Health Policy

Journal of General Internal Medicine

, Volume 29, Issue 10, pp 1410-1413

First online:

Structuring Payment to Medical Homes After the Affordable Care Act

  • Samuel T. EdwardsAffiliated withSection of General Internal Medicine, Veterans Affairs (VA) Boston Healthcare SystemMassachusetts Veteran’s Epidemiology Research and Information Center, VA Boston Healthcare SystemHarvard Medical School
  • , Melinda K. AbramsAffiliated withThe Commonwealth Fund
  • , Richard J. BaronAffiliated withAmerican Board of Internal Medicine
  • , Robert A. BerensonAffiliated withThe Urban Institute
  • , Eugene C. RichAffiliated withMathematica Policy Research
  • , Gary E. RosenthalAffiliated withUniversity of Iowa Carver College of MedicineIowa City VA Health Care System
  • , Meredith B. RosenthalAffiliated withDepartment of Health Policy and Management, Harvard School of Public Health
  • , Bruce E. LandonAffiliated withDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical CenterDepartment of Health Care Policy, Harvard Medical School Email author 

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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.