in small, medium and large MHs. Health care utilization metrics and process of care were computed for all patients across MH types. Healthcare utilizations encompassed hospital admissions, including ambulatory care sensitive conditions (ACSCs) hospitalizations, emergency department (ED) visits, specialty visits, pharmacy, 30-day and 90-day readmissions. Process of care measures comprised diabetes care metrics (e.g., HbA1c monitoring, microalbumin, lipid panel, eye exam). Negative binomial GEE regression models compared healthcare utilization rates and logistic GEE regression models compared the prevalence of process of care measures between MH sizes. RESULTS:  Of all 16 MHs in Parma, 5 were classified as large MHs, 6 as medium MHs, and 5 as small MHs. There was no significant difference in healthcare utilizations across MH types, except for 90-day congestive heart failure readmissions that were higher in small and medium sized-MHs compared to large MHs (RR small vs large: 2.71, 95%CI:1.48-4.99; RR medium vs large:1.79, 95%CI:1.11-2.89). No significant differences for rates of recommended diabetes care processes were found, except for microalbumin tests that were more commonly performed in small and medium MHs (OR small vs large: 1.43, 95%CI:1.03-1.99: OR medium vs large:1.96, 95%CI:1.50-2.57). CONCLUSIONS: This early evaluation of recently implemented MHs found little evidence of differences in healthcare utilization metrics and processes of care among MHs depending on the scope of services offered. Further research is needed to characterize the relationship between healthcare metrics and organizational structures of MHs.