Journal of General Internal Medicine

, Volume 29, Issue 10, pp 1410–1413

Structuring Payment to Medical Homes After the Affordable Care Act


  • Samuel T. Edwards
    • Section of General Internal MedicineVeterans Affairs (VA) Boston Healthcare System
    • Massachusetts Veteran’s Epidemiology Research and Information CenterVA Boston Healthcare System
    • Harvard Medical School
  • Melinda K. Abrams
    • The Commonwealth Fund
  • Richard J. Baron
    • American Board of Internal Medicine
  • Robert A. Berenson
    • The Urban Institute
  • Eugene C. Rich
    • Mathematica Policy Research
  • Gary E. Rosenthal
    • University of Iowa Carver College of Medicine
    • Iowa City VA Health Care System
  • Meredith B. Rosenthal
    • Department of Health Policy and ManagementHarvard School of Public Health
    • Division of General Medicine and Primary CareBeth Israel Deaconess Medical Center
    • Department of Health Care PolicyHarvard Medical School
Health Policy

DOI: 10.1007/s11606-014-2848-3

Cite this article as:
Edwards, S.T., Abrams, M.K., Baron, R.J. et al. J GEN INTERN MED (2014) 29: 1410. doi:10.1007/s11606-014-2848-3


The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

Copyright information

© Society of General Internal Medicine 2014